FEMA-EC990302 (2)® WI (Q3 jqq-�-1 99-02-02PO4:_-'5 RCVD
7Thety With A Beautiful Future BUILDING, PERMIT APPLICATION
% 33 Print or Type in a Clear,'Legible Manner
Job Address: I Date: ^
Lot: ^ Block: Subdivision: l �f\ i Phase or Section Number:
Owner /� �' Address: Phone #:
�✓ a
Contractor: Il_ Its Address: Phone #:
�1
Description of Work to be Done Class of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
Area of Building in Square Feet (� �
First Floor Garage -/ LJ Value of Work
to be Performed
Second Floor Other
11 517— GRAY AREA FOR OFFICE USE ONLY
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 specified herein or not. The granting of a permit does not presume to
give authority to late or cancel the provisions of any other federal, state or local law
regulating S,gltst cti of the performance of construction.
tl .--
LW 1 0
Stature Contra or or Authori ed Agent
Electrical Contractor Plumbing Contractor
Print Name
Mech ica] (
FPMC - 1 (4/94)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
O.M.B. NO. 3067-0077
• ELEVATION CERTIFICATE Expires May 31, 1996
FEDERAL EMEAGENCY 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.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
STREET DDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY MAIC NUMBER
e.rJ/i 6i-0-6lL
OTHER DESCRIPTION (Lot and Block Numbers,tc.
CITY
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
ZIP CODE
1. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE OF FIRM INDEX
5. FIRM ZONE6.
ASE
use depth)ELEVATION
(in AO Zones, FLOOD
17a
ems► 0
1=�►1
is 17,F41CDP
L1 Z
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): GVD'29 ❑ Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has esta (shed a BFE for this building site, indicate
the community's BFE: I 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). FIRMZones
,�All -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
I
of I +; I5 .L 1 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 elevation of 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 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 LLJ . ❑ 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: ;X1NGVD '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 refetence mark used appears on FIRM Yes -1 No (See Instructions on Page 4)
5. The reference level elevation is based onInly
actual construction El construction drawings
(NOTE: Use of construction drawings isalid 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.) 1 I ,�
6. The elevation of the lowest grade immediately adjacent to the building is: l I All] 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: ❑-1 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 COKIINUAYION
^• 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 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 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 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.
CE TIFIER'S NAME LICENSE NUMBER (or Affix Seal)
Vila 11A40
COMPANY NAME i
CITY
f-AJ
STATE ZIP
_Sx 71 /64CZJ
ATE PHONE
_P / 9 g SAS/7)7_4.7–IZCi-9
official, 2) insurance agent/company, and 3) building owner.
Copies should be made of this Certificate for: 1) community
COMMENITS:
ON Willi
SLAB DASEMENT
A V A
ZONES ZONES p, ZONES
-G�
REFERENCEBASE
LEVEL, ELEVATION
r" REFERENCE
BAS EADJACENT LEVEL
FLOOD ..� GRADE [[[
ELEVATION REFERENCE ADJACENT
LEVEL GRADE
ON PILES,
PIERS, OR COLUMNS
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
-10 -ALL PARTEGSIN''LERESTED IN PREMISES SURVI%YEU:
A'Re ictered Pr les + .d Land eyr r, rl��hrr + cerl� Ihal i rarc'id smy�y ue made I if c m,und d i% d.,rc undr r m+ fir III a u11 -Mg de%0hed prrr"m.
' and Ihcre ne encroachments u m adjoining oinin to rty or the adbininF nn rocements ume a1:IlrltXa r, rl xwN n as
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COUNTI( OF TARRANT
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"To the Lienholders and/or the Owners of the Premises surveyee end to
FLOOD NOTE: 1 hereby certify hat a property desciribed herein '
within a specia ood hazard iren as identified by the
The undersigned does hereby certify that this survey was this day made
Federal Insurance Administration, Department nr; Houting and Urban
on the ground of the properly legally described hereon and is correct, and that
Development, the flood hazard area being identified is
there are no discrepancies, conflicts, shortages in area, boundary line conflicts,
_ of the Federal Insurance Administration Plood Hazard
encroachments, overlapping of improvements, visible lines or roads in place,
fkwndary Map effcc•tivr. on +
r•xcrpt as shnwn herenn nnrl thP, sniff rr"`^r! ha!: avc^•s to sr'.:! from a
for the - -- — -- ---
dedicated roadway except as shown hereon."
f
Dated:
I _
SUnVFYING CO.
pAtil` VOR BEARING:
David Pollard RPS 01518
David
Ordcr No. __ __.__�____
1003 Central Drive, Sulle 309
NOf FOR CONSTRUCTION
Bedford, TX 76021 Metro (817) 281.1249
CITY OF COPPELL
PLANS ARE REVIEWED FOR MOVIE
D
APPROVAL OF SINGLE
FAAMILYY`E, SWENCE ONLY.DATE
OTHER L�PIrr TI0i�i5 OIZ BY ova! of ttie plans and specifications shall not
CALL -OUTS ON PLOT PLAN App* R in
HAVE N2,1 BEEN
with the rued to mean Clty of Coppell Building
codesnstruction
and Zonhv
PPRO IV
ARE �1, j� APPROVEIV
,AND Ordinances.
QuIIRED
ii',.1VI.�. �� n!��✓� FORM BOARD
SURVEY REQUIRED
44'-0"
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1416 GRAPEVINE GREEK DR
Innovative New Ideas
PLOT PLAN
For Traditional Home Design
I" = 20'
LOT 10, BLOCK G
RIVEFFELL ESTATES
Between The Lines
GOPPELL, TEXAS
FIRST TEXAS HOMES
RIDDLE (12Y28/Q8)
Residential Designers and Planners
BRI-44-D(Fb45A )
Arlington, Texas Metro 817-261-4121 FAX 817-274-4717
* Builder/Owner to verify and check all aspects of this site and plot plan prior to any
construction