FEMA-EC940105® 398 Za
DEC 2 2 13
The City With A Beautiful future BUILDING PERMIT APPLICATION
Building Inspections Division
I
Print or Type in a Clear, Legible Manner -- --- FjobAddress: 8 �q v CA. Date: z/9J
Lot: 4- Block: 4 Subdivision: wC- 4 e s �'� C Phase or Section Number:
DQ /los, T 7s2sL
Owner: Address: Phone #: 3T,3 _ 00 Z 7
►/e ��wetvc� S 1 %8 Dom,eN o„4 Rd S.,"J,
Contractor: Address: Phone #:
Description of Work to be Done Class of Work: "New ❑Addition ❑ Alteration ❑ Repair ❑Demolition
- �ZV!S-
of Building in Square Feet
First Floor 14 8/.
Second Floor 1 7 59
Garage
Other
NOTICE Per
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 Zon.ir
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 Appr(
and correct. All provisions of laws and ordinances governing this type of work will be Come
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.
4&^ &'/' ioo ..IDG L--, Ca-- i" ral j
gnature of Contractor or Authorized Agent Print Name
1 44Qr g/ec1, N, 4,-,or1
Electrical Contractor Plumbing Contractor Mechanical Contractor
BIR • 1 (2/821
Value of Work
to be Performed 2 / 10. a o 6
5 GRAY AREA FOR OFFICE USE ONLY
Ae-;' PziR'v UY t7r-,vlc Lop M;✓ N T
32.17'
,�..J -82'
FLOOD PLAIN - - 6.37'
Z I 20' MAINTENANCE ESMT
' -- - - - -
��
i
F.E.M.A. LFTTER REQUIRED.
_ , MiN1M� M f f.
l�
w
z,
x
of
0
i
> X10'1"
1brn� 8
52 8 �'1�✓lJ
0.1 CN NEW RESIDENCE
�t FF = 452.24 i O
FP = 451.44 J
��•� �m
Col �I<oti i rWA
FORM BOARD
SURVEY REQUIRED
CONC N.10
DRIVE 10' X 10'
--� - ----- ------ ---------
10' UTIL ESMT i . T.P. ESMT.
I
41�0• ,Li45'i�a
— —
$TRL _T
7 5.80'
9 8 6 LA G U N A D R I V E
SITE PLAN NORTH
SCALE: 1''=20'0" LOT— 4, BLOCK— A.
CITY OF CUPPELL
RVITIEWED
4
BY DATE
Approval o in,, plans and specifications shall not
be construes ,;&ean construction in direct con-
flict with in(- Cltv Coopcll I f ilr' n;r Codes and
Zoning Ordinances
M B. No
tLtVHI IVN UUMFICATE EpfeSM.8y 067 01)
33.199)
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTIONU fh'
. o ! Is certlhcats 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 appli;:able 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
BUILDING OWNER'S NAME 1 I 1
_ V _t�I:SA r4r4 - s �� L, t L, -acs
STREET ADDR S (IES nduding Apt.. UNI. Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
Z12 4 , aLck A
FOR INSURANCE COMPANY USE
POLICY NUMBER
COMPANY NAIC NUMBER
CITY
STATE ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
I . COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE OF FIRM INDEX
5. FIRM ZONE
6. BASE FLOOD ELEVATION
/ )1o
0010
(onAD7, ws. use14 aePml
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 0 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::...! •. LI -.J.L.J feet NGVD (or other FIRM datum -see Section B, Item 7).
SECTION C BUILDING ELEVATI64 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)• The top of the is at an elevation
of ------ A-1 iA.A feet 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_1.11 I U 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 I -L1 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 -I .IJ 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: IJ NGVD '29 ❑ Other (describe
under Comments on Page"2). (NOTE: If the elevatiomdatum used in measuring the elev ' t than that used on
the FIRM (see Section B. Item ?J, then convert the elevations to Md -datum system used on the FIRM and show the conversion
equtWon under Comments 5p Page 2.)
4. Elevation reference mark used appears on FIRM: ❑lYes ❑ No (See Instructions on Page 4) WN rrO JN
5. The reference level. elevation is based on: ❑ actual construction ❑ construction drawings C4 4,— .-_ -s
(NOTE: Use of construction drawings is only valid if the bullding does not yet have the reference level floor in place, in which
case this certificate will only be valid for the buAding during the course of construction. A post -construction Elevation Certiflcat§
will be required once construction is complete.)
6. The elevationof the lowest grade immediately adjacent to the building is: l I I I I I.0 feet NGVD (or other FIRM datum -see
Section B. Item 7).
SECTION D COMMUNITY INFORMATION
i
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._1I.1 I .0 feet NGVD (or other FIRM datum -see Section B. Item 7).
2. bate of the start of construction or substantial improvement
' FEMA Form i11.31r MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
4
'{'
A.
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) isrequired. ?
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'unabfe 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.
W l< Lr
CERTIFIER'S NAME
V.
f tic&�4SE NUMBER (or Affix Seal
TITLE`'
c 7 -COMPANY NAME
ADDRESS
_—!
GTY t
STATE ZIP
SIGNATOR 214) 24 2 I o
® DATEPHONE --- ,-
Copies should be madeof this Certificate for: 1) community official, 2) Insurance agenUcompany, and 3) building owner.
COMMENTS:
NOTE: This "Elevation ;Gerficate" is valid for item 2(a) only and In so much as changes made on the
— face of this Aument. This is a certification of elevation of form boards only.
� — L
The property referenced hereon is not located in a FEMA 100 year flood hazard as per referenced
panel
The elevations shown were taken from grading plan of Waters Edge Addition. ---
ON
SLAB i
A rl<
ZONES ZONES'
aASE
/LOOP
ELEVATION
GRADE
WITH ,
ASEMENT
A
ON PILES.
PIERS. OR COLUMNS
A y
ZONES ZONES
REf ERENCE
LEvfl wi
ELEYAI.GN
n .AD+ACENI
- I1G 1 (115 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.
y.
Page 2
\LL
• SURVEY PLAT
FORM SURVEY
ELEVATION CERTIFICATE FOR TOP OF FORM
ADDRESS: 986 LAGUNA LANE, COPPELL, TEXAS
LOT 4, BLOCK A, WATERS EDGE ADDITION, COPPELL, DALLAS COUNTY, TEXAS
LAK E
20 MAINTENANgE
81 ACCESS ESMT.
PEPPLAT PG 3426 8
PEP PLAT
N58°16'Ip"E
2.17
<
PROPOSED IOOYR.
> N 70°29r17
LOT 4
FLOOD PLAIN LIMIT
PER PLAT
pg' 11"E
t44
LOT 3
LOT 5 _
W
BLOCK
A
�:
I o.0
8.2 ti
FOMS aAJLy
M
�
" '
986
LAGUNA LANE
W
No
TOa OF FOQA45 45Z.37
t(7
°
M
WopasCB FF= 452.24
0v "
M
�
Z
10.0
m
9.4 N
25' BL
----
IOC UTI.L ITY ESM'T.
N
IO`X IOC PA ED SMUT.
S 56039'29"W 67.57' Z >RF
5.80
�-1 (Reference Bearing) R=325.00'
LAGUNA LANE
Bearing Source: Recorded Plat
TO: THE PRGPERTY SHOWN HEREON IS NOT LOCATED IN A DESIGINATED
ZONE A (100 YEAR FLOOD HAZARD AR A) ACCORDING TO FEMA MAP:
PROPERTY IS LOCATED IN ZONE:
AVERY EDWARDS PANEL : 0 /U DATED: ID-I(P-9)
[ do hereby certify that the plat shown hereon represents the results of a survey made on the ground by O F
ms or under my direction and supervision. Visible and apparent Improvements to the property found on the
ground are shown hereon. Except as shown hereon there were no visible and apparent encroachments or .� •.....••• F
protrusions of Improvements found on the ground. This survey Is subject to alleasements of record •• S T E 9•�••f
Thls survey was performed exclusively for the above mentioned partles. Use of this survey for any other /LP.�G F • 9
purpose or by others shall be at their risk. . Q •. �• ..
SCALE Ill. ZD,
DATE .1-4-94
JOB NO. 9310
DRAWN BY C. P.
SHIELDS AND LEE SURVEYORS
1421 FERNDALE AVENUE
DALLAS, TEXAS 75224
(214) 942-8496
W. R. LEE » • 1
.............................
9s9 2038 �.'�
�'• °F E S S o. O
~�••SUik ��
W.R, Lee, R.P.L.S 2038