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TY> CITY OF STEPHENVILLE FLOODPLAIN DEVELOPMENT PERMIT APPLICATION (City of Stephenville)

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CITY OF STEPHENVILLE
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
**All construction will also require a building permit**
This is an application packet for a Floodplain Development Permit. Certain
sections are to be completed by the Applicant, and certain
sections are to be completed by the local Floodplain Administrator (FPA).
The National Flood Insurance Program (NFIP) provides flood insurance to individuals at much lower premiums than could otherwise
be purchased through private insurers, and makes certain federal monies available to local communities. In order for citizens to be
eligible for the national flood insurance rates, or for communities to receive certain kinds of federal monies, the community must agree
to meet minimum floodplain standards. This application packet is a tool to ensure that the minimum standards are met.
In a participating NFIP community, flood insurance policies can be purchased from any local insurance agent at the national rate.
Even though the policy may be issued as if it were coming from the insurance company you deal with, it is actually a Federal NFIP
policy printed on the insurance agency’s letterhead. The rates are determined by the flood risk zone in which you live and by the
elevation of the lowest floor of your home, not by the insurance company, and should be the same regardless of which agent or agency
sells you the insurance.
You may buy flood insurance for your own peace of mind, you may be required to buy it before a lending institution will make or
refinance a loan, or you may not be buying flood insurance at all. Whatever the case, if the property which you propose to develop is
located within a “Special Flood Hazard Area” on a flood map issued by the Federal Emergency Management Agency (FEMA), you
MUST obtain a Floodplain Development Permit prior to beginning the project. This is a requirement of the local Flood Damage
Prevention Ordinance of your community, and there are penalties for failing to do so.
Floodplain Development Permits are ONLY required for developments in areas designated as “Special Flood Hazard Areas” of
FEMA-issued flood maps. Flood maps can be reviewed at the office of your local FPA, or online at the FEMA website
(www.FEMA.gov).
If you are proposing a development of any kind (constructing a new building, adding on to an existing building, clearing land, placing
fill, grading land, mining, dredging, drilling, etc…) in a floodplain, you MUST submit Section I of this application for a Floodplain
Development Permit to your local FPA. Depending upon the type of development you are proposing, additional forms may be
required. For example, all new buildings in a Special Flood Hazard Area require an Elevation Certificate to document that the lowest
floor of the building is elevated to a certain height relative to the anticipated flood crest of the “base flood” event. The Elevation
Certificate and other forms are provided in Section III of this application packet, but should only be completed if they are required
by the FPA for the proposed development.
Typically, the Applicant completes Section I of this packet and submits the information to the local FPA. The FPA reviews the
submission and determines whether or not additional information is needed. If it is, the FPA will request the additional information
from the Applicant. Once all required materials have been submitted, the FPA will make a permitting decision and either issue or deny
the requested Floodplain Development Permit. (Denied permits may be appealed per the provisions of the local Flood Damage
Prevention Ordinance.)
The Applicant should understand that a Floodplain Development Permit is only a permit to complete the proposed development. It is a
permit to, for example, build a house, construct a baseball field, install a drainage ditch or septic system or grade a parcel of land.
Before the house can actually be occupied, or the developed land used, a Compliance Certificate must be issued by the local FPA. The
FPA will perform an inspection after the project is completed, or perhaps several inspections throughout the progress of the project, to
make sure that the development is compliant with the requirements of the local Flood Damage Prevention Ordinance. Once the
Compliance Certificate has been issued, the process has been completed.
For developments (See Other Development Activities under PROJECT INFORMATION on the following form) other than
buildings/structures, applicants may be required to furnish details regarding the location, areal extent, depth/height (of fill or dredging,
for example), and other descriptive information. An engineering study may be required to determine the impact of any development
which may change the area, depth and velocity of flooding.
INSTRUCTIONS FOR COMPLETION
SECTION I
General Information
Self-explanatory. Note items 7 and 8 under this heading.
Owner Information
List the contact information for the owner(s) of the property where development is proposed. All owners of the property
must sign the application.
Applicant Information
If you are applying for this development permit, but are not the owner of the property, list your contact information here. If
you are the property owner, leave this section blank.
Project Information
Check the box(es) beside the type of development that is being proposed. Note that some types of activity require the
estimated cost of the proposed project to be disclosed so the Floodplain Administrator (FPA) can determine whether or not
the improvement is a “substantial improvement.”
Signature
Print your name, sign your name, and date the application.
