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FEMA-EC990615® �� P The City With ABeautiful Future BUILDING PERMIT APPLICATION i A DEPT )�433 ' Print or Type in a Clear, Legible Manner -- Job Address:Date: / ( _ C", Lot: Block: Subdivision: i f Phase or Section Number: Owner i �,�> Address \ Phone #:,'l t 7 Z,1A 31 1GJ Y`SI, Contractor: Address: i Phone #: Description of Work to be Done Class of Work: ew ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition Area of Building in Square Feet First Floor jl�� ) Garage Ll Value of Work to be Performed Second Floor ��, Other �� 3 I yq 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 violate or cancel the provisions of any other federal, state or local law regulating co ction of the perf6rm�ttce of construction 1_, ,i Jr �nature of�tractor or Au ori4:d Agent riot Name 1 [// j/ Electrical Contractor Plumbing Contractor Mechanical 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. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER;5.MME POLICY NUMBER �71 IF'—SCA MSS STREET ADDRESS (Including Apt., Unit, Suite and/or Bldd Number) OR P.O. R UTE AND BOX NUMBER COMPANY NAIC NUMBER OTHER DESCRIPTIOPPL.t and Block Numbers, etc. 1.-,-,T i— CITY R $TTAATE ZIP CODE SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. (in AO ZoneASE s use dept ELEVATON coo t o ' �- J 19s J A 1 ` '47S 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 ❑ Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: ❑ .❑ feet NGVD (or other FIRM datum—see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, Indicat the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 2(a). FIRMI Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of l 1 `4$ .0 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 IJ .l❑ 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 L_1_J.❑ 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:KNGVD'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: KYes ❑ No (See Instructions on Page 4) 5. The reference level elevation is based on: actual construction LI 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���� . �� 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: LLH❑❑ . ❑ 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. I certify that the information in Sections 8 and C on this certificate represents my best efforts to interpret th valiaoie. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Cod i p � V. �" T��f�ii► CERTIFIER'S NAM LICENSE NUMBER (or Affix S DAV TITL COMPANY NAME ye Y51S +off . P. t► • J --a - -- ZIP ADDREpSS CITY SIGNAT A / , °ts��g _ � I7� Zt-1-1L 7 - Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner. COMMENTS: REFERENCE FLOOD ELEVATION WITH ON PILES, ON BASEMENT PIERS, OR COLUMNS SLAB A V A A V ZONES ZONES ZONES ZONES ZONES REFERENCE LEVEL BASE ,---� lf1ti. 11W FLOOD GRADE GRADE ;yy� ` LEVEL 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 REFERENCE LEVEL FLOOD ELEVATION ADJACENT SUMEY PLAT OF 10 ALL VARTIFS�IN1 F'RFS IT 1) IN PRF,NIISPIS SUitVF i EM: ,A R,rictrred FwJ—um,d Lan I Su....... d" herrh) cert () Ihar a cn,,t"I ,une. Ih.im and Ihi, d'rr -AI t p,, i4m of the ,41nt de n (,,n .md there are_.. en, 1.1M hnunR urm the a,tinminr pmr ri, or rhr aJ...ninp nq,v,rnrrni. urv, rhr rrrlrn% Lmn,n a� l .1 6,1 M In it t r �ti i O M r LIQ L o i I d" ori i -- q3 _251_ F.( 'j°4 i° Yv roP �� s rt i n r'AU, *ro P ro P t-1 .1 X10.88 1!3. r) r), 14 Zo ciFZAP-EVlt f- CV--F.--e. DFZ1VE STA'I F OF TEXAS COUNTY OF TARRANT 1.: rbr I_irr-lorr� andwr the O'.,ncrc m Iftc rwmi,, ;urvcyed and It, the undrt6rnrd does hereby certify that this sutvry v:as this day made I+n thr ptound of the properly legally described hrrcon and is correct. and that there are no discrepancies, conflicts, shortages in arca, boundary line conflicts. encrnarhrnents, nyerlarring of improvements, visible lines or mads in place• rccrpr ac chnun hrrr.,n on,l Ihnl cai.l dcdicalyd n,arluay rrccpt as slioun hereon. Dated BASIS I l)R BEARING: Oldcr No. NO I I OR CONSI RCI II )N — - - WINE I].()OI) No I f I hent,) entity that t11•- prr,perty described herein uilhin a �pccial Ib,n(1 11:171rd area m identified by the Frdcrnl fmstwml ^ Adminiaruion, Ih l,artment of Flousing and tItban I)c,rl„pnrcnt, thr f11v.,1 h:n:nd arc:, hrinF identified as of the F Metal Insurance Administration Floud Na7ard Itound:Ir Nf:Ip rffcctiae on ---�_ --- for 1hI' a �Kt ---------- Af' !�tIDVF 11,IG CO David Pollard 14113 N1518 1903 Central Drive, Suile. 309 fledford, TX 76021 Metro (817) 267-1249 tl+ I J r - -- 0 CJ ccs I U 1!3. r) r), 14 Zo ciFZAP-EVlt f- CV--F.--e. DFZ1VE STA'I F OF TEXAS COUNTY OF TARRANT 1.: rbr I_irr-lorr� andwr the O'.,ncrc m Iftc rwmi,, ;urvcyed and It, the undrt6rnrd does hereby certify that this sutvry v:as this day made I+n thr ptound of the properly legally described hrrcon and is correct. and that there are no discrepancies, conflicts, shortages in arca, boundary line conflicts. encrnarhrnents, nyerlarring of improvements, visible lines or mads in place• rccrpr ac chnun hrrr.,n on,l Ihnl cai.l dcdicalyd n,arluay rrccpt as slioun hereon. Dated BASIS I l)R BEARING: Oldcr No. NO I I OR CONSI RCI II )N — - - WINE I].()OI) No I f I hent,) entity that t11•- prr,perty described herein uilhin a �pccial Ib,n(1 11:171rd area m identified by the Frdcrnl fmstwml ^ Adminiaruion, Ih l,artment of Flousing and tItban I)c,rl„pnrcnt, thr f11v.,1 h:n:nd arc:, hrinF identified as of the F Metal Insurance Administration Floud Na7ard Itound:Ir Nf:Ip rffcctiae on ---�_ --- for 1hI' a �Kt ---------- Af' !�tIDVF 11,IG CO David Pollard 14113 N1518 1903 Central Drive, Suile. 309 fledford, TX 76021 Metro (817) 267-1249 F LL fLAiNS ARE kEWE WEi� FOR J , 0Y 'N FA Mi O Y. Apprval 1-J 0'FP1.,AN !"ides X10 Eu"Witu WMI tln Crty AN,) A-4ZE IN�LL APPROVED. 65.00' 10, ur: . . . . . . . . . . . . BL 521-011 WI E3L ------------- ------ -------------- 16, C -OW, 441-01!? 4 MaZFF 552.3FF 9W.5FF RE M.A. LETT.".:), 'Llfr�'Yll F,','.qED. Ca in M MTIM j f it W2 -of T, SMVF-'Z REQXIMED M2 -2%f=F L------- — ------ 59 5 5 L - ii 4' GONG. In WALK 1420 &RAFEVINE CREEK 011 Innovative New Ideas PLOT PLAN For Traditional Home Design III = 20' LOT I BLOCK A RIVERVIEY4 EST. Between The Lines COPPELL, TX FIRST TEXAS HOMES BRI -44-A (f�'+21PZ SPEC, 1/15/1:144 Residential Designers and Planners r -'I 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