FEMA-EC9502207They With A Beautiful Future BUILDING PERMIT APPLICATION 95
JS73. /, Print or Type in a Clear, Legible Manner
Job Address:
, Date:
1
Lot: 5 r Block: AS Subdivision: �¢s DC1 Phase or Section Number:
Owner: /._, , /. , Address: Phone #: O
Contractor: r Address: Phone #:
Description of Work to be Done Class of Work: fie' ❑Addition ❑ Alteration ❑ Repair ❑Demolition
�rLE MII.N u s r o M
of Building in Square Feet
i
First Floor ,995(p Garage Value of Work
to be Performed �
Second Floor_ Other_ �I�
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 or the performance of construction.
%A "ap 1-0
Sianature of ContractisforAuthorized Aalnt t Name
ELEVATION CERTIFICATE O.M.B. May 31, 1 y31, 199933
Expires M
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 I FOR INSURANCE COMPANY USE I
BUILDING OWNER'S N/AAMM'E�� ' POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY MAIC NUMBER
'?61 2. LikC LINA— 6x-tvE
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
L -or t S , $Lv c,K A LJ -4- FKS e�b &e- PR • T7/Jo
CITY
(20 WPe2S 1- D/Klc C ouwry 7W*5 ZIP CODE
/tGc� 750(9
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
4 D d' 7 Q
OIO
0010
G
APPUL IS_, fh
q
(in AO Zones, use depth)
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): 1�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: 11415'0 11 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). FIIRMI Zones All -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of LZ .& 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 1 1 1 1 1 ,❑ 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 LL. ❑ 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 ❑❑ . ❑ 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: 0 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: 1:1 Yes Yes LJ (See Instructions on Page 4)
5. The reference level elevation is based on: Factual 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 duting 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: LL141541. U 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).
?. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
v
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 Ai—A30, AE, AH, A (with 13FE),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), the ' #h"eature(s) not
included in the certification under Comments below. The diagram number, Section C, Item 1, must stll at teikf
ea
1 certify that the information in Sections B and C on this certificate represents my best efforts to inter , �t t .t3a
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. CoracEiran:Q1�.,� �,�
r,
Ty III �•>'
CqIFIER'S NAME ► � � LICENSE NUMBER (or Affix Seal)
TITL ► COMPANY NAME
�S7 #0A&VC 6V10nl/-YL �/+Ijb <7tAf_✓ey01t._.
ADDRESS CITY STATE ZIP
1 , & Zoo 538 Di_ Vas T ?c 7Szz$
SIGN T R DAT /�� r#I
Cdples should be made of this Vertificate 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 BASE LEVEL
REFERENCE
LEVEL FLOOD
LEVEL
ELEVATION
BASE '.' 7':'. :.,.
ADJACENT :. REFERENCE
BASE
FLOOD
FLOOD
ELEVATIONREFERENCEADJACENT GRADE LEVEL
ELEVATION
LEVEL GRADE
:::i::.':'.::::,::<;::':. `•'.': ::t;t`:
. .. ...... .:..... ... ::...
:�:: ADJACENT.:
�7
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
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E REVIEWED I' &I
APPROVAL OF SINGLE
'AMILY RESIDENCE ONLY.0•1
OTHER DEPICTIONS OR
;ALL -OUTS ON PLOT PLAN
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WATERS EDGE f
BY DATE
Approval of the ns and specifications shall not T
be'construeb to mean constructioniin di�redc� d-�.
fIict with the City, of Coppet
Building
Zoning Ordinances
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