SECTION II
Floodplain Information
The FPA will determine – for the sole purpose of administering the local Flood Damage Prevention Ordinance – the position
of the proposed development relative to community floodplains and floodways. This determination is not binding at any
lending institution or with any insurance agency, but is used to determine whether or not a Floodplain Development Permit
and/or any other forms are required prior to commencing the proposed project.
Section II requires a map and panel number(s), a listing of the flood source for the proposed development, and contains a
checklist of additional documents required for the FPA to make an informed permitting decision.
If any of the additional documentation is required, the FPA is to notify the applicant, allow a reasonable length of time for
submission of the documents, and then review all submissions to determine whether or not the permit will be issued.
If an item on the form is not applicable, such as for Other Development Activities, put NA in the blank.
SECTION III
Forms
The Elevation Certificate and Floodproofing Certificate are FEMA documents. Periodically, they expire and are replaced
by new forms which must be used by surveyors and engineers which complete these documents. Therefore, they are
separate documents.
SECTION IV
Permit Determination
The FPA will
indicate whether or not the proposed development is conformant with the requirements of the local Flood
Damage prevention ordinance, and whether or not the requested permit is issued. If the decision is to NOT issue the permit,
the FPA will provide an explanation of the perceived deficiencies to the Applicant.
SECTION V
Certificate of Compliance
The FPA will
indicate the “As-Built” lowest floor elevation for structural developments, list any inspections that have
been performed, and issue the Certificate of Compliance to the Applicant if appropriate.
FLOODPLAIN DEVELOPMENT
PERMIT APPLICATION FORM
<COMMUNITY>
OFFICE USE ONLY
Date Received:
File Number:
SECTION I: Applicant and Project Information
GENERAL INFORMATION
1. No work of any kind may begin in a floodplain area designated as A, A1-30, AE, AO, AH, or B until a floodplain
development permit is issued.
2. The permit may be revoked if any false statements are made in this application.
3. If revoked, all work must cease until a permit is re-issued.
4. The development may not be used or occupied until a Certificate of Compliance is issued.
5. The permit will expire if no work is commenced within 6 months of the date of issue.
6. The permit will not be issued until any other necessary local, state or federal permits have been obtained.
7. By signing and submitting this application, the Applicant gives consent to the local Floodplain Administrator or his/her
representative to make reasonable inspections prior to the issuance of a Certificate of Compliance.
8. By signing and submitting this application, the Applicant certifies that all statements contained in SECTION I of the
application, and in any additional attachments submitted by the Applicant, are true and accurate.
OWNER INFORMATION
Mailing address:
Property owner(s):
Telephone n
umber:
Fax number:
Signature(s) of property owner(s) listed above
1
e-mail address:
1
Attach forms if there are additional property owners. This
permit application
will not be accepted without the signature of
all property owners. The signature is an acknowledgement and
consent to this floodplain development permit application.
APPLICANT INFORMATION
Notes: Applicant:
Telephone number:
Fax number:
Signature of applicant listed above
Section I continued on back
City of Stephenville
File Number:
PROJECT INFORMATION
Project
Block
Address
Lot
Subdivision
Legal Description (Attach to this document)
A. Structural Development (Please check all that apply.)
Type of Structure
Residential
(1 to 4 families)
Residential (More than 4 families)
Non-Residential
Elevated
Floodproofed
Combined Use (Residential and Non-Residential)
Manufactured (mobile) Home
Located within a Manufactured Home Park
Located outside a Manufactured Home Park
Type of Structural Activity
New Structure
Addition to Existing Structure
2
Alteration of Existing Structure
2
Relocation of Existing Structure
2
Demolition of Existing Structure
Replacement of Existing Structure
2
Estimate Cost of Project
B. Other Development Activities
Excavation (not related to a Structural Development listed in Part A.)
Clearing
2
If the value of an addition or altera
tion to a Structure
equals or exceeds 50% of the value of the structure before
the addition or alteration, the entire structure must be
treated as a substantially improved structure.
A relocated
structure must be treated as new construction.
equals or exceeds 50% of the value of the structure
before the addition or alteration, the entire structure
must be treated as a substantially improved structure.
A relocated structure must be treated as new
construction.
Placement of fill material
Grading
Mining
Drilling
Dredging
Watercourse alteration
Drainage improvement (including culvert work)
Individual water or sewer system
Roadway or bridge construction
Other development not listed above (specify)
SIGNATURE
I certify that to the best of my knowledge the information contained in this application is true and accurate.
