FEMA-EC001012Cl P'l The Clty With A Beautiful Future B U I L D I NG" P E R M IT APPLICATION
Print or Type in a Clear, Legible Manner
Job Address:Z/6 L� v� �� G Date: ^�^
Lot: Block: G Subdivision: / �� Phase or Section Number:
Owner
E� O �, S Address: /�4AWY Phone #: ��?� 2 2�
Contractor: ffU Address: fir/ Phone #: G'72, WZ
[Description of Work to be Done Class of Work: ItNew ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
Area of Building in Square Feet
First Floor ,2- 7,-7,
Second Floor 1218
NOTICE
Garage a
Other
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 copolruction of the performance of construction.
Signatpfof Contractor or Authorized A Int / Print Name
�� Lj /t- otic ✓wb "� E'/, Crc�.41,"'C/�
Electrical Contractor Plumbing ontractor Mechanical Contractor
FPMC - 1 (4/94)
Value of Work
d�
to be Performed
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002-.
t ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO
L
STATE
etc.)
, etc. Use Comments section if necessary.)
Company NAIC Number
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTALD M: SOURCE: 1_1 GPS (Type):
( W - f/#' - ##.##" or ##.#####*) lJ NAD 1927 I,�IAAD 1983 lJ USGS Quad Map I I Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER TB2. COUNTY NAME B3. STATE
L'DPP GC D/ LL 1115X 1 7—Y
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
DATE
EFFECTIVE/REVISED DATE
ZONE(S)
(Zone AO, use depth of flooding)
5
❑ d) Attached garage (top of slab)
_ ft.(m)
w
�p�arms�►
❑ e) Lowest elevation of machinery and/or equipment
B10. Indicate the source of th . Base Flood Elevation (BFE) data or base flood depth entered in B9.
1_I FIS Profile 1�FIRM 1_1 Community Determined L_1 Other (Describe):
B11. Indicate the elevation datum used for the BFE in 69: 1_1 NGVD 1929 1_1 NAVD 1988 1_1 Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1 Yes I UNo
Designation Date:
SECTION C - BUILDING ELEVATION INFOEMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 1_1Construction Drawings* I_IBuilding Under Construction* l_lFinished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number _�_ (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1_1 Yes 1_1 No
❑ a) Top of bottom floor (including basement or enclosure)
41o7-40 . ---t.(m)
❑ b) Top of next higher floor
❑ c) Bottom of lowest horizontal structural member (V zones only)
41e"7. '7 U. ___Urn).
ft.(m)
'i
_
$ o
5
❑ d) Attached garage (top of slab)
_ ft.(m)
w
�p�arms�►
❑ e) Lowest elevation of machinery and/or equipment
.........„..^..........
servicing the building
_ ft.(m)
NN ��Y J.RO�WELL���
❑ f) Lowest adjacent grade (LAG)
ft.(m)
2 .
1597
O g) Highest adjacent grade (HAG)
_
_ ft.(m)
�opess1 Ar
9�
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade
SURO
❑ i) Total area of all permanent openings (flood vents) in C3h
sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, 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.
CERTIFJ�� �Ocv,C LL ,�`�jLICENSE NUMBER¢S.g
TITLE.0 e vz yDle C9yI�Afjl�/C {/ /CQI 'ee c �O• /
ADDRESS L T2� 45�m)e000 %77 1/' STATE 7•SZIP 06
SIGNATURE /O _ /DATE GO TELEPHONE SG
FFMA Fnrm Al .141 Al Jr. RFF PF\/PPCF RIr1F Fr1P r.nNTINl IATIr1N PFPI Ar:FR Al 1 PRF\/lnI IC FIIITIONR
R SURVEY PLAT H
R
LOT 4 BLOCK C OF MADNOLIA PARK AN ADDITION TO THE CITY OF COPPELL, DALLAS COUNTY
TEXAS REC. IN VOL. 98145, PG. 506, P.R.D.C.T.
.... ..................... "R = 593.80'
:.:.:- .... :: ALLEY .. .
.............................. .
-.-.-.•.•... ..........
FND. " X ' x
lo
_ _ S
TRANSFORMER 2.5' UTIL. 30`
C; l
lo
8.7
LOT 4
BLK. Clo
Wo
�o
oO
Z 14.8 IL-
Q�
.!n
00
FORMBOARDS
LOT 5
8.7
9.0
10.3 LOT 3
3 BO .L.
0
c�
lo
R "- 453.80, 25. 6
REFERENT B
N 57°54'03 KING
140 LEVEE PLACE
I hereby certify that on the 12THday of OCT. 2p OO this survey was made on the ground and this survey plat has been prepared as per the field
notes thereby produced, and it properly represents the facts as found on the ground. This survey plat has been prepared in accordance with, and in
substantial compliance with , all rules and regulations promulgated by the Texas Board of Professional Land Surveying. Unless otherwise noted, the
surveyor has relied solely on the record data provided in the title commitment for the determination of the boundaries of the land parcel surveyed and for
any easements of record which may be shown or addressed on the survey. The survey shows viable easements, encroachments, conflicts, or
protrusions apparent on the ground.
r OF
a Date OCTOBER 13, 2000 Q�GI'd'f9� 00-4884
JOH
GF No. HARRY J. ROIIELL
4597
0 LEGEND O Scale: 1"= 20' !�,�..�q
''4 HARRY
1/2" Steel /Iron Rod Found O �S�V%
1/2" Steel / Iron Rod Set 0 - R 0 W E L L
Property Line B y : & Associates. INC.
Wood Fence — . — " — . — —
Surveying & Engineering
Chain Link / hire Fence X—X—X—X—X
1301 Elm Street Ste. 201
Overhead Electric — E— E— E— arrollton, Texas 75006 (972) 242-6879
NJ try
CITY OF COPPELL
REVIMVED
'A A A A 17/�-Aia
DATE
94ypproval of the plans and specNIMIons 3ball not
lie construed to mean construction In direct conflict
.,,ith the My of Coppell Building codes and Zoning
I
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