FEMA-EC971121The City With A Beautitul Future
Job Address:
Lot: Block:
Owner
Contractor: f:
Description of Work to be Done
Area of Building in Square Feet
First Floor .30-r7
Second Floor
BUILDING PERMIT APPLICATI01V
Print or Type in a Clear, Legible Manner
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NOV - 7 1997
mmw Ftl- Date: /-,o 7-
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Z Subdivision: D /
Address:
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Address:
d
Class of Work: New ❑ Addition
NOTICE
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Phase or Section Number:
S
?sa/� Phone #:
� aj3� 9 � �. -- X6 2
CPhon
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❑ Alterfia&n ❑ Repair ❑ Demolition
A19 AV 4
Garage `�`� �< Value of Work S
Other7y d d
3 v to be Performed 7(�
S to/ GRAY AREA FOR OFFICE USE ONLY
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.
' SSigngtuy of Contractor or Authorized Agent /Print Name
/scat ✓(�—
Electrical Contractor Plumbing Contractor Mechanical Contractor
FPMC - 1 (4/94)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
ELEVATION CERTIFICATE
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 LOMR).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOh INSURANCE COMPANY USE I
BUILDING OWNER'S NAME POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBERI COMPANY NAIC NUMBER
3I.I
64 E�,PT/,� L
54716VtA7A/E"
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
.COT L Dom' e,40 CDPP�GL ESTS.
CITY STATE ZIP CODE
CoP,o.ECL ,,?;X.
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)
O
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: 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 _/_ .
2(a). FIRM Zones Ai -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
r(b).
of U 7�.14J feet NGVD (or other FIRM datum -see Section B, Item 7).
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 I I I I I 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 UJ . U feet above ❑ or
below ❑ (check one) the highest grade adjacent to the building.
141)
Q (d). FIRM Zone AO. 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. If no flood depth number is available, is the building's lowest floor (reference
\O level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
03. Indicate the elevation datum system used in determining the above reference level elevations: ❑ NGVD '29 ElOther (describe
lk 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.)
O 4. Elevation reference mark used appears on FIRM: ❑ Yes t4 No (See Instructions on Page 4)
q, 5. The reference level elevation is based on: X 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: I I I I I I . U feet NGVD (or other FIRM datum -see
Section B, Item 7).
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 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, Sectio _
�,.
CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal) • ��1
ok/.tGL `TS / ...••.��aw..�es•....
TITLE COMPANY NAME .••.••. �•.••••••..
ca 407
ADDRESS CITY- .•';�lTa4 0.41 1 ZIP
13o/ C .PEE C DLL o 7-Y. 006 ►<�
SIGNATURE DATE PHONE
zt��� -Z/-917 L1972,)242-_6"675
Copies should be made this Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owner.
COMMENTS: BENI'.y /I9.d.P,[J _500. n2.E" Ca77 "If" @ SOW-Ao�ST aD,t &,/ - P
51111521 59 � /
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R] SURVEY PLAT' ---
LOT 6 BLOCK 1 OF OLD COPPELL ESTATES AN ADDITION TO THE CITY OF COPPELL,
DALLAS COUNTY, TEXAS REC. IN VOL. 96020, PG. 2443, P.R.D.C.T.
CITY OF COPPELL
VOL. 89127, PG. 4336, D.R.D.C.T.
\
DT 6 \�
3LK I
•o
FORMBOARDS ^'
TOP OF FORMS ELEV. = 507.40
tY CALLRD S 4.12
35-4 HEARTHSTONE LANE
HR
8
101°29'43"
1 hereby certify that, on the _-I-ST day of NAV_ 19 y7_, this survey was made on the ground as per the field notes shown on this survey
1 and is true, correct., and accurate as to the dimensions of the subject property and size, location and type of buildings and improvements thereon,
if any. I'he survey shows all easements and visible easements ofwhich 1 have knowledge or have been advised affecting the subject property.
There are no encroachments, conflicts, or protrusions visible on the groand other than those shown.
OF
NOVEMBER 25, 1997 /5��� Go�a9
Date : ------ — i� �..... �. JOB # : 97-6 --
HARRY J. R0 WF. LL
- GF No. 459i
LEGEND (P.
Scale: 1" = 25 IL SUIt�'�'� MAR RY
1 /2" Steel /Iron Rod Found O
1/2" Steel / Iron Rod Set lJ J
1'roperty Line V v O 19r 1
TL
• & Associates,
ji
INC. C.
`tuod N'cuee Surveying& Engineering
hHinLinWreFence---X-X —X
X 1301
75006
e.21-
Electric F -F Carrollton,Ca Texas 75OOGT7777 7-777T --- --'
s
CITY OF COPPELL
VOL. 89127, PG. 4336, D.R.D.C.T.
i
ti
v
4+ j
CITY OF COPPELL
VOL. 89127, PG. 4336, D.R.D.C.T.
\
DT 6 \�
3LK I
•o
FORMBOARDS ^'
TOP OF FORMS ELEV. = 507.40
tY CALLRD S 4.12
35-4 HEARTHSTONE LANE
HR
8
101°29'43"
1 hereby certify that, on the _-I-ST day of NAV_ 19 y7_, this survey was made on the ground as per the field notes shown on this survey
1 and is true, correct., and accurate as to the dimensions of the subject property and size, location and type of buildings and improvements thereon,
if any. I'he survey shows all easements and visible easements ofwhich 1 have knowledge or have been advised affecting the subject property.
There are no encroachments, conflicts, or protrusions visible on the groand other than those shown.
OF
NOVEMBER 25, 1997 /5��� Go�a9
Date : ------ — i� �..... �. JOB # : 97-6 --
HARRY J. R0 WF. LL
- GF No. 459i
LEGEND (P.
Scale: 1" = 25 IL SUIt�'�'� MAR RY
1 /2" Steel /Iron Rod Found O
1/2" Steel / Iron Rod Set lJ J
1'roperty Line V v O 19r 1
TL
• & Associates,
ji
INC. C.
`tuod N'cuee Surveying& Engineering
hHinLinWreFence---X-X —X
X 1301
75006
e.21-
Electric F -F Carrollton,Ca Texas 75OOGT7777 7-777T --- --'
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