(PRINTED NAME) (SIGNED NAME) (DATE)
File Number:
SECTION II: (To be completed by Floodplain Administrator)
FLOOD INFORMATION
(number and suffix) 1. The proposed development is located on FIRM map panel:
2. The date on the FIRM is
3. The proposed development is located in Zone:
(A, A1-30, AE, AO, AH, B, C, D, or X)
YES
4. Is the proposed development located in either
of the following zones? A, A1-30, AE, AO, AH, B, or shaded X
NO If NO, no permit floodplain development is required.
5. If the proposed development is located in Zone B or shaded Zone X, a floodplain development permit is only
required if the Development
is a “critical facility” as defined in the Flood Damage Prevention Ordinance. Otherwise,
no floodplain development permit is required in Zone B or shaded Zone X.
YES NO
6. If the proposed development is located within either Zone A1-30 or Zone AE, is
it also located within a “regulatory floodway”?
7. If YES, a No Rise Certificate is necessary before proceeding. If NO, continue
If the proposed development is located within Zones A, A1-30, AE, AO, AH, B or shaded X (critical facilities only),
apply the criteria of the Flood Damage Prevention Ordinance to minimize flood damages to the proposed Development
and to adjacent properties as well.
For structures, the provisions of the ordinance specify that the lowest floor, including utilities, be elevated
feet above the base flood elevation. Therefore, it is necessary that the following information be
provided:
8. Base flood elevation at the site: feet above mean sea level (MSL)
9. Vertical datum used in the Flood Insurance Study, on flood maps and in surveys is:
10. Source of the base flood elevation (BFE)
FIRM (flood map)
Flood Insurance Study Profile #
Other sources of the BFE (specify):
11. Proposed lowest floor elevation (including utilities): feet above MSL
(This elevation must be greater than the BFE. For non-residential structures, floodproofing may be used in lieu of
elevation. See ordinance for details, including freeboard, flood vents and other requirements.)
3
Certificates require
completion by a
Professional Land
Surveyor or Registered
Professional Engineer, as
indicated.
12. The following documents may be required. Check applicable.
Maps and plans of the development, including non-buildings/structures
An Elevation Certificate
3
– required for all structures
A Floodproofing Certificate
3
– required if floodproofing a non-residential structure
A No-Rise Certificate
3
– if the proposed development is in a “regulatory floodway"
An elevation study showing BFEs on developments exceeding 50 lots or 5 acres in Zone A
An engineering study to determine impacts of a development.
A copy of Wetlands Permit from the U.S. Army Corps of Engineers if required; and other local, state, federal
permits. Other permits:
■
File Number:
SECTION III : (Forms which may be required by the Floodplain Administrator)
ELEVATION CERTIFICATE (with Instructions)
Separate Attachment. Submit o
nly if
required
to
do
so by the Floodplain Administrator.
FLOODPROOFING CERTIFICATE
Separate Attachment. Submit o
nly if
required
to
do
so by the Floodplain Administrator.
NO-RISE CERTIFICATE
Attached. Submit only if required to do so by the Floodplain Administrator.
File Number:
FLOODPLAIN DEVELOPMENT PERMIT
<COMMUNITY>
OFFICE USE ONLY
Date Issued:
File Number:
SECTION IV : (To be completed by the Floodplain Administrator)
PERMIT DETERMINATION
I have determined that the proposed development
IS
IS NOT
,
in conformance with local Flood Damage Prevention Ordinance Number _______________,
dated:_______________________
Reasons for non-conformance are contained in a separate document.
The Floodplain Development Permit
IS
IS NOT
issued, subject to any conditions attached to and made part of
this permit.
Reasons for denial are contained in a separate document.
,
______________________
________________________
______________________
___________
SIGNATURE DATE
The applicant is reminded that this document is a development permit only. An inspection must be performed and a
Compliance Certificate must be issued before the development can be occupied or used.
APPEALS
The decision of the Floodplain Administrator to approve or deny the issuance of a development permit is subject
to appeal to the Appeal Board.
Is the denial of the permit appealed to the Appeal Board? Yes No
Hearing date:
_____________________
Appeal Decision
Approved?
Yes No
Reasons/Conditions of Decision:
_______________________________________________________________________________________________________
____________________________________________________________________________________________
City of Stephenville
File Number:
CERTIFICATE OF COMPLIANCE
<COMMUNITY>
OFFICE USE ONLY
Date Issued:
File Number:
SECTION V : CERTIFICATE OF COMPLIANCE
“AS-BUILT” ELEVATION (to be completed by the applicant after construction)
The following information must be provided for structures that are part of this application. This section must be completed by
a Professional Land Surveyor or a Professional Engineer (or attach a certification to this application).
