FEMA-EC960207 (2)7 The City With A Beautiful Future BUILDING PERMIT APPLICATION
A 18 96
d y Print or Type in a Clear, Legible Manner
Job Address: J� I Co U Kf— Date: / 60)
/ 1224�
Lot: Block: Subdivision: �( Phase or Section Number:
Owne':S ;Address: 7 I wa,*) c:()
Phone #:U-2; Mo
Contractor: Address: Phone #:
Description of Work to be Done Class of Work: ew ❑Addi on
_ ❑Alteration ❑Repair ❑Demolition
lrea of Building in Square Feet /
First Floor �41 Garage
Second Floor Other
NOTICE
This permit becomes null and void if work or construction authorized is not commences
within 180 days, or construction on work is suspended or abandoned for a period of 180 day.4
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 tc
give authority to violate or cancel the provisions of any other federal, state or local Is%
regulating constry iption or the performance of construction.
Signature of Contactor or Authorized ent Print Name
Electrical Contractor P 'ng Contractor M or
FPMC 1 (4194)
-7�2—
Value of Work 4l 0
to be Performed !:G� ow.
GRAY AREA FOR OFFICE USE ONLY
SURVEY PLAT
JIMMY W. POGUE, INC.
This is to certify that I have, this date, made a careful and accurate survey on the ground of property located at
No.-,r�OQ `KINGSMILL COURT in the city of, COPPELL, Texas
Lot No. 43 , Block No. A City Block No.
Of FAIRWAYS OF R IVERCIIASE an addition to the
City of COPPELL , DALLAS COUNTY, Texas, according to the MAP thereof
recorded in Volume 9 3 0 5 6 page 2367 MAP Records DALLAS County, Texas.
GOLF COURSE LANDSCAPE. EASEMENT
VOLUME 87174, PAGE 3438, DEED
RECORDS, DA 148 COUNTY, TEXAS
SO.
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VISIBILITYW14-r%n OF 1/2 /1. R. F . 0.00
1183' 37' 31"W REFERENCE BEARING PER PLAT
KINGSMILLdCOURT
hereon
The plat is a true representation of the property, by Found survey, y
and dimensions of said property being as indicated by the plat: the size, location and type of baildings and PAUL A . Ii I DA LGO
improvements are a shown. all improvements being within the boundaries of the property, set back from
property limes the distance indicated, and that the disnnces from the nearest intersecting street, or road. REGISTERED PROFESSIONAL
is as shown on said plat, all corner monuments are as shown. LAND SURVEYOR NO. 4490
THERE ARE NO ENCROACKWENTS OR PROTRUSIONS E,Cef,'ErP7 A S—'W&JIU
Ibis survey was petformod in connection with the uamsaegpm
Scale 1"= 20' deseribae m OF. No. JIMMY W. POGUE, INC.
Of IIOLMES BUILDERS 3510 MARVIN D. LOVE FREEWAY
D,, 1-25-96 Tale Company. Use of this awry for my other purpose or by any DALLAS, TEXAS 75224
odw pw*s A&H be strkdy prohibited as this survey to a copyright PHONE (214) 371-0666
515 0 8 owned by Ihnsy W. Pepw, bar , and all other uses are forbidden.
Joe No: witimut prior wrioem consent of An" W. Dogma, Inc.
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
STR E AD RE�Including Apt., Unit, Suite and/or Bldg umber) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
CJ
OTHER DESCRIPTIQJ4 Lot and Block Numbers, etc.)
CITY n STATE 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)
1
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): �GVD '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 . ❑ 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 AlIfeet
0, AE, AH, and A (with BFE). The top of is at an elevation
of � . NGVD (or other FIRM datum—see Section B, Item 7).
(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 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 . ❑ 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: L:"GVD '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: El Yes �.N'O (See Instructions on Page 4)
5. The reference level elevation is based on: I/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 . U 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
_)DF::o DD 'Cie 15c:>8 —
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 punishab/e�.,,x r imprisonment under 18 U.S. Code, Section 1001.
NAME
c prg c!� Ll .01 MER (or Affix Seal)
4j45-
ZIP
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
LEVEL BASE LEVEL
REFERENCE
FLOOD
LEVEL
ELEVATION
•'ri•
may:
BASE
FLOOD ADJACENT •::•: '�#k: REFERENCE
BASE
FLOOD
t.
ELEVATION REFERENCE ADJACENT GRADE "t�: LEVEL
ELEVATION
LEVEL GRADE "^}}
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.
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