Fillable FLOODPLAIN DEVELOPMENT PERMIT APPLICATION (City of Renssealaer, NY)

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FLOODPLAIN DEVELOPMENT PERMIT APPLICATION (City of Renssealaer, NY)

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The FLOODPLAIN DEVELOPMENT PERMIT APPLICATION (City of Renssealaer, NY) form is 5 pages long and contains:

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  • 42 check-boxes
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APPLICATION #
PAGE 1 of 4
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
SECTION 1: GENERAL PROVISIONS (to be read
and signed by APPLICANT):
1. No work 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 is issued.
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 Local Administrator or his/her representative to make reasonable inspections required to
verify compliance.
8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION
ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE.
Applicant Signature Date
A
pplicant Contact Information (name, company, mailing address, phone):
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
SECTION 2: PROPOSED DEVELOPMENT (T
o be completed by APPLICANT)
NAME ADDRESS TELEPHONE
APPLICANT
BUILDER
ENGINEER
CONSULTANT
PROJECT LOCATION
:
To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the
street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-
known landmark. A sketch attached to this application showing the project location would be helpful.
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
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APPLICATION #
PAGE 2 OF 4
DESCRIPTION OF WORK (Check all applicable boxes):
A. STRUCTURAL DEVELOPMENT
ACTIVITY
STRUCTURE TYPE
New Structure Residential (1-4 Family)
Addition Residential (More than 4 Family)
Alteration Non-residential (Floodproofing? Yes)
Relocation Combined Use (Residential & Commercial)
Demolition Manufactured (Mobile) Home
Replacement
ESTIMATED COST OF PROJECT:
$
B.
OTHER DEVELOPMENT ACTIVITIES:
Fill 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)
Individual Water or Sewer System
Other (Please Specify)___________________________________________________________________
After completing SECTION 2, APPLICANT should submit form to Local Administrator for review.
SECTION 3: FLOODPLAIN
DETERMINATION (To be completed by 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 located in a Special Flood Hazard Area. FIRM zone designation is .
100-Year flood elevation at the site is Ft. NGVD (MSL) /
Unavailable
The proposed development is located in a floodway.
FBFM Panel No. Dated
See Section 4 for additional instructions.
Local Administrator Signature Date
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APPLICATION #
PAGE 3 OF 4
SECTION 4: ADDITIONAL INFORMATION REQUIRED (T
o 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.
Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres,
whichever is the lesser, the applicant must
provide 100-year flood elevations if they are not otherwise available).
Plans showing the extent of watercourse relocation and/or landform alterations.
Plans showing top of proposed new fill elevation in FT. NGVD (MSL).
Plans showing proposed flood proofing protection level (non-residential only) in FT. NGVD (MSL). For flood
proofed 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 calculations supporting this finding must also be
submitted.
Other:
……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….
SECTION 5: DEVELOPMENT PERMIT DETERMINATION (T
o be completed by LOCAL ADMINISTRATOR)
I have determined that the proposed activity: A.
Is / B. Is not in conformance with provisions of Local Law # 2 of
6/17/1987 and / or Special Use Permit Approved on ____________________ by the Planning Commission. The development permit
is issued subject to the conditions attached to and made part of this permit.
L
ocal Administrator Signature Date
If BOX A is checked
, the Local Administrator may issue a Demolition, Grading, or Building 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 the Board of Appeals.
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APPLICATION #
PAGE 4 OF 4
APPEALS: Appealed to Board of Appeals?
Yes No Hearing date:___________________
Appeals Board Decision --- Approved?
Yes No
Conditions
…
……………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………….
SECTION 6: AS-BUILT ELEVATIONS (To
be submitted by APPLICANT before Certificate of Compliance is issued)
The following information must be provided for project structures. This section must be completed by a registered professional
engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas / Zone V
, bottom of
lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL).
2. Actual (As-Built) Elevation of floodproofing protection is: FT. NGVD (MSL).
NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant.
SECTION 7: COMPLIANCE ACTION (To
be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will conduct regular inspections to ensure compliance.
INSPECTIONS:
DEFICIENCIES?
YES NO
DATE BY
DEFICIENCIES? YES NO
DATE BY
DEFICIENCIES? YES NO
DATE BY
SECTION 8: CERTIFICATE OF COMPLIANCE (T
o be completed by LOCAL ADMINISTRATOR)
Certificate of Compliance issued prior to granting of Certificate of Occupancy:
ISSUED BY DATE
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA
(OWNER MUST RETAIN THIS CERTIFICATE)
TO BE COMPLETED AND ISSUED PRIOR TO FINAL INSPECTION FOR A CERTIFICATE OF OCCUPANCY
SECTION A (To be completed by APPLICANT – sign either A.1 or A.2 not both)
PREMISES LOCATED AT
OWNER:
OWNER ADDRESS:
CHECK ONE: NEW BUILDING EXISTING BUILDING FILL OTHER: ________________________
1. I CERTIFY THAT I HAVE COMPLIED WITH THE REQUIREMENTS OF LOCAL LAW # 2 of 6/17/1987 (City
Code Chapter 105), AND THE SPECIAL USE PERMIT APPROVED ____________________.
APPLICANT SIGNATURE DATE
<OR>
2. I CERTIFY THAT I HAVE COMPLIED WITH THE REQUIREMENTS OF LOCAL LAW # 2 of 6/17/1987 (City
Code Chapter 105), THE SPECIAL USE PERMIT APPROVED ____________________, AND THE AREA VARIANCE
GRANTED ____________________.
A
PPLICANT SIGNATURE DATE
SECTION B (To be completed by LOCAL ADMINISTRATOR)
This certifies based on a final site inspection that the above described floodplain development complies with
requirements of Flood Damage Prevention Local Law Number 2 of 1987, or has a duly granted variance.
LOCAL ADMINISTRATOR SIGNATURE
PERMIT NO: PERMIT DATE:
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FLOODPLAIN DEVELOPMENT PERMIT APPLICATION (City of Renssealaer, NY)

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Completed 14 July 2020

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