FEMA-EC9611227The(��*C'a�7`��y With A Beautiful Future BUILDING PERMIT A P P L I CATION
Print or Type in a Clear, Legible Manner
Job Address: o -,4 —A ,LD Mr
Date: l — ) / / - /
Lot: ^ Block: _-Z Subdivision:
Ql 21-
�'4-4o S Phase or Section Number:
OwnerM Address:
�D S/ C
�� Phone #:
0
Contractor.C 4, 1"1� S Address:
/ 2 2— 44446;
v A S Pone #: 92'2
Description of Work to be Done Class of Work: New ❑ Addition
A ❑
Iteration Repair ❑ Demolition
111.1S: LcJ
f D I/ p 2 -Sr- L -
Area of Building in Square Feet
First Floor -7 �! 0 Garage —)4$04
Value of Work -2
7
to be Performed
Second Floor SIC Other
GRAY AREA FOR OFFICE USE ONLY
NOTICE
Permit Fee:
'"" Receipt Number:
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
Zoning District:
Occupancy Classification
at any time after work is commenced.
Approved B'
I hereby certify that I have read and examined this application and know the same to be true
C;omlflents.
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.
Sig re of Contractor or Authorized Agent 4'rint Name
- �9E ��,�
--46,4-6-
Electrical Contractor Plumbing Contractor Mechanical Contractor
FPMC - 1 (4/94) ��
ELEVATION CERTIFICATEO.M.B.No3067-0077
Expires May 31, 1993
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
BUILDING OWNER'S NAME I POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER I COMPANY MAIC NUMBER
330_ //,E A,p T�i/STo,�/,� L,I A/,6
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
L o 7' i2_ QL ack l OGD eos�,�.�GG-
CITY STATE ZIP CODE
ey /�Io.�LL �, %i�•
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)
490 /'70
1
Sb /
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): f 4 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: ❑ [._.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 -1___ .
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
of L_' 1,51013 .I l91 feet NGVD (or other FIRM datum–see Section B, Item 7). r W �, 0,1 e b
(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 ❑ 1 ❑ LJ 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 0 (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.[__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 [-1 No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: [_ INGVD '29 [-_I 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 /actual
ZYes ; No (See Instructions on Page 4)
5. The reference level elevation is based on: LvJ 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 L__ _is[o_Lzi.L`11 feet NGVD (or other FIRM datum -see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
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: L_1_ -L-1 -1, _j .L_feet NGVD (or other FIRM datum–see Section B, Item 7).
Date of the start of construction or substantial improvement
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 iaw 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 R and C on this certificate represents my best e;
1 understand that any false statement may be punishable by fine or imprisonment under
CERTIFIER'S NAME
TITLE
ADDRESS
13D/ . FZ C;rv, F sT�
LICENSE
COMPANY NAME
CITY
data available.
on 1001.
_1" STATE ZIP
DATF PHONE
should be maqyof tl•s Certificate for: 1) community official, 2) instrancri agent/company, and 3) building owner.
I
a
A
PPELL
31-
5
D D
ATE
ATE STREET CUT
SL
hall
Approval Of the plans and specifications shall not not
be cors rued to mean construction in direct conflict
with the City of Coppell Building codes and Zoning
Ordinances.
a
01 -9 - -
—J—_—
CITY OF COPPELL
l �
A id, zwa! of —:d specifications shall not
be cors+•:. _; .,. r : a,� construction in dire,-- conflict
with iiie City of Coppell Building codes and Zoning
Ordinances.
t it
Lzr-- _ 1