FEMA-EC980910- 7-98PO4: 10 RCVD
7TheyWBeautiful Future BUILDING PERMIT APPLICATION,,
Print or Type in a Clear, Legible Manner
Job Address: Date:
Lot: Block: Subdivision: ver } Phase or Section Number:
Owner j, ` C� Address:(),
Contractor: �5Q "Y -r Address: Phone #:
Description of Work to be Done Class of Work: — N ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
Area of Building in Square Feet
�j
First Floor ` Garage Value of Work
to be Performed
Second Floor V Other
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.
I 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 specifie rein or not. The granting of a permit does not presume to
give author' y to violate or c the provisions of any other federal, state or local law
regulatin c nstructiogjof the a rmance of construction.
jam, a�
Lz
s
re of C ntra or or Auth iz d Agent t N m
1p are
Electrical Contractor Plumbing Contractor echanical Contractor
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 LOMB).
Instructions for completing this form can be found on the following pages.
BUILDING OWNER'S NAME
SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE I
POLICY NUMBER
STREET ADDRESS (Includin��,Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER I COMPANY NAIC NUMBER I
OTHER
'J
etc.)
CITY .01 STATE ZIP CODE
C-Meie�� 7-3:r
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
A90170
0010
M��-
1
(in AO Zones, use depth)
1
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '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: I I I I I .❑ 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 et NGVD (or other FIRM datum–see Section B, Item 7).
(b). FIRM Z 75 VV 30, 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 MINAMIR 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 1-11L] ❑ 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 LLL .❑ 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: ❑ Yes ❑ No (See Instructions on Page 4)
5. The reference level elevation is based on: ❑ 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: 1114l4i .l4' 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: L1JJ ILl 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 13FE),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.
I certify that the information in Sections B and C on this cettificate represents my best efforts to interpret the data available.
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal)
AY, ��rl�40 A5_18
TITLE COMPANY NAME
Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner.
COMMENTS:
ON WITII ON PILES,
SLAB BASEMEN r PIERS, OR COLUM14S
A V A A V
ZONES ZONES ZONES ZONES ZONES
REFERENCE
LEVEL
REFERENCE
REFERENCE BASE
LEVEL
LEVEL rLOOD
ELEVATION
....� •.... .:.....; .. ., .?
i;:J''iPg.'' �:• :
':';
BASE
I::i;.
.
BASE . ;;I•.":;:;• ,t,i;; REf-ERENCE
ADJACENT
FLOOD
FLOOD GRADE"` LEVEL
•'�+'
ELEVATION
ELEVATION REFERENCE ADJACENT
LEVEL GRADE
. .,.,lr!,�:5.,..!:!.i'.:�.!i. •::::.'i�:'.
is ADJACENT'
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
SURVEY PLAT OF
TO ALL PARTIES INTERESTED IN PREMISES SURVEYED: �
A lle�jktNnfesa La Sune nr, do hereby Certify t care I survey wast a of the ground this date under In .0 coition oft fullnrinr de%crihed pm(crn.
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and there we encroachments upon the adjoining property or the adjoining improvements upon the described property known as
1403 �i�A��V 11•l�E Ci2�.�UG nIZ1Y�
► 56r `j'00" W -75,00
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151 A LLE CO1,C. ~ +9
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STATE OF TEXAS OR�'sg a 0
COUNTY OF TARRANT VA
"To the Lienholders and/or the Owners of the Premises surveyed and to FLOOD NOTE: I hereby certify that the pr rty described her n /D'/
- within a special flood hazard area as identified by the
The undersigned does hereby certify that this survey was this day made Federal Insurance Administration, Department of I -lousing and Urban
on the (round of the property legally described hereon and is correct, and that Development, the flood hazard arca being tdentirtH as
there are no discrepancies, conflicts. shortages in area, boundary line conflicts, _ _ of the Federal Insurance Administration Flgtod Hazard
encroachments, overlapping of improvements, visible lines or roads in place, Boundary Map effective on
except ns shown hereon and That -;d re„rcrt,,, has ac-n� to tsr:d frntn a ---
dedicated roadway except as shown hereon." for the
t
Dated:
By' - ----- -- ----- -_— _ ...- -
BASIS FOR BEARING: 'AP SURVEYING CO. t
Otdcr Nn, David Pollard RPS 01518
NOT FOR CONSTRUCTION 1903 Central Drive, Suite 309
Bedford, TX 76021 Metro (817) 267-1249
L
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Cir t OF COPP LL
REVIE. ED
A p p.- ov J of j 1; i
not
In dknt coniiict
V11,111h tin. croy of coppo'! �'vlldiug codes a'n'd Zoning
Ordinances.
FORM ]BOARD
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PLANS ARE REWE WED FX
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PLOT PLAN
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LOT I BLOCK B
RivtRviEm EST.
COPPELL, TX
FIRST TEXAS HOMES
PRESTON M6520)
N-01`450 MOM&
Builder/Owner to verify and check all aspects of this site and plot plan prior to any construction