Fillable CITY OF TOMBALL FLOODPLAIN DEVELOPMENT PERMIT APPLICATION SECTION (City of Tomball)

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CITY OF TOMBALL FLOODPLAIN DEVELOPMENT PERMIT APPLICATION SECTION (City of Tomball)

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PERMIT NO. __________
Issued 7/13/09 Page 1 of 4
CITY OF TOMBALL
FLOODPLAIN DEVELOPMENT
PERMIT APPLICATION
SECTION 1: General Provisions (APPLICANT to read and sign)
1. No work of any kind may start 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. Development shall not be used or occupied until a Certificate of Compliance and/or Occupancy is issued.
5. The permit will expire if no work or construction is commenced within six (6) months of issuance, or if construction or work
is abandoned for a period of six (6) months at any time after work is commenced.
6. Applicant is hereby informed that other permits may be required to fulfill local, state, and federal regulatory requirements.
Separate permits are required for building, electrical, plumbing, heating, ventilation or air conditioning.
7. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not.
8. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law
relating to construction, nor does it give authorization or approval to encroach on any easement or property or violate any
deed restrictions.
9. The City of Tomball shall never be liable for any damage or loss by reason of the issuance hereof.
10. Each holder and other persons acting under authority of this permit are personally responsible for compliance with all the
above provisions and assume the entire risks incidental to the work being permitted.
11. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required
to verify compliance.
12. THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS
APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE.
APPLICANT’S SIGNATURE ___________________________________________________ DATE _______________
APPLICANT’S NAME (In Print) _________________________________________________
SECTION 2: Proposed Development (To be completed by APPLICANT)
OWNER INFORMATION: ____________________________________________________________________________________
STREET ADDRESS: ________________________________________ CITY ________________STATE: ______ ZIP: ________
PHONE NUMBER: _____________________ EMAIL: _____________________________________________________________
ENGINEER INFORMATION: _________________________________________________________________________________
STREET ADDRESS: ________________________________________ CITY ________________STATE: ______ ZIP: ________
PHONE NUMBER: _____________________ EMAIL: _____________________________________________________________
ARCHITECT INFORMATION: ___________________________________________________________________
STREET ADDRESS: ________________________________________ CITY ________________STATE: ______ ZIP: ________
PHONE NUMBER: _____________________ EMAIL: _____________________________________________________________
CONTRACTOR INFORMATION: _____________________________________________________________________________
STREET ADDRESS: ________________________________________ CITY ________________STATE: ______ ZIP: ________
PHONE NUMBER: _____________________ EMAIL: _____________________________________________________________
PROJECT LOCATION:
To avoid delay in processing the application, please provide enough information to easily identify the project location. Include an area
map with the project location identified.
Project Title: ________________________________________________________________________________________________
Project Address: _____________________________________________________________________________________________
Subdivision (If applicable): _________________________________ Legal Description: ___________________________________
Lot No.: ____________________________ Block: _______________________________ Tract: ____________________________
Revised 10/1/2015
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PERMIT NO. __________
Issued 7/13/09 Page 2 of 4
DESCRIPTION OF WORK (Check all applicable boxes):
A. STRUCTURE TYPE
ACTIVITY STRUCTURE TYPE
New Structure Residential (Single Family)
Addition Residential (Duplex)
Alteration Residential (Multi-Family)
Relocation Non-Residential
Replacement Floodproofing
Demolition Combined Use (Residential & Commercial)
Manufactured Home (Single Lot)
Manufactured Home (Manufactured Home Park)
ESTIMATED COST OF PROJECT $___________________________________
B. OTHER DEVELOPMENT ACTIVITIES
Clearing Filling Mining Drilling Grading
Excavation (Except for Structural Development Checked Above)
Watercourse Alteration (Including Dredging and Channel Modifications)
Drainage Improvements (Including Culvert Work)
Road, Street, or Bridge Construction
Subdivision (New or Expansion)
Utility Extensions (Water, Sanitary, and Gas)
Individual Water or Sewer System (If allowed by Ordinance)
Other (Please Specify) __________________________________________________________________
DESCRIPTION: ___________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
FLOODPLAIN DETERMINATION
SECTION 3: Floodplain Determination (To be completed by the Local Administrator)
The proposed development is located on FIRM Panel No. _____, Dated ___________.
The Proposed Development:
Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete
and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
Is partially located in the Special Flood Hazard Area, but building/development is NOT.
Is located in a Special Flood Hazard Area
FIRM Zone designation is _____________.
“100-Year” flood elevation at the site is: _______________ft. NGVD (MSL)
Unavailable
Is located in the floodway.
FBFM Panel No. ______________________________________________ Dated: ________________________
(If different from the FIRM panel and date)
See Section 4 for additional instructions.
SIGNATURE: _______________________________________________________ DATE: ______________________
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PERMIT NO. __________
Issued 7/13/09 Page 3 of 4
SECTION 4: Additional Information Required (To be completed by Local Administrator)
The applicant must submit the documents checked below before the application can be processed:
A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions, and
proposed development.
Development plans, drawn to scale, and specifications, including where applicable: details for anchoring
structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below
the first floor, details of floodproofing of utilities located below the first floor, and details of enclosures below the
first floor.
Also, ______________________________________________________________________________________
Subdivision or other development plans. (If the subdivision or other development exceeds 50 lots or 5 acres,
whichever is lesser, the applicant must provide “100-year” flood elevations if they are not otherwise available.
Plans showing extent of watercourse relocation and/or landform alterations.
Change in water elevation (in feet) ______________________________
Meets ordinance limits on elevation increases
YES NO
Top of new compacted fill elevation ______________________________________________ ft. NGVD (MSL).
Floodproofing protection level (non-residential only) _________________________ ft. NGVD (MSL). For
floodproofed structures, applicant must attach certification from registered engineer or architect.
Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any
increase in the height of the “100-year” flood. A copy of all data and hydraulic/hydrologic calculations
supporting this finding must also be submitted.
Plan and certifications addressing mitigation of fill.
Other: _____________________________________________________________________________________
___________________________________________________________________________________________
SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINSTRATOR)
I have determined that the proposed activity: A.
Is
B.
Is not
In conformance with provisions of Code of Ordinance Chapter 38. The permit is issued subject to the conditions attached
to and made part of this permit.
SIGNATURE: _______________________________________________________ DATE: ______________________
If Box A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee.
If Box B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and
resubmit an application to the Local Administrator or may request a hearing from Board of Appeals.
APPEALS: Appealed to Board of Appeals?
Yes No
Hearing Date: __________________________________________
Appeals Board Decision – Approved?
Yes No
Reasons/Conditions: ___________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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PERMIT NO. __________
Issued 7/13/09 Page 4 of 4
SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certification of Compliance is
issued)
The following information must be provided for structures that are part of this application. This section must be
completed by a registered professional engineer or a licensed land surveyor (attach a certification to this application).
Complete 1 and 2 below:
1. Actual (As-Built) Elevation of the top of the lowest floor, including basement is: ____________ft. NGVD
(MSL).
2. Actual (as-Built) Elevation of floodproofing protection is _____________ ft. NDVG (MSL).
3. Actual (As-Built) Fill Mitigation.
SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMISTRATOR)
The LOCAL ADMINSTRATOR will complete this section as applicable based on inspection of the project to ensure
compliance with the community’s local law for flood damage prevention.
INSPECTIONS DATE: ____________ BY: _____________________________ DEFICIENCIES?
Yes No
DATE: ____________ BY: _____________________________ DEFICIENCIES?
Yes No
DATE: ____________ BY: _____________________________ DEFICIENCIES?
Yes No
SECTION 8: CERTIFCATE OF COMPLIANCE (To be completed by LOCAL ADMINISTRATOR)
Certificate of Compliance issued: DATE: ___________ BY: _______________________________________________
OFFICIAL USE ONLY
DRAINAGE BASIN: _________________________ TOTAL ACREAGE OF SITE: _____________________ acres
PROJECT ACREAGE (Area of Site being developed for Impact Fees):________________________ acres
FLOODPLAIN REVIEW FEE $
____________
TOTAL AMOUNT DUE $
____________
SIGNATURE: _______________________________________________________ DATE: ______________________
CITY ENGINEER
CITY COMMENTS: ________________________________________________________________________________
__________________________________________________________________________________________________
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CITY OF TOMBALL FLOODPLAIN DEVELOPMENT PERMIT APPLICATION SECTION (City of Tomball)

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Completed 5 August 2020

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