FEMA-EC9903167Theutiful Future
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BUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Manner
Job Address:
Date:
_
Lot: Block:
Subdivision:
S Phase or Section Number:
Owner I 4
/'h�S Address:
r' I . Phone #:
'Ka^
g (,O�
`I
Contractor: rl a
Address:
Phone #:
Description of Work to be Done
Class of Work: New ❑ Addition
❑ Alteration
❑ Repair ❑ Demolition
' ;I^1A/p 4APAL/
Area of Building in Square Feet [�
First Floor—/:? 7 a Garage ` Value of Work p�
to be Performed L _ �, ooy `r
Second Floor U / Other G
C_; O S 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 construction of the performance of construction.
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O.M.B. NO. 3067-0077
ELEVATION CERTIFICATE ExpireiMay 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
BUILDI G OWNER'S NAM POLICY NUMBER
Pi rst I egos 4ayLes
STREET ADDRESS (Incyding Apt., Unit, Suite and/or Bldglumber) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
OTHER DESCRIPTCgN (Lot d Block Numbers, etc.)
L y BMK A ):iiy�ryif_w E;?7 5
CITY STAT ^ 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. BASE FLOOD ELEVATION
(in AO Zones, use depth)
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I
4491 -0—
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE):/NGVD'29 U 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 I .0 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). FIRMS Zones
� �A1-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 14151 t l .1 feet NGVD (or other FIRM datum—see Section B, Item 7).
(b). FIRM Zones V1 430, 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 .0 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 W . U 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 i I LU 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 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 FIRM: / Yes ❑ No (See Instructions on Page 4)
5. The reference level elevation is based on: / actual construction ❑ construction drawings
I (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: 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 I .0 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 4n
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.
CERTIF�IL_Jl. � I I[ A..�� ---- LICENSE� �' NUMBERr Affix Seal) —
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 i ZONES ZONES ZONES
REFERENCE
LEVEL
REFERENCE
REFERENCE BASE
LEVEL
LEVEL FLOOD
0
ELEVATION
BASE
BASE .•::f.:: •ADJACENT REFERENCE
FLOOD
••. :';
FLOOD GRADE '', LEVEL
ELEVATION
ELEVATIONIREFERENCEI ADJACENT
LEVEL GRADE
GRADE
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
I
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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S'I'A'TF, OF TEXAS
('01IN7Y OF TARRANT
'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 pmperty legally described hereon and is correct. and that
there are no discrepancies, conflicts, shortages in area, boundary line conflicts,
encroachments, overlapping of improvements, visible lines or roads in place,
rxrrpt as shown hereon and 1h01 cnirl nr""�rr h tr :trc^'z', t:r a;; ln,in n
dedicated roadway ezecpl as shown hereon.—
DAM
BASIS ['OR BFARING:
Otdcr No.
NOT FOR CONSTRUCTION
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FI')OD NOTF: I hctchv certify that the property described herein
'.-:ithin a special flood hazard area as identified ht the
Federal Imumnce Adminisrratimt, Dr'partntenl of Nousing and Uthan
Developmelt, the florrd hazard arca being identified as
of the Federal Insurance Administralion frlood Hartrd
11rnn Bary Lent) Mfcctive on -----------
for Ific
Af SUFIVFYIN(l CO
David Follard RPS N1518
1903 Central Drive, Suile 309
Redford, IX 76021 Metro (817) 267-1249
Im
' SURVEY PLAT OF r
TO Al
j, frAR'FIES M'FRESTEI) 1N 1'RT;N11SEi'S SURVEYED: T
L' ►—�V*1 '.011'4ILD .4Rrplsletrd 1'tnlr%sum.d Land Sancyi�r, d,+ hereby I crlir% Ihn :I rar+lal wr�ry + I� m do d II ml 'hi, d.w 1-1 r m nl ..... 11n nl the fnllnuin'f+ dmrihed pn ry
find there tireenaoachmenta n{r+n the sdj�,ininr pmrcriv or the :1,10iniur inq+rro el-nts utvin the dr.rr iled rn+rerry I a<
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x-7167, .
STA"1 E 01' T EX AS
COUNTY OFTARRANT
"Fo the Lienholders and/or the Owners of the Premises surveyed : nd to
the undersigned docs hereby certify that this survey was this day made
on the ground of the property legally described hereon and is correct. and Ihat
there are no discrepancies, conflicts, shortages in area, boundary line conflicts,
encroachments, overlapping of improvements, visible lines or roads in place,
rxcepf av shrtw- hrtrrrn noel Ibt•t rnirl I,.,,. :Ice.•,:: to a1.! L•et:, :I
dedicated roadway except as shown hereon."
1M=
BASIS I OR BEARING:
Older No. - --. — -----
NOT FOR CONSTRUO'74ON
P.G .FE�'
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S`9� 151! e,%.
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FL')OD NOTE: 1 hrtchv ccutifv that the property described herein
within a special florid hazard wren 63 identified b\ the
Federal Insurance Administration, Department of Housing rind Urhnu
I)rvcloPmc�l, the, flood hazard arca being identified as
of the Fcdcrnl Insurance Administration flood Harrod
lioundary Kill elfroke on _----- -----.
for the
All SUMFYIN(I CO
Davin Pollard RPS 01618
1703 Central Drive, Suile, 309
Medford, IX 76021 Mntto (817) 267.1249
it
K,
This is to certify on this date that the elevations and drainage pattern shown on the attached
survey plat were developed from a survey of the property, and accurately and truely depict the
elevations as they existed on the date of said survey. The reletive elevations depicted may
change subsequent to the date hereof, due to the subsidence or upheaval of the soil, addition or
remo veal of soil by acts of man, erosion, wind, water, or other factors. Therefore, this survey
may not acturately depict the elevations and drainage pattern of the above property after the
date of the survey. The elevations and drainage patterns shown hereon are in accordance with
the overall subdivision plans of said subdivision.
Date of Survey
order No.
I'