FEMA-EC000207The City With A Beautiful Futuro BUILDING PERMIT APPLICATION
Print or type In a Clear, Legible Manner
Job Address: T/14� Date:
Lot: Block: /e Subdivision: z a /J� �_ Phase or Section Number:
Owner Address: J�ol ,/ Phone 7fe
✓ x Qs -• /ctJ
Contractor: / `�S Address:tco S -o3 Phone #:
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Description of Work to be Done Class of Work: 2 -New ❑ Addition ❑ Alteration ❑Repair ❑ Demolition
Area of Building in Squares Feet
First Floor �p/ Garage Value of Work
c, to be Perfored ��
mdn <D
Second Floor Other
FPMC - 1 (4/94)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
ELEVATION CERTIFICATE O.M.B. No. 3067-0077
FEDERAL EMERGENCY MANAGEMENT AGENCY Expires July 31, 1999
f 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 prd-
vide 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). You are not
required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form.
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE
POLICY NUMBER I
Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
nr�l�ki D II IOt �t al#Blxk Numbers, etc.)
0
STATE ZIP CODE
Taxa S
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): U NGVD '2s IJ Other taescnoe vn oder,)
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: 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 suhject 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 I I IW1512 .�8 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 I I II ❑.❑ 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 L—J . U 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 .0 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: ❑ 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: ❑ Yes ❑ No (See Instructions on Page 4)
5. The reference level elevation is based on: ❑ actual 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: 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 I .❑ feet NGVD (or other FIRM datum—see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAR 97 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
1. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE OF FIRM INDEX
5. FIRM ZONE
6' din AO Zonnes,, use ASE FLOD Edept ON
L
'ri 8a 1 70
0010
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): U NGVD '2s IJ Other taescnoe vn oder,)
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: 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 suhject 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 I I IW1512 .�8 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 I I II ❑.❑ 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 L—J . U 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 .0 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: ❑ 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: ❑ Yes ❑ No (See Instructions on Page 4)
5. The reference level elevation is based on: ❑ actual 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: 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 I .❑ feet NGVD (or other FIRM datum—see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAR 97 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
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) 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-
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list t •
included in the certification under Comments below. The diagram number, Section C, Item 1, must still be enter
I certify that the information in Sections 8 and C on this certificate represents my best efforts to interpret the d •• ••.•�••'••
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Sectio 4M VALME
• .......•.....fit..,
5190-,.
CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal)
TITLE COMPANY NAME '
flPor Sler&O/ JPf'0;e_S51Qn)a.Iiaryd Stiryr-yor Ro(vM SrwPU1 Vy)uo _A) C'_
ADDRIEbS CITY TATE ZIP
GLI I e6lltvaa rvo %So7
SIGNAT E DATEPHONE
OD
Copies sho d be made of this Certificate 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
FRE FERENCELEVEL
BASE
LEVEL FLOOD
REFERENCE I
LEVEL
ELEVATION
BASE
BASE
ADJACENT:: REFERENCE
FLOOD GRADE LEVEL
FLOOD
ELEVATION
ELEVATION IREFERENCEI ADJACENT
LEVEL GRADE
ADJACENT.::
m
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
PROPERTY DESCRIPTION
,Address! 626 Stratford Lane Lot 7 Block B of Stratford Manor, an addition,to the City of Coppell, Dallas County, Texas, according to the plat -
thereof recorded in Volume 99167, Page 28 of the Map Records of Dallas County, Texas.
Lot 8
CM
I/YIRF S89'38'1 6!' E 181.14' c
lbM Pod d d
O O N
I 57.5
Q 62.35 -C
04 a
1
m O
? V aid C
' 20.83 +
O J 4 0)
I
0) �
r N I
Ln
Lot 7
I
p 0' 33.55 Forms Only o ,q
03 T.O.F.=458.88' 4 3
I
32.2 25.5 Grade=458.05' `� U
1
3075
N o
32.253.65 `r 1 0)
p
I 0,
51.0 0 : I v
30.8
W
I
M
l '/ 'RF N89'38-16 W 169.56'
Lot 6
NOTES: (1) Source bearing is based on recorded plat unless otherwise noted. (2) Drainage arrows, if shown, were determined by elevations shown
hereon. (3) (CM) = Controlling monument. (4) Surveyor's seal will appear with red ink on certified copies.
CERTIFICATION
On the basis of my knowledge, information and belief, I certify to Modsor Homes that as a result of a survey made on the ground to the normal
standard of care of Registered Professional Land Surveyors practicing in the State of Texas, I find the plat hereon is true, correct, and accurate as to
the boundaries of the subject property, and if shown, location and type of buildings and visible improvements hereon, if any, and correctly shows the
location of visible easements and rights-of-way and other matters of record which are shown on the recorded plat or are a part of a title
commitment/survey request. Except as shown on the survey there are no encroachments or protrusions of visible improvements.
Scale: 1"=30 Date: 2/7/2000 Revised: Job No. 000170
Title commitment/Survey Request File No. dated
G rEq 9
ROOMS SURVEYING, INC.
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2000 AVENUE G
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SUITE 804
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PLANO, TX 75074
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Phone Number (972) 423-4372 Fax Number: (972) 423-7523