FEMA-EC981130(* r== m�
The City With A Beautiful Future BUILDING PERMIT APPLICATION A ��A 7�r3
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.�L 9 Print or Type in a Clear, Legible Manner 10-09-9 LP04:34 RCVD
Job Address: 1 C' (,1,�)� 'S �g=Q Date: 1
Lot: 1 Block: Subdivision: `� n t \� , n 31 Phase or Section Number:
Owner
Contractor:_ (j Address:
Description of Work to be Done Class of Work: New ❑ Addition
Area of Building in Square Feet
First Floor Garage
Second Floor l -a> Other
I\[111Vto) y
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 specifi d herein or not. The granting of a permit does not presume to
give auttrty to violate or can 1 the provisions of any other federal, state or local law
reeulatifiQ construction 'of t verf ance of construction.
i
Cgnalure of of
\ I
Electrical Contractor
FPMC - 1 (4/94)
or or pth'zedlent
Pontractor
4o)
Mechanical Contractor
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Phone #:
❑ Alteration ❑ Repair
❑ Demolition
Value of Work j Qclro
/ �(1��
to be Performed I t t uC- .
GRAY AREA
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
O.M.B. NO. 3067-0077
• ELEVATION CERTIFICATE Expires Moy31, 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 I FOR INSURANCE COMPANY USE I
WA QjNG OWNER'S NAME POLICY NUMBER
1 I g -ST I mnA�S 4A40 A1n M 5
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
1,513 CW"
OTHER
��-
OTHER DESCRIPTION (L and Block Numbers, et
"T
CITY rATE ZIP CODE
� PPfd
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
(in AO Zones, use depth)
1
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE):,ZNGVD'29 L1 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 1 1 1.❑ 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
1
of 1 14 54.P1 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 .❑ 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 L ❑ . ❑ 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? 2Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations;,Fo_-<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: LJ 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: 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),Vi—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.
1 certify that the information in Sections 8 and C on this cerlificate 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.
GERTIFIER'S NAME LICENSE NUMBER (or Affix Seal)
COMPANY NAME
STATE ZIP
rJ
Copies should be made of this Certificate for: 1) community official, 2j 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 ft
REFERENCE
LEVEL
REFERENCE
REFERENCE BASE
LEVEL
LEVEL FLOOD
ELEVA IION
LNES
BASE
BASE .:::•';:::REFERENCEADJACENT :�
FLOOD
ELEVATION
FLOOD GRADE LEv[L
ELEVATION REFERENCE ADJACENTLEVEL
GRADE
r:: :-'r�•, :;.:...; .'r.;
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 PLATOF
TO ALL PARTIES INTERESTED IN PREMISES SURVEYED:
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I. "- V1 — kZ _ 0_ Re iVered Profe ! I Lund Surveyor, du hetehy cenYy that ! candid �urvev x,t� madc r I the pro!md thi, day undrr mt urc,kion nr the (,,It in 'Vi pmft'm
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and there are encroachments upon the adjoining pmperty or the adj,,ining improvemenn up,n the de�crihed purr•ri) known ai
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STATE OF TEXAS
COUNTY OF TARRANT
i "To the Lienholders and/or the Owners of the Premises surveyed and to
The undersigned does hereby certify that this survey was this day made
on the ground of the property legally described hereon and i% correct, and that
there are no discrepancies, conflicts, shortages in area, boundary line conflicts,
enr'roachments, overlapping of improvements. visible lines or roads in place,
excrpt ns xhown hereon, and flint %aid property has nccess to and from a
dedicated roadway except as shown hereon."
Datcd:
BASIS FOR HARING:
Order No. __---
NOT FOR CONSTRUCTION
13 -CAL -FE 1't = 201
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FLOOD NOTE: I hereby certify that the property described herein
_. within a special flood hazard area as identified by the
Federal Insurance Administration, Department of HotAing and Urhan
Development, the flood hazard aren being identified as
of the Federal Insurance Administration Flood 1-1mid
Houndnry htnp effective on ____ _ _ -------
for the ----- ----- ---- ---- -
AP SURVEYING CO.
David Pollard RPS 01518
1903 Central Drive, Suite 309
E3odford, TX 7602.1 Metro (617) 267.1249
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