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tyWith A Beautiful Future BUILDING PERMIT APPLICATION 0102-E320131 FMEO
Print or Type in a Clear, Legible Manner
Job Address:' C (.,� ('-/ ;. V `� Date: f 1
i , /I I h-2
Lot: j Block: Subdivisions \ ` t /, '� `,} Phase or Section Number:
Owner C�k ' ,� Address: 4 1L hone #:11
Contractor: Address: Phone #:
Description of Work to be Done Class of Work: JCTNew ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
(n�i����1�U
Area of Building in SquareFeet
First Floor T 6 `�
Second Floor
it 3-7
NOTICE
/
Garage /
Other r;
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 spec' herein or not. The granting of a permit does not presume to
give authority to violate Cance the provisions of any other federal, state or local law
re u m constructioq of t e perf ance of construction.
Sign ture of ontractor or uth ized Agent rint Name
Electrical Contractor Plumbing Contractor Mechanical Contractor
FPMC - 1 (4/94)
V4
Value of Work � �1 h c b r,� �
to be Performed
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 WNER'S NAME POLICY NUMBER
94st %xa-> 4101"El.5
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
OTHER DESCRIPTION (Lot and Block,Numbers, etc.)
WIRE 5
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 ZONE
6. BASE FLOOD ELEVATION
(inAO Zon s, use depth)
40170
Flo
�1,40,011
/� l99
!%-SIT
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE):XGVD'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 _).❑ 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 I .
2(a). FIRMI Zones
l,Al-A 0, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of ❑�I0. 1 feet NGVD (or other FIRM datum—see Section B, Item 7).
(b). FIRM Zones V1430, 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 ,U 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 I. ❑ 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 W . ❑ 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: VNGVD '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 71, 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 FI5M:,�J 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: 14eet 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 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 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.
CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal)
TITLE COMPANY NAME
Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner.
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
_
. ::.<:iti`L;N: •::: i::. ry7.ar,. :'l'
BASE
BASE , :: �,.>
BASE•'
. • • r •• ADJACENT:° + REFERENCE
FLOOD
FLOOD
FLOOD GRADE •'• =1`^+, LEVEL
4A
ELEVATION
E LN! REFERENCE ADJACENT '
LEVEL GRADE .n.�y.
... ... "'J. ..
ADJACENT::
::Ci:: r.: •:.G: i:.'.�.i:7•:i::
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
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"In the Lienholders and/or the Owners of the Premises surveyed and to
FLOOD NOTE: I hereby certify That the property describedherein
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 1-16usitrg and tfrbnn
on the ground of the property legally described hereon and is correct. and that
Development, the flood hazard nren being identified 'as
there are no discrepancies, conflicts, shortages in area, boundary line conflicts,
- of the Federal Insurance Administration Flood Hazard
encronchments, overlapping of improvements, visible lines or roads in place.
Boundary hint, effective on
evcrpt as shwa n baron, and that said property has aCce41 to and fmrn o
s rrlicnted roadway except as shown hereon."
for the -- ——� -- -
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flak%I:
REARING:
AP sunVEMIG CO .
Or
Order Nov.
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Daviel pollard RrS #1518
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'OT FOR CONSTRl1CTlON
1903 Central Drive, Suite 309
Bedford. TX 76021 Metro (817) 267.1249
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