e proposed development is located on FIRM Panel No. , Dated
FBFM Panel No. (if applicable) Dated
e Proposed Development:
Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is
complete and No Floodplain 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 (100-Year Floodplain) - FIRM zone designation is
• 100-Year base flood elevation at the site is: ft. NGVD (MSL)
• Lowest Floor Elevation (with 2ft freeboard) is: ft.
Unavailable (If BFE is unavailable, elevation of the lowest floor and all utilities must be
constructed to be 4 foot above highest adjacent grade)
Elevation Certificate Required – FEMA Form 81-31
s located in the floodway.
No-Rise Certification Required
he 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.
evelopment plans, drawn to scale, and specifications, including where applicable: details for
anchoring structures, proposed elevation of lowest floor (including basement), elevation of
lowest duct work, elevation of lowest equipment (including electrical), flood vents for water
flow (two per side located within 1’ of outside grade with a total of 1”square opening per each
sq. ft. of enclosure), foundation mortar (surewall with fiber for drystack in cases of mobile
homes), 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.
levation Certificate Required – FEMA Form 81-31
o-Rise Certificate Required – 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
loodproofing Certificate (non-residential)– FEMA Form 81-65
lease see attached sheet for additional requested information.
(Certifications not required the following structures within Zone A, AO, AE, or A1-30 – Recreation Vehicles meeting requirements of Section 8-
17(6)(a); Temporary Structures meeting requirements of Section 8-17(7); or Accessory Structures less than one hundred fifty (150) square feet
meeting requirements of Section 8-17(8) of the Town of Burgaw UDO.)
Floodplain Determination (To be completed by the Floodplain Administrator)
Additional Information Required (To be completed by Floodplain Administrator)
Floodplain Administrator Signature: Date: