"Application for Permit to Develop in a Special Flood Hazard Area" - Alabama

Application for Permit to Develop in a Special Flood Hazard Area is a legal document that was released by the Alabama Department of Economic and Community Affairs - a government authority operating within Alabama.

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APPLICATION FOR PERMIT TO DEVELOP IN A SPECIAL FLOOD HAZARD AREA
(Model Permit For Use by Participating NFIP Communities in the State of Alabama)
COMMUNITY: _________________________________
PERMIT NUMBER: ________
The undersigned hereby makes application for a permit to develop in a designated Flood Hazard Area (100 Year
Floodplain). The work to be performed is described below and in attachments hereto. The undersigned agrees that all
such work shall be done in accordance with the requirements of the Flood Damage Prevention Ordinance of
________________________(City/Town/ County) and with all other applicable Federal, State, and local regulations.
Owner or Authorized Agent’s Name: ________________________________________________________
Builder/Contractor’s Name: ________________________________________________________________
Address: ________________________________________________________________________________
Phone and Fax Numbers: __________________________________________________________________
Site Location (include tax parcel identification) ________________________________________________
TO BE COMPLETED BY APPLICANT:
Section A. Description of Work (Check Appropriate Item(s).
1. Proposed Development Description:
2. Type of Construction:
____ Alteration or Repair ____ Manufactured (Mobile)
_____ Accessory Structure ____ Residential
____ Filling
Home Installation
_____ Addition
____ Temporary-
____ Relocation
____ Dredging
_____ Demolition
Structure
____ Grading
____ Subdivision
_____ Non-residential
____ Other -
____ New Construction
____ Water Course Alteration
(Describe)
____ Other (Describe)
_____ Improvement (to existing Structure)
3. Comments: ____________________________________________________________________________
________________________________________________________________________________________
4. NOTE: Applicant understands and agrees that this permit is issued on the conditions and facts described; any
permit may be repealed if conditions or facts change; permit void if the activity has not begun within 180 days of the
issuance date; and the permit will remain valid for one year from date of issuance.
* Section B. Alterations, Additions, or Substantial Damage/Improvements to an existing structure.
1. What is the estimated market value of the existing structure?
$ ______________________.
2. What is the estimated cost of the proposed construction?
$ ______________________ .
3.
If the cumulative cost of the proposed construction in conjunction with any previous improvements during a ten (10)
year rolling period equals or exceeds 50 percent of the market value of the structure then the substantial
improvement/damage requirements apply. (Complete Substantial Improvement /Damage Certification forms).
4.
* If substantially damaged, has Increased Cost of Compliance (ICC) Coverage Checklist been reviewed?
Section C. Site Identification.
1. Is the proposed development in an identified floodway? _____Yes _____ No
2. If the answer to item one, Section C., is yes, has a “No Rise” Certification been completed and attached?
3. What flood zone and panel number appear on the Flood Insurance Rate Map (FIRM) or Flood Hazard Boundary
Map (FHBM) in the proposed development area? ______ Zone
______ Panel Number
4. What is the Base Flood Elevation (BFE) at the site? ______ Feet above Mean Sea Level (M.S.L.)
5. What is the required Lowest Floor Elevation (Including Basement)?_________________________M.S.L.
6. What is the elevation to which all attendant utilities, including all heating and electrical equipment will be
installed or flood proofed? ______ Feet Mean Sea Level (M.S.L.)
7. If the structure is flood proofed, the required floodproofing elevation is ___ feet/foot above BFE (one foot
minimum).
8. Will the proposed development require alteration of any water course? _____ Yes _____ No
9. Is the proposed development in a “V” Zone? If yes, attach completed “V” Zone certification form and insure
propane tanks are anchored and during plans review, insure swimming pools meet FEMA “V” Zone Requirements.
10. Is the proposed development in a Coastal Barrier Resource Area (CBRA) or an Otherwise Protected (Coastal)
Area (OPA). _____ Yes _____ No. If “Yes” Stop. Special provisions are applicable to this area.
Check with the Flood Damage Prevention Ordinance Administrator before proceeding with this application.
Section D. Non-Residential Construction
1. Type of flood protection method used? (Check correct box(es)) _____Floodproofing _____Elevation
NOTE: Appropriate, current FEMA Form Required.
APPLICATION FOR PERMIT TO DEVELOP IN A SPECIAL FLOOD HAZARD AREA
(Model Permit For Use by Participating NFIP Communities in the State of Alabama)
COMMUNITY: _________________________________
PERMIT NUMBER: ________
The undersigned hereby makes application for a permit to develop in a designated Flood Hazard Area (100 Year
Floodplain). The work to be performed is described below and in attachments hereto. The undersigned agrees that all
such work shall be done in accordance with the requirements of the Flood Damage Prevention Ordinance of
________________________(City/Town/ County) and with all other applicable Federal, State, and local regulations.
Owner or Authorized Agent’s Name: ________________________________________________________
Builder/Contractor’s Name: ________________________________________________________________
Address: ________________________________________________________________________________
Phone and Fax Numbers: __________________________________________________________________
Site Location (include tax parcel identification) ________________________________________________
TO BE COMPLETED BY APPLICANT:
Section A. Description of Work (Check Appropriate Item(s).
