APPLICATION FOR PERMIT
TO DEVELOP IN A
FLOODPLAIN AREA
Address of Proposed Development:
Name of Owner: Telephone:
Address: e-mail:
Telephone:
e-mail:Address:
Design Professional:
Telephone:
e-mail:Address:
Builder:
A. DESCRIPTION OF WORK:
New Building
Manufactured Home
Improvement to Existing Building
Filling
Other
Estimated Cost of Proposed Development:
3. Per the Floodplain Insurance Rate Map (FIRM), what is the zone and panel number of the parcel
where the proposed development will take place?
Zone Panel
1. Proposed Development Description:
2. Please provide one seperate copy of site plan and specifications for this application.
Yes No
NoYes4. Is any part of the proposed development in the floodplain?
5. Is any part of the proposed development in the floodway?
(street) (zip)
Page 1 of 3
NoYes3. Is there a non-conversion agreement?:
B. COMPLETE FOR NEW CONSTRUCTION:
1. Base Flood Elevation at the site:
feet NGVD.
2. Required lowest floor elevation (including basement):
feet NGVD.
3. Elevation to which all attendant utilities, including all heating and
electrical equipment will be protected from flood damage:
feet NGVD.
C. COMPLETE FOR ALTERATIONS, ADDITIONS OR IMPROVEMENTS TO EXISTING
STRUCTURES:
1. What is the estimated market value of the existing structure?
2. What is the cost of the proposed construction?
3. If the cost of the proposed construction equals or exceeds 50 percent of the market value of the
structure, then the substantial improvement policy will apply.
D. COMPLETE FOR NON-RESIDENTIAL FLOODPROOFED CONSTRUCTION:
1. Must attach floodproofing details and specifications.
feet NGVD.
2. The required flood proofing elevation is
3. Flood proofing certification by a registered engineer is attached:
Yes No
E. COMPLETE FOR SUBDIVISIONS AND PLANNED UNIT DEVELOPMENTS:
1. Will the subdivision or other development contain 50 lots or 5 acres? NoYes
2. If yes, does the plat or proposal clearly identify base flood elevations?
3. Are the 1% Floodplain and Floodway delineated on the site plan?
Yes No
Yes No
Page 2 of 3
Yes4. Is there proper flood venting in the foundation?:
4. Is there proper flood venting in the foundation?:
Yes
N/A
N/A
GENERAL PROVISIONS (Applicant - read thoroughly, sign, and date)
1. No work may begin until a permit is issued.
2. The permit may be revoked if any false statements are made herein.
3. If revoked, all work must cease until permit is re-issued.
4. Certificates of Occupancy for new development will not be issued until conditions of this permit are met.
5. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local, state, and federal regulatory
requirements.
7. Applicant hereby gives consent to the City of Morgantown regulatory departments to make reasonable inspections
required to verify compliance.
8. The flood hazard boundary maps and other flood data used the the City of Morgantown in evaluating flood hazards
to proposed developments are considered reasonable and accurate for regulatory purposes and are based on the best
available scientific and engineering data. On rare occasions, greater floods can and will occur and flood heights may
be increased by man-made and natural causes. Issuance of an exemption certificate does not imply that developments
outside the identified areas of special flood hazard will be free from flooding and flood damage. Issuance of an
exemption certificate shall not create liability on the part of the City of Morgantown or any officer and employee of
the same in the event flooding or flood damage does occur.
9. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS
APPLICATION ARE, TO THE BEST OF MY KNOWLEDGW, TRUE AND ACCURATE.
Date:Applicant Signature:
7. Local Administrator Signature:
5. Work Inspected by:
Date:
4. Elevation Certificate Attached: Yes No
3. As-Built lowest floor elevation:
feet NGVD.
2. Is "NO Rise Certification" and supporting data attached? Yes No
1. Are other Federal, State, or local permits required?
ADMINISTRATIVE USE ONLY
Page 3 of 3
6. Permit Approved: Yes No (statement attached)
Note: