ࡱ> jli d@bjbjdd jcc/7:   $   P]$ j/HLQQQ,,,.......$1h4/,,/QQ$/###QQ.#.##),a.Qp'U-4.:/0j/-.45x 5ha.5a.t, #Zr,,,//",,,j/5,,,,,,,,, : Flood Hazard Development Permit Application & Permit Forms For Communities with Unnumbered A Zones [60.3(b)] CONTENTS Cover Letter Decision Tree Flood Hazard Development Permit Application Flood Hazard Development Permit Part I Flood Hazard Development Permit Part II Flood Hazard Development Permit For Minor Development Flood Hazard Development Permit For Floodproofing Non-Residential Structures Hydraulic Openings Certificate Certificate of Compliance FEMA Elevation Certificate FEMA Floodproofing Certificate This document was prepared by the fb88 Floodplain Management Program Dept. of Agriculture, Conservation & Forestry 93 State House Station 17 Elkins Lane Augusta, fb88 04333-0093 Phone (207) 287-2801 FLOOD HAZARD DEVELOPMENT APPLICATION ____________________, fb88 (All applicants must complete entire application) [60.3(b)] Application is hereby made for a Flood Hazard Development Permit as required under Article II of the Floodplain Management Ordinance of , fb88, for development as defined in said ordinance. This permit application does not preclude the need for other municipal permit applications. Owner: _____________________________________________ Phone No.: __________________________________________ Applicant: ___________________________________________ Phone No.: __________________________________________ Contractor: __________________________________________ Phone No.: __________________________________________ Address: _____________________________________________ ____________________________________________________ Address: _____________________________________________ ____________________________________________________ Address: _____________________________________________ ____________________________________________________LEGAL DESCRIPTION Is this part of a subdivision? ( Yes ( No If yes, give the name of the subdivision and lot number: Subdivision: _____________________________ Lot #: __________ Tax Map: ______________________________________ Lot #: __________ Address: _______________________________________ Street/Road Name Zip Code: ______________________________________ Town/Zip Code General explanation of proposed development: _____________________________________________________________________ ___________________________________________________________________________________________________________ Estimated Value of Proposed Development (all materials and labor): $_______________ Proposed Lowest Floor elevation [for new or substantially improved structure]: ___________ OTHER PERMITS Are other permits required from State or Federal jurisdictions? ( Yes ( No If yes, are these other permits attached? ( Yes ( No ( Not Applicable Federal and State Permits may include but are not limited to: ME/DEP/Natural Resource Protection Act, Site Location of Development Act, Metallic Mineral Exploration, Advanced Exploration and Mining; USACE/Section 9 &10 of the Rivers and Harbors Act/ Section 404 of the Clean Water Act; Federal Energy Regulation Commission. SEWER AND WATER Sewage Disposal: ( Public ( Private ( Existing ( Proposed ( Not Applicable Type ____________________________________ Water Supply: ( Public ( Private (This section to be completed by Municipal Official) LOCATION Flooding Source (name of river, pond, ocean, etc.): __________________________________________________________________ ( A Zone ( FRINGE ( FLOODWAY (( width of floodplain in A Zone) Base Flood Elevation (bfe) at the site _____ ( NGVD or ( NAVD [Required for New Construction or Substantial Improvement] Lowest floor elevation of proposed or existing structure __________ ( NGVD or ( NAVD [Required for New Construction or Substantial Improvement] Basis of unnumbered A Zone bfe determination: ( From a Federal Agency: ( USGS ( USDA/NRCS ( USACE ( Other _______________________ ( From a State Agency: ( MDOT ( Other ________________________________________________ ( Established by Professional Land Surveyor ( Established by Professional Engineer ( HEC/RAS ( HEC II ( HY 7 ( TR20 ( TR55 ( Quick-2 ( Other ________________________________ ( Highest Known Water Level ( Other (Explain) ______________________________________________________________________________ VALUE If the development involves work on an existing structure, enter the Market Value of existing structure before improvements: $ __________ What is the value of the improvements? (all materials and labor): ________ ( New Construction or Substantial Improvement ( Minor improvement or minor addition to existing development TYPE OF DEVELOPMENT Check the appropriate box to the left of the type(s) of development requested and complete information for each applicable line: ( 1. Residential Structure Dimensions ( 1a. New Structure _______________________ ( 1b. Add to Structure _______________________ ( 1c. Renovations/repairs/maintenance ( 2. Non-Residential Structure ( 2