"Floodplain Development Permit Application" - Town of LaGrange, New York

Floodplain Development Permit Application is a legal document that was released by the Building, Zoning and Fire Prevention Department - Town of LaGrange, New York - a government authority operating within New York. The form may be used strictly within Town of LaGrange.

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TOWN OF LAGRANGE
120 Stringham Road, LaGrangeville, New York 12540
Tel. No. (845) 452-2046
FLOODPLAIN DEVELOPMENT
PERMIT APPLICATION
NO. __________
IDENTIFICATION OF APPLICANT:
APPLICANT NAME
PHONE ________________________
ADDRESS _______________________________________________________________________________________________
TYPE OF DEVELOPMENT PROPOSED
[
] Residential Structure(s)
Number of Structures _____
Number of stories per structure* __________________
Basement: [ ] Yes
[ ] No
Number of dwelling units per structure ___________
[ ] Non-Residential Structure(s)
Number of Structures
Number of stories per structure*
Basement: [ ] Yes
[ ] No
Type of Structure ___________________________________________________________________
(commercial, industrial, etc.)
Will structure(s) be flood proofed?
[ ] Yes
[ ] No
[ ] Other (specify) _____________________________________________________________________
_______________________________________________________________________
LOCATION OF PROPOSED DEVELOPMENT
Street Address ______________________________________________________________________
Lot & Block No. _____________________________________________________________________
Other Description (attach plans in duplicate showing location, dimensions and elevation
of area in question; existing or proposed structures; fill; storage or materials, drainage
facilities).
TOWN OF LAGRANGE
120 Stringham Road, LaGrangeville, New York 12540
Tel. No. (845) 452-2046
FLOODPLAIN DEVELOPMENT
PERMIT APPLICATION
NO. __________
IDENTIFICATION OF APPLICANT:
APPLICANT NAME
PHONE ________________________
ADDRESS _______________________________________________________________________________________________
TYPE OF DEVELOPMENT PROPOSED
[
] Residential Structure(s)
Number of Structures _____
Number of stories per structure* __________________
Basement: [ ] Yes
[ ] No
Number of dwelling units per structure ___________
[ ] Non-Residential Structure(s)
Number of Structures
Number of stories per structure*
Basement: [ ] Yes
[ ] No
Type of Structure ___________________________________________________________________
(commercial, industrial, etc.)
Will structure(s) be flood proofed?
[ ] Yes
[ ] No
[ ] Other (specify) _____________________________________________________________________
_______________________________________________________________________
LOCATION OF PROPOSED DEVELOPMENT
Street Address ______________________________________________________________________
Lot & Block No. _____________________________________________________________________
Other Description (attach plans in duplicate showing location, dimensions and elevation
of area in question; existing or proposed structures; fill; storage or materials, drainage
facilities).
1.
Describe the work to be covered by the permit for which the application is made.
2.
Indicate the use or occupancy for which the proposed work is intended.
3.
Provide the proposed elevation, in relation to mean sea level, of the lowest floor (including
basement or cellar) of any new or substantially improved structure to be located in Zones
A1 – A30, AE or AH, or Zone A if base flood elevation data are available.
4.
Provide the proposed elevation, in relation to mean sea level, to which any new or
substantially improved non-residential structure will be floodproofed.
5.
Provide a certificate from a licensed professional engineer or architect that any utility
floodproofing will meet the criteria in Section 45-16 (C), Utilities of the Town Flood
Damage Prevention Code.
6.
Provide a certificate from a licensed professional engineer or architect that any non-
residential floodproofed structure will meet the floodproofing criteria in section 45-18,
“Non-Residential Structures”.
7.
Describe the extent to which any watercourse will be altered or relocated as a result of
proposed development. (Computations by a licensed professional engineer must be
submitted that demonstrate that the altered or relocated segment will provide equal or
greater conveyance than the original stream segment.)
Applicant Engineer: __________________________________
Date:
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