FEMA-EC961004The City With A Beautiful Future
L77 3Y
BUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Manner
Job Address:Z2)�W
Date: q _ 1�
Lot: If) Block: Subdivision: Ptj\Y1A1SjLAS OFCbpt-r- I 1 -Phase or Section Number: I
Owner
Address:
Phone #:
Contractor. � � }� Address: B T CF` Phone #: Lf
Description of Work to be Done 1 1 Class of Work: XNew El Addition ❑ Alteration ❑ ❑DDemolition
Repair emolition
NELS) :S MG LE F7" l LY
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.
I
/r
U M.B. NO, 30670077
ELEVATION CERTIFICATE E xpir es May 31, 1996
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does riot provide a waiver of life Ilood insurance purchase requirement This form is used only to
provide elevation inlormatton 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
BUILDING OWNER'S NAME POLICY NUMBER
STREET ADDRESS (Including Apt., Unit. Suite and/or Bldg Number) On PO. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
-- 605_7 We5-t _Aeni"n 5u�a_. �/`r`ve---------------
OTIIER DESCRIPTION (Lot and Block Numbers, e1c )
Lnf %tie Peti im:5v,1 o� _pe
CITY Cppe I I T)( STATE ZIP CODE
�
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
I COMMUNITY NUMBER
'180
2 PANEL NUMBER
3 SUFFIX
1 4 DATE OF FIRM INDEX
S FIRM ZONE
X
6 BASE FLOOD ELEVATION
(in AO Zones, use depth)
3 o
.
'. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): [ANGVD '29 [ -I Other (describe on back)
3. For Zones A or V, where no BFE is provided On the FIRM, and the community ties established a BFE for this building site, indicate
the community's BFE: 11 - I.- L.I. I.1 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 IIIe diagrams found on Pages 5 and 6 that best
describes the subject building's reference level J _
2(a). FIRM Zones Al -A30, AE, AI4, and A (with BFE). Tlie lop of the reference level floor from the selected diagram is at an elevation
of 1A. -A I-I.Iq feel NGVD (or other FIRM dalum-see Section B, Item 7).
(b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of life reference level from
the selected diagram, is at an elevation of [. L. 1. - I- 1_ 1. 1 - I feel NGVD (or other FIRM dalum-see Section B, Item 7).
(c). FILM Zone A (without BFE). The floor used as the reference level from the selected diagram is UJLJ feet above U 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 _11 - I feel above I-.) or below 11 (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? IJ Yes [_I No IJ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: IXXNGVD'29 I-1 Other (describe
under Comments on Page 2). (NOTE: If the elevation datum used in measuring lire elevations is different than that used on
the FIRM (see Section B, Item 71, then convert the elevations to life datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation referencb mark used appears on FIRM: ❑ Yes [A No (See Instructions on Page 4)
5. The reference level elevation is based on: I_,;�raclual construction r1 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 fife building during IIIe 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: S.feet NGVD (or other FIRM datum -see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
I. II the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is riot the "lowest floor" as delined in the community's floodplain management ordinance, life elevation of the building's "lowest
floor" as delined by the ordinance is: 1, I I _ L. I- 1. I ! feet NGVD (or other FIRM datum -see Section B, Item 7).
?. Dale of the start of construction or substantial improvement
fEMA Form 81-31, MAY 93 REPLACES ALL. PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONf1NUATION
I
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by stale or local law to certify elevation
information when the elevation information for Zones Al -A30, AE, All, A (with SFE),VI-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
ce►tilicalion. In the case of Zones AO and A (without a FEMA or community issued 8FE). a building official, a properly owner, or an
owner's representative may also sign the cerlilicalion.
Reference level diagrams 6, 7 and 8 - Distinguishing Fealures-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 Fealure(s), then list the Fealuie(s) not
included in the certification under Comments below. The diagram number, Section C. Item 1, must still be entered.
I certify #hat file information in Sections B and C on this certificate represents my best efforts to interpret (lie data available.
I understand that any false statement may be punishable by line or imprisonment under t8 U.S. Code, Section 100 f.
,70Ilevx 12cc,p RilCS 4 SI
CERTIFIE 'S NAME LICENSE NUMBER for Affix Seal)
CANQAIAIECQ_—.SFrey(cES
TI1LE COMPANY NAME �11 � S �� � � � r yjO
_
S'7 _Z 6 L B� �� e e e Z to
ADDRF11Y STATE ZIP
SIGNATURE r• DATE PHONE
INY '� j :N
�o1ri�1 II official, 2) Insurance agent/company, and 3) building owner.
Copies should be made of this Ce �"a8S1 y
COMMENTS: % A t S UeUA. I _-
ff r 1
(1►f? _—lCzy`e �4 S i7o Cl C �� S /dc Tvlt ��C%Spin _ . % �� Fhe/V
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Ah--_�".—��5��oe� Ley i 5 /rs2fa� D Cc
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t
WITH
ON PILES,
ON
BASEMENT
PIERS. OR COLUMNS
SLAB
A
A v
A v
ZONES
ZONES ZONES
ZONES ZONES
,
REFERENCE
REFERENCE
REFERENCE eASE
FLOOD
IEVEI
LEVEL
LEVitWa
ELEVATION
—LA-LAM.
BASE
BASE - ADJACENT :Rf FERENCE
F000
ELEVATION
FLOOD GRADE LEVEL
ELEVATION REFERENCE AOJACENt A.
LEVEL GRADE
..
(iY! moi:::..: ri•:
Ii: 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 lop of the reference level floor.
Elevations for all V Zones should be measured at the bottom of file lowest horizontal structural mernber.
Page 2
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12' DRAINAGE ESMT.
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68.58'
4' CONC. WALK 10' CONC. DRIVE 7.5' UTILITY ESMT.
PERRY HOMES DESIGN
• — 1996 — PERRY HOMES"
ARCHITECTURE & INTERIORS
T PENINSULA DRIVE
05 OA
\PtNINSULAS OF COPPELL
COPPELL, TEXAS
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