FEMA-EC940803® w yg5oJ� 31
7They With A Beautiful Future BUILDING PERMIT APPLICATIONy�- 1 3 94
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170A Z 1 Print or Type in a Clear, Legible Manner
Job Address: Date: _Ll
Lot: Block: Subdivision:cc Phase or Section Number:
Owner: Q nk n 111 fin,, A Address: ) I .✓ ��%�n �1fr lI ,V � Phone #: Ut I � Gi/lQL
Contractor:u 1 Address: `� ne #: (.447—/C/
Description of Work to be Done Class of Work: New ❑Ad 'h n ❑ Alteration ❑ Repair ❑ Demolition
,,,
of Building in Square Feet
First Floor I
Second Floor -1
Garage �"
Other
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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 tune after work is commenced.
I hereby certify that I have read and examined this application and know the same to be true
and correct. All pE
'm o and ordinances governing this type of work will be
complied w' ecified herein not. 1be granting of a permit does not presume to
give ty vor cangel the ovisions of any other federal, state or local law
xactorpr'Authoriz4ed Agent nt Name t
Plumbing Contractor Mechanical utractor
Value of Work
to be Performed
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GRAY AREA FOR OFFICE USE ONLY
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ELEVATION CERTIFICATE °.Me."d30"°`
LrpnaJMoyJr, 15
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certllicato docs not provide a waiver of tho flood insurance purchase requirement. This form is used only to
provide elevation information necessary to ensur8 compliance with applicable community floodplaln management ordinances, fo
dJelerrnine the proper insurance premium rate, andior to support a request for a Letter of Map Amendment or Revislon (LOMA or LOMR).
Instructions for completing this form can be found on the following pages,
SECTION A PROPERTY INFORMATION
FOR INSURANCE COMPANY UriF
BUILDING OWNER'S NAME POLICY NVMPER
177E�'�'��'S
S Mt -Gr A DRESS (Including Apt., Unit, Salto anp or Bldg Ntnngor) OH PO rtOU1'E ANI) Box NUMSFR COMPANY NAIC NUMBER
OTHER DESCHIPIION (Lot and Block Numbers, etc.)
/V
STATE rip Cone
C•—�/ SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the following from the proper FiRM (See Instructions):
1. C OMMUNITY NUMBEH
2. PANEL NUMBtH
J ;;ut t`IX
d DAt L Ut PIfIM INUEA
5 FtHM ZONE
6. BASE FLOOD ELEVATION
_49��Q
OO1e
(In AO Zanrs, ucu drPth)
Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE):. ; N(3VD '29 i 10ther (describe on back)
3. For Zones A or V, where no BFE is provided on the FIRM, and this community has established a BFE for this building site, irtdimite
the community's BFE:4_5Wr'0.' 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). F113M 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 147W47. I feet NGVD (or other FIRM datum -see Section B, Item 7).
(b), FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, Is at an elevatlon of lest 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 I. I,! i feet above! or
below I, 1 (check one) file highest grade adjacent to the building,
(d). FIRM Zone AO. The floor used as the reference frivol from thu soleclod diagram is ' 1 feet above I or below! : (check
one) the highest grade adjacent to tho building. If no flood Unpth numbur is available, is the building's lowest floor (reference
level) elevated In accordance with the community's floodplain Management ordinance? 1 ! Yes !. J No I i Unknown
3. Indicate the elevation datum system used In determining the above reference level elevations: IJ NGVD'29 !....,j Other (describe
under Comments on Page 2). (NOTE: Y the elevation datum used in measuring the elevations is different than that used on
the FiRM [see Section B, Item 71, then convert the eiev tions to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)_ /� %
4, Elevatlon reference mark used appears on FIRM: Fes �.) No (See Instructions on Page 4)
5. The reference level elevation is based on: ; actual construction ;...1 construction drawings
(NOTE: Use of construction drawings is only valid it 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 pest -construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjarent to the building Is: i p vl -I feet NGVD (or other FIRM datum -see
Section B, Item 7). EG�y ow GGT
SECTION D COMMUNITY INFORMATION
1. If file community official rusponsibia for verifying building elevations spudfios that the reference level Indicated in Section C, Item 1
is not the "lowest floor" as defined in tho community's floodplalrr manaoenlunt ordnance, the elevation of the building's "lowest
floor' as defined by the ordinance is' ' ' ! fuut NGVD (of other FIRM datum -see Section 8, Item 7).
