FEMA-EC980128�u >1 L
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The City With A Beautiful Future BUILDING PERMIT APPLICATION n r, 2 9 1997
Print or Type in a Clear, Legible Manner _--------
Job Address: 7,2 8 Z e X 12 q &o ru Vjf M-* 2l0 90-3 'N
Date: � e', C P. IM
Lot: 020 Block: l� Subdivision:sumrn�t �t Rin Phase or Section Number:
Owner Address:100, BOK 136 Co'01pe11 Phone#: 972_393-.2076
Contractor: snm le, Address: Phone #:
Description of Work to be Done Class of Work: 50 New ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
Area of Building in Square Feet
First Floor -5` 8
Second Floor I'M
NOTICE
Garage -7%n
Other 4
finim `f l -o 6
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.
Signature of Conlractor or Authorized Agent Print Name
Electrical Contractor Plumbing Contractor Mechanical Cont actor
FPMC - 1 (4/94)
Value of Work � 60
to be Performed -S6 t7. QQX 60
—
A
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
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III SURVEY PLAT
LOT 20 BLOCK C OF THE SUMMIT AT THE SPRINGS PHASE 1 AN ADDITION
TO THE CITY OF COPPELL, TEXAS, REC. IN VOL.. 97023, PG. 3493,
M. R. D. C. T.
9 28°51-26„ W 6.54 R = 275
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LEXINGTON AVENUE
1 1 hereby certify that. on thel_�)Irllday of FEB. , 19_ � , this survey was made on the ground as per the field notes shown on this survey
I.i and is true, correct, and accurate as to the dimensions of the subject property and size, location and type of buildings and improvernents thereon,
{ if any. The survey shows all easements and visible easements ofwhich I have knowledge or have been advised affecting the subject property.
There are no encroachments, conflicts, or protrusions visible on the ground other than those shown.
/ OF
Ilat e FI;RRITARY 10, 19911 /�SctsT£RFoay\
n IC)R 98-1302
.......
/ HARRY J. ROW F. LL
GF No. \ X597
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I,EGI"NI) Scale: 1" _ 30' �tid URV 1-1AU)RY
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1/2" Stpel Iron Rod Found O A / %�
I /2" Sled /Iron Rod Set I% 0 T W E AJ I J
Property Line y
Wood Fence �,�,� V & Associates. INC
Surveying Fc Engineer
Chain Link / Wire Fence u---X--X—X---x —
n 1301 Flrn Street Ste. 201
YII
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.
BUILDING OWNER'S NAME
SECTION A PROPERTY INFORMATION I FOh INSURANCE COMPANY USE I
POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER I COMPANY NAIC NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
Z- o 7' .Z O ,, .G oe e/ ,*f -W /T IV T 7'11 SP/�i.✓G S
CITY STATE ZIP CODE
CdPP.CGL . TX.
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)
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 U. U 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 Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of 1___1.__ 141. * feet NGVD or other FIRM datum—see Section B, Item 7 .
OV -0r,45.' .EGEK -510-9-4 w.lvs TiyX 6N
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le"i(b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
Qthe selected diagram, is at an elevation of I 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 Ii.0 feet above ❑ or
o, 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 .0 feet above ❑ or below ❑ (check
444 one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
ll 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: ❑ NGVD '29 ❑ Other (describe
u 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: ❑ Yes KNo (See Instructions on Page 4)
5. The reference level elevation is based on: Zactual 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 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.
1 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.
CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal)
TITLE COMPANY NAME
ADDRESS CITY STATE ZIP
1341 el -W, 6 rge,-- 77 TX. 7 scot
SIGNATURE DATE PHONE
/-Zy-9g . ( 972) 247 -- Se. '72
Copies should be made of this Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owner.
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