1. Proposed Development Description:
2. Type of Construction:
____ Alteration or Repair ____ Manufactured (Mobile)
_____ Accessory Structure ____ Residential
____ Filling
Home Installation
_____ Addition
____ Temporary-
____ Relocation
____ Dredging
_____ Demolition
Structure
____ Grading
____ Subdivision
_____ Non-residential
____ Other -
____ New Construction
____ Water Course Alteration
(Describe)
____ Other (Describe)
_____ Improvement (to existing Structure)
3. Comments: ____________________________________________________________________________
________________________________________________________________________________________
4. NOTE: Applicant understands and agrees that this permit is issued on the conditions and facts described; any
permit may be repealed if conditions or facts change; permit void if the activity has not begun within 180 days of the
issuance date; and the permit will remain valid for one year from date of issuance.
* Section B. Alterations, Additions, or Substantial Damage/Improvements to an existing structure.
1. What is the estimated market value of the existing structure?
$ ______________________.
2. What is the estimated cost of the proposed construction?
$ ______________________ .
3.
If the cumulative cost of the proposed construction in conjunction with any previous improvements during a ten (10)
year rolling period equals or exceeds 50 percent of the market value of the structure then the substantial
improvement/damage requirements apply. (Complete Substantial Improvement /Damage Certification forms).
4.
* If substantially damaged, has Increased Cost of Compliance (ICC) Coverage Checklist been reviewed?
Section C. Site Identification.
1. Is the proposed development in an identified floodway? _____Yes _____ No
2. If the answer to item one, Section C., is yes, has a “No Rise” Certification been completed and attached?
3. What flood zone and panel number appear on the Flood Insurance Rate Map (FIRM) or Flood Hazard Boundary
Map (FHBM) in the proposed development area? ______ Zone
______ Panel Number
4. What is the Base Flood Elevation (BFE) at the site? ______ Feet above Mean Sea Level (M.S.L.)
5. What is the required Lowest Floor Elevation (Including Basement)?_________________________M.S.L.
6. What is the elevation to which all attendant utilities, including all heating and electrical equipment will be
installed or flood proofed? ______ Feet Mean Sea Level (M.S.L.)
7. If the structure is flood proofed, the required floodproofing elevation is ___ feet/foot above BFE (one foot
minimum).
8. Will the proposed development require alteration of any water course? _____ Yes _____ No
9. Is the proposed development in a “V” Zone? If yes, attach completed “V” Zone certification form and insure
propane tanks are anchored and during plans review, insure swimming pools meet FEMA “V” Zone Requirements.
10. Is the proposed development in a Coastal Barrier Resource Area (CBRA) or an Otherwise Protected (Coastal)
Area (OPA). _____ Yes _____ No. If “Yes” Stop. Special provisions are applicable to this area.
Check with the Flood Damage Prevention Ordinance Administrator before proceeding with this application.
Section D. Non-Residential Construction
1. Type of flood protection method used? (Check correct box(es)) _____Floodproofing _____Elevation
NOTE: Appropriate, current FEMA Form Required.
Page 2
TO BE COMPLETED BY ADMINISTRATOR/BUILDING DEPARTMENT
Issue No. 4
Section E. Subdivision.
1. Does this subdivision or other development contain 50 lots or 5 acres (whichever is less)? ____ Yes ____ No
2.
* If yes, base flood elevation data must be provided by the developer.
Section F. Administrative:
1. The applicant understands that an on-site inspection is required at the time of completion of the lowest floor
and/or lowest horizontal supporting member is in place.
2. At the time of inspection, a certified Elevation Certificate using a current FEMA Form 81-31 and is required
to be on-site and the original on file in the Inspection Department Office.
3.
If for any reason elevation does not comply with the required height above BFE (Base Flood Elevation)
alterations will be required to be made before continuing construction.
4. A Final Inspection is required on the structure after the building is completed and ready for occupancy.
The benchmark is to be left on site until the development is completed at that location.
5. Provide “As Built” Floodproofing certification, if required, by a registered professional engineer.
6. Applicant is responsible for acquiring (required and approved) Local, State, or Federal permits prior to
the start of construction.
7. Comments: (Attach additional comments if necessary) ___________________________________
Section G. Attachments: (Check and provide all that apply)
 Site Plan required showing buildings and improvements, flood zones, base flood elevation (a completed FEMA
Elevation Certificate is required for each structure).
 Building floodproofing (FEMA Floodproofing Certificate required) plans certified by registered architect or
professional engineer. (Required for non-residential floodproofing in lieu of Elevation Certificate).
 Building elevation plans by registered architect or professional engineer (required for elevated construction).
 * An “Approximate” zone elevation determination by professional land surveyor or registered professional
engineer and submitted on a FEMA Elevation Certificate. Exhaust all resources (TVA, USACE, ALDOT, etc..) to
establish BFE for areas where Base Flood Elevation has not been determined by FEMA.
 “No-Rise/No-Impact” certification by registered professional engineer. (Required for development in floodway
to include hydraulic and hydrologic analyses supported and submitted on FEMA Form MT-2).
 “V” Zone Certification by registered professional engineer. (Required for coastal construction in areas
identified on FIRM as Zone V, VE, or V1-30).
 * Complete Increased Cost of Compliance Coverage Checklist, if applicable, and attach to this permit.
I, the undersigned, understand that I must comply with the _______________________ (City/Town or County)
Flood Damage Prevention Ordinance (Resolution) and all applicable Local, State, and FEMA regulations. In
.
addition, permanent electrical service will not be energized until all provisions are compliant
Applicant’s Signature: ___________________________________________ Date: ________________________
Local Administrator’s Signature: ___________________________________ Date: ________________________
______________ APPROVED
______________ DENIED
_______________CONDITIONAL
COMMENTS RELATING TO CONDITIONAL APPROVAL: (Attach additional comments if necessary)
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