2. Date UI the dart of construction or aubsicrnUal unprovurti,u,rt
FEMA Form 81-31e MAY 90 Itt III A( f S Al I Pllt V101 i5 1 I)t r IONS SEE REVERSE 310E FOR CON71NIJA71ON
IL'L IIU:cjl1
SECTION I? 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 Al—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 AU 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 --It 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, Ilem 1, must still be entered.
I certify that the Information In Sections B and G 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.
CE1A1 N's NAME ,,--�� LICENSE NUMBER (or ABM Seal)
TITLE �� COMPANY NAME
ADUNESS - -ITY STATE --- -- -ZIP
T—
SIGNATIIFT _ nATF_ . PNnwa
Copies SF�td de
COMMENTS!
for: 1) community official, 2) Insurance agent/company, and 3) building owner.
ON WITH ON Poli,
BLAB BASLMCNT PIEnD, On COLUMNS
A v A A v
torltti ZONE8 7rairs ZONGS ZONIS
RENEIILKE
1,L FL 111 NCE �-"-�,'xrJ�"�' LEVEL
REFERENLE
LEVEL FI(M
LEVEL
FIEVA10M
j
4 I'.
tAEFE!AVN1C9
: >'
AH
els
FLOOD
FLOOD
NATION i GRADE .�"i! LEVEL(IRAT)r
ELlVAllal
12
ADJACEMC'.
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.
Pace 1
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P-L-M.A. LET7U R_
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LIN:
"jcCUTJ
GiTY OF COPPELL T1
REVIEWED
4 PATE 77 15 q 4/
A pprOvt',", 0, IMS a4d specifications shall not
be convm*L, 'i,,,!8n construction in direct con-
thtt with the City of Coppe,4-- }A.
r)rdmwcps Oodm
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PLOT rLAN
1 443 KARAM DKIVE
0
LOT 14 01-OCK D
VILLAGE AT C01-rONW000 CKEEK 5FC, IV
DALLAI-15 COONTY. T'FXA�>
PLA�L,
C050
V A'E JLA" 7, 1004
.462 tow
J PENCAe
SURVEY PLAT
BARRY S. RHODES Registered Professional Land Surveyor (214) 475 - 8940
A
This is to certify that I have, this date, made a careful and accurate survey on the ground of property located
at No. �f�f3 �eA�/�JM �eivF , in the city of C'oropEl� Texas
Lot No. !Q , Block No. City Block No.
of�GLA6EATl'orTovW000 �PEGk SEC7v Iv , an addition to the City of �o�pEcC L>>s,�/mss
Texas, according to the �OLAT recorded in Volume at page
of the Map Records of l7oGG aS COUNTY, TEXAS.
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The plat hereon is true, correct, and accurate representation of the property at determined by jS7E
survey, the lines and dimensions of said property being as indicated by the plat: the size, location, 02..*
and type of buildings and improvements are as shown, all improvements being within the boun
dories of the property, set back from property lines the distance indicated, and that the distance [TARRY S. RHODES
from the nearest intersecting street, or road, is as shown on said plat. ........................
THERE ARE NO ENCROACHMENTS, CONFLICTS, OR PROTRUSIONS.'°q0 3691 ���
Z • FEss��.• -L
Scale: "- zo THIS SURVEY WAS PERFORMED EXCLUSIVELY FOR SUR`
Date: $ — /— 9
G. F. No.: USE OF THIS SURVEY FOR ANY OTHI=R PURPOSE
�1
OR OTHER PARTIES SHALL BE AT THEIR RISK
Chockkeded
JabC- .4 ,� AND UNDERSIGNED ISNOT RESPONSIBLE TO OTHERS
by:: C=f/f FOR ANY LOSS RESULTING THEREFROM.
tltYTr49 r 31 NOMI