1. The Actual (“As-Built”) elevation of the top of the lowest floor, including the basement, is
feet above MSL (vertical datum:
).
2. The Actual (“As-Built”) elevation of floodproofing protection is feet above MSL
(vertical datum: ).
OTHER DEVELOPMENT ACTIVITIES (non-buildings/structures)
Provide documentation that the development has satisfied the conditions of granting the permit. This
may i
nclude documentation provided by a surveyor, engineer or other professional.
COMPLIANCE ACTION (to be completed by the Local Floodplain Administrator)
The Floodplain Administrator will complet
e this section as applicable based on inspection of the development to ensure
compliance with the community’s local flood damage prevention ordinance.
Inspections: Date:
By: Deficiencies?
Date: By: Deficiencies?
Date:
By:
Deficiencies?
Date:
By: Deficiencies?
Date:
By:
Deficiencies?
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
CERTIFICATE OF COMPLIANCE ACTION (to be completed by the Local Floodplain Administrator)
Certificate of Compliance issued.
SIGNATURE DATE
This Certificate of Compliance indicates that structures may now be occupied and non-structural developments may be utilized.
City of Stephenville
NATIONAL FLOOD INSURANCE PROGRAM
ENGINEERING “NO-RISE” CERTIFICATE
FOR TEXAS COMMUNITIES
SITE INFORMATION
Date Project
Community
Address
County
Applicant
Name
Address Block
Telephone
Engineer
Name
Lot
Subdivision Legal
Description
Address
Telephone
PROJECT INFORMATION
Description of Development:
Principal Use of Premises:
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
NFIP map(s) and panel(s) affected:
Effective dat
e of map:
Base Flood Elevation on FIRM:
Name of flooding source:
CERTIFICATION
This is to certify that I am a duly qualified Professional Engineer licensed to practice in the State of Texas. I further
certify that the attached engineering data supports the fact the proposed development would not result in any increase in
flood levels within the community during the occurrence of a base flood event.
CERTIFIER’S NAME
LICENSE NUMBER
(embossed seal)
COMPANY NAME
SIGNATURE DATE
TITLE
FLOODPLAIN DEVELOPMENT PERMIT
<COMMUNITY>
OFFICE USE ONLY
Date Issued:
File Number:
SECTION IV : (To be completed by the Floodplain Administrator)
PERMIT DETERMINATION
I have determined that the proposed development
IS
IS NOT (non-conformances to be described in a separate document)
IS
IS NOT (reasons for denial to be described in a separate document)
issued, subject to any conditions attached to and made part of this permit.
SIGNATURE DATE
The applicant is reminded that this do
cument is
a development
permit
only.
An inspection must be performed and
a Compliance Certificate must be issued before the development can be occupied or used.
in conformance with local Flood Damage Prevention Or
dinance Number:
d
ated:
T
he
Floodplain Development Permit
City of Stephenville
,
.
CERTIFICATE OF COMPLIANCE
<COMMUNITY>
OFFICE USE ONLY
Date Issued:
File Number:
SECTION V : CERTIFICATE OF COMPLIANCE
“AS-BUILT” ELEVATION (to be completed by the applicant after construction)
The fo
llowing information
m
ust
be provided
for structures that are part of this application. This section must be completed by
a Professional Land Surveyor or a Professional Engineer (or attach a certification to this application).
1. The Actual (“As-Built”) elevation of the top of the lowest floor, including the basement, is
feet above MSL (vertical datum:
).
2. The Actual (“As-Built”) elevation of floodproofing protection is feet above MSL
(vertical datum: ).
COMPLIANCE ACTION (to be completed by the Local Floodplain Administrator)
The Floodplain Administrator will complete this section as applicable based on inspection of the development
to ensure compliance with the community’s local flood damage prevention ordinance.
Inspections: Date: By: Deficiencies?
Date: By: Deficiencies?
Date: By: Deficiencies?
Date: By: Deficiencies?
Date: By: Deficiencies?
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
CERTIFICATE OF COMPLIANCE ACTION (to be completed by the Local Floodplain Administrator)
Certificate of Compliance issued.
SIGNATURE
DATE
This Certificate of Compliance indicates that structures may now be occupied and non-structural developments may
be utilized.
City of Stephenville
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Completed 16 July 2020

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