Fillable Application No. Building Permit progress. right at home. (City of Norfolk Nebraska)

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Application No. Building Permit progress. right at home. (City of Norfolk Nebraska)

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U.S.A. forms for City of Norfolk Nebraska

BROWSE CITY OF NORFOLK NEBRASKA (NE) FORMS

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progress. right at home.
Rev. 4-2019
Planning & Development
309 N 5
th
St
Norfolk, NE 68701
P402-844-2280 F402-844-2028
www.ci.norfolk.ne.us
Application
No.
Building
Permit
No.
Date:
TO THE ZONING/BUILDING ADMINISTRATOR: The undersigned hereby makes application for a permit to develop in a
flood plain. The work to be performed, including flood plain protection works, is as described below and in attachments
hereto. The undersigned agrees that all such work shall be done in accordance with the requirements of the
Flood Plain Management Ordinance and with all other applicable county/city ordinances and the
laws and regulations of the State of Nebraska.
Owner or Agent Date Builder Date
Address Address
Telephone:
Telephone:
1. Location: 1/4, 1/4, Section , Township , Range __
Street
Address:
2. Type of Development
Filling _____ Grading _____ Excavation _____ Routine Maintenance _____
Minor Improvement_____ Substantial Improvement_____ New Construction_____
3. Description of Development: __________________________________________
4. Premises: Size of site _____ft. x _____ft. Area of site: ___________________
Estimated cost: $____________ Principle Use: __________________________
Accessory uses (storage, parking, etc.) __________________________________
5. Addition or modification to nonconforming use? Yes No
Assessed value of structure: $ _____________
progress. right at home.
Rev. 4-2019
Planning & Development
309 N 5
th
St
Norfolk, NE 68701
P402-844-2280 F402-844-2028
www.ci.norfolk.ne.us
6. Property located in a designated Floodway (FW District)? Yes No
IF ANSWERED YES, CERTIFICATION MUST BE PROVIDED PRIOR TO THE ISSUANCE OF A PERMIT TO
DEVELOP THAT THE PROPOSED DEVELOPMENT WILL RESULT IN NO INCREASE IN THE BASE
FLOOD (100-YEAR) ELEVATION.
7. Property located in a designated Floodway Fringe (FF or FP District)? Yes No
a. Elevation of the Base (100-year) Flood ft., NGVD
b.
Elevation/floodproofing
requirement ft., NGVD
c. Elevation of the proposed development ft., NGVD
d. Elevation of top of finished floor ft., NGVD
THIS PERMIT IS ISSUED WITH THE CONDITION THAT THE LOWEST FLOOR (INCLUDING BASEMENT FLOOR)
OF ANY NEW OR SUBSTANTIALLY IMPROVED RESIDENTIAL BUILDING WILL BE ELEVATED 1.0 FT. ABOVE
THE BASE FLOOD ELEVATION. IF THE PROPOSED DEVELOPMENT IS A NON-RESIDENTIAL BUILDING, THIS
PERMIT IS ISSUED WITH THE CONDITION THAT THE LOWEST FLOOR (INCLUDING BASEMENT) OF A NEW
OR SUBSTANTIALLY IMPROVED NON-RESIDENTIAL BUILDING WILL BE ELEVATED OR FLOODPROOFED 1.0
FT. ABOVE THE BASE FLOOD ELEVATION.
8. Source of Base Flood Elevation Data if not available on FIRM: __________________________
Panel number of FIRM: _______________
9. Other permits required?
Corps of Engineers 404 Permit: Yes No
Nebraska Department of Natural Resources: Yes No
Other: ____________________________________________________________
progress. right at home.
Rev. 4-2019
Planning & Development
309 N 5
th
St
Norfolk, NE 68701
P402-844-2280 F402-844-2028
www.ci.norfolk.ne.us
Compliance with all provisions of the City of _____________________, Flood Plain
Management Ordinance No. ___________________ shall be made.
S E A L
__________________________________
Registered Land Surveyor or Registered Engineer
THIS PERMIT IS ISSUED WITH THE CONDITION THAT THE DEVELOPER/OWNER WILL PROVIDE
CERTIFICATION BY A REGISTERED ENGINEER, ARCHITECT, OR LAND SURVEYOR OF THE “AS-BUILT”
LOWEST FLOOR (INCLUDING BASEMENT) ELEVATION OF ANY NEW OR SUBSTANTIALLY
IMPROVED BUILDING COVERED BY THIS PERMIT.
Plans and specifications approved this day of , 20 .
Signature of Developer/Owner Authorizing Official
______________________________
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Application No. Building Permit progress. right at home. (City of Norfolk Nebraska)

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Completed 10 November 2021

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