FEMA-EC980312® �1Q fi.q r -4 2101MS
The City With A Beautiful Future BUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Manner
Job Address: ' 1 -_1 q/ t j �e
Lot: 19
Block:
Owner
Contractor:
Description of Work to be Done Class of Work:
I V) Q I-p-
Area of Building in Square Feet
First Floor-
Second
loor Second Floor -:::�K LI -IL
Subdivision:W
Address:PE
i�
Address: l C: (0
4�9ew ❑ Addition
A" I \I V- cbn ,
Garage
Other 1
GRAY
NOTICE
This permit becomes null and void if work or construction authorized is not commenced
within 180 days, or construction on work is suspended or abandoned for a period of 180 days
at any time after work is commenced.
1 hereby certify that I have read and examined this application and know the same to be true
and correct. All provisions of laws and ordinances governing this type of work will be
complied with whether specified herein or not. The granting of a permit does not presume to
give authority to violate cancel the provisions of any other federal, state or local law
regulating construction of he rformance of construction.
Date: V� p h ' Le
Won Phase or Section Number:
Al 71j , : -61-7
Phone #:
❑ Alteration ❑ Repair
F E 8 18 1998
❑ Demolition
Value of Work
to be Performed
4 �
Signature of Co
ctor or #uthonzed Agent
.
Print Na
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,tom � �< �
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Electrical Contractor
Plumbing Contractor
Mechanical Contractor
y sayP Q3r
,.ax i .,.
FPMC - 1 (4/94)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
O.M.B. NO. 3067-0077
ELEVATION CERTIFICATE Expires May 31, 1996
FEDERAL EMERGENCY MANAGEMENT AGENCY
` NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found on the following pages.
OWNER'S NAME
SECTION A PROPERTY INFORMATION j FOR INSURANCE COMPANY USE
POLICY NUMBER
STREET ADD ESS (Includin Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY MAIC NUMBER I
��ade
b121VC
OTHER DESCRI TION (Lot and Block Numbers, etc.)
z f �4, aLo_-K a ,e j ver-o?w &sra res
CITY STATE ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
1. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE OF FIRM INDEX
5. FIRM ZONE
6. BASE FLOOD ELEVATION
-7 Cor O
t�
^ � � _
(in AO Zones, use depth)
447
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ;ZNGVD'29 ❑Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: ❑ feet NGVD (or other FIRM datum–see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level __ .
2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of 1 1 1414 171.IJ feet NGVD (or other FIRM datum–see Section B, Item 7).
(b). FIRM Zones V1 430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of I I I I I ,❑ feet NGVD (or other FIRM datum–see Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is ❑J . ❑ feet above ❑ or
below ❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is ❑—I I. ❑ feet above ❑ or below ❑ (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: ❑ NGVD '29 ❑ Other (describe
under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on
the FIRM (see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: VYes ❑ No (See Instructions on Page 4)
5. The reference level elevation is based on: 0 actual construction ❑ construction drawings
(NOTE. Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is: I I AA AT feet NGVD (or other FIRM datum -see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: I I I I .❑ feet NGVD (or other FIRM datum–see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones Ai—A30, AE, AH, A (with BFE),V1—V30,VE, and V (with BFE) is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the
certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not
included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered.
/ certify that the information in Sections 8 and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S,NAAMME LICENSE NUMBER (or Affix Seal)
TITLE COMPANY NAME
R . P L, 8. 14 P,
ADDRESSCITY STATE ZIP
COMMENTS:
ON WITH ON PILES,
SLAB BASEMENT PIERS, OR COLUMNS
A V A A V
ZONES ZONES ZONES ZONES ZONES
REFERENCE
REFERENCE BASE LEVEL
REFERENCE
LEVEL FLOOD
LEVEL
ELEVATION
BASE.'
ADJACENT'': REFERENCE
BASE
FLOOD
FLOOD :i
ELEVATION REFERENCE ADJACENT GRADE _r;.. LEVEL
ELEVATION
LEVEL GRADE
..
.i.....:...:
ADJACENT:..
�.:..'r.; .:.:.: �...
GRADE '
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
Page 2
LAN
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"1'041,1, PARTIES INTERESTED IN PREMISES SURVEYED:
ln
« WV ARepisttted Pro(csci,mal La I Suncyor, do h rchy crrtify that a rarc(nt %4tt%cv wn madc of the rrois d.
und this ,mdr m
- vper.i�inn nr the (ounainE deurihed rwrpwy.
,s s
S:ZZisCL�7-�
__. and 16cre are _ _ encroachments orym the adj„ininp prorctly or the adjoining imprnsemcnts urv,n the descrihcd pn•pen) known as
P-
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STATE OF TEXAS
COUNTY OF 'I'ARRANT 1311 Z 1� b,
"fo the uenhoidcrs and/or the owners of the t'renlfses surveyed and to I'LOOD NOTE: I hereby certify that the property described herein
within a special flood hazard wren n1 identified by the
1 fie undersigned docs hereby certify that this survey ps this day made Federal Insurance Administration, Department bf Mousing and Urban
on the ground of the property legally described hereon and is correct, and I1111 Development, the flood hazard wren being identified as
there ore no discrepancies, conflicts, shortages in arca. Mwndary line conflicts, _ _ of the cedes) Insurance Administrntion Hood Ilazard
encroachments, overlapping of improvements. visible lines or roads in place' hunncfary Nifili effective on
cxcrpl as dsnwn heroin, and that swirl propetty has accc':s to and front n
for the
dedicated fn;111 w';1y' C7(CCpt a1 sllnwn hCrCn11. ---------------------------_--
Dated:
RASIS FUR 13EARING: AP SUnVEYING CO.
O ider N,+. _. David Poitard nrs o518
- ---- - — 1903 Central Orlve, Suite 309
NOT roit CONSTIMCIION Uedford, TX 76021 Metro (817) 267-1249
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BRI -44 (Fb128)
Arlington, Texas Metro 81 %—Zb i -4121 FAX 817-274-4717
817
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W * Builder/Owner to verify and check all aspects of this site and plot plan prior to any construction