FEMA-EC980120 (3)The City WithABeautiful Future BUILDING PERMIT APPLICATION On 1 t,; 1997'
9
Print or Type in a Clear, Legible Manner
1
Job Address: I VIA21Q„ (� Date: j �0,1 �fz.-r I d
Lot: Block: Subdivision: �, 2C ,1 Phase or Section Number:
Owner �i �� Address: ��Q , �1 n Phone #:
contractor: a cn Address: Phone #:
N Description of Work to be Done 1 Class of Work:Vew ❑ Addition ❑ Alteration ❑ Repair p El Demolition
12lml
Area of Building in Square Feet
First Floor 00
Second Floor
NOTICE
Garage ��_ e Value of Work �� �(J�,`t�D
to be Performed J -�
Other % � D '
GRAY AREA FOR OFFICE USE ONLY
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 constructionZZ
of construction.
Signature of Contractor or Authorized Agent Print Name
--lr (� amctK 9, ,r
Electrical trontractor Plumbing Contractor Mechanical Contractor
FPMC - 1 (4/94)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
O.M.B. NO. 3067-0077
' ELEVATION CERTIFICATE Expires May 31.1996
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.
SECTION A PROPERTY INFORMATION
BUILDING OWNER'S
STREET ADDRESS (Including Apt., Unit, She and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
-- LJAJ Ad
----
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
i_ ,tip 3i . ONI , .I` I�Z t W rFa2. Y� &LAZ 91,:r s
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):
1. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE OF FIRM INDEX 5. FIRM ZONE
6. BASE FLOOD ELEVATION
A
(in AO Zon s, use depth)
4?
4W/ 70
o&zZIS'I
7. Indicate the elevation datum system used on the FIRM for Base/Flood Elevations (BF€Klished
GVD '29 �_� Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has esta a BFE for this building site, indicate
the community's BFE: L]_L 11 -].LJ 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 __I .
2(a). FIRM Zones
At-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of LL %I.11 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 L L LIL] .1.-_1 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 LLQ . LJ feet above LJ or
below i (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 Ll --LLJ 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? 1_1 Yes L ] No [_1 Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: ❑ NGVD '29 L] 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 71, 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 LI No (See Instructions on Page 4)
5. The reference level elevation is based onllyv
ctual construction L] construction drawings
(NOTE: Use of construction drawings islid 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: LL_CT_L7117_I.1.f] 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 l-
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: Ll_LL1-1 . Ll fc-et NGVD (or other FIRM datum—see Section B, Item 7).
?. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
r—, 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-breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) rot
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.
1 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)
E)AYf �>_ (AQ C%l 5"ttN
TITLE COMPANY NAME
-� -->4C-.(%D,,2 (f1 /01
ADDRESS
CITY
Copies should be made of this Certificate for: 1) community official, 2) insurance agenVcompany, and 3) building owner.
ZIP
ON WITH ON PILES,
SLAB BASEMENT PIERS, OR COLUMNS
A V A A V
ZONES ZONES ZONES ZONES ZONES
REFERENCE
REFERENCE BASE LEVEL
REFERENCE
LEVEL FLOOD
LEVEL
ELEVATION
"'
BASE
BASE .., ADJACENTREFERENCE
FLOOD
FLOODELEVATION
GRADE LEVEL
ELEVATION REFERENCE ADJACENT
LEVEL GRADE
y
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 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
SURVEY PLAT OF
•IYO ALL PARTIES INTERESTED IN PREMISES SURVEYFI):
Registered Profession and Surveyor, do hereby certify-baLLCWful w vev was made of the ground this date under my su si ' n of the foltnvstng described propem.
Jeul
and there are encroachments upin the adjoining property or the adjoining improvement, upon the described property kniun as
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109 SUNK-1SE 13RIVE nP�4t�•
STATE OF TEXAS 911 A 1
COUNTV OF TARRANT
"To the Lienholders and/or the Owners of the Premises surveyed and to FLOOD NOTE: 1 hereby certify that the property described herein
--- within a special flood hazard area as identified by the
The undersigned does hereby certify that this survey was this day made Federal Insurance Administration, Department of Housing and Urban
on the ground of the property legally described hereon and is correct, and that Development, the flood hazard arca being identified as
there are no discrepancies. Conflicts• shortages in arca, boundary line conflicts, — of the Federal Insurance Administration Flood Hazard
encroachments, overlapping of improvements, visible lines or roads in place, Boundary Map effective on
except ns shown hereon, and that said property has access to and from a — --
dedicated madwny except ns shown hereon." for the_ -
Dated:
tJy: ---- - - --- ---
FIASfS FOR RFARING: AP SURVEYING CO.
Otdcr Nn. David Pollard RPS M1518
— — 1003 Central Drive, Suite 309
Nor FOR CONSTRUCTION 1901
TX 76021 Metro (817) 267.1249
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Arlington, Texas Metro 817-'2-61-4121 FAX 817 214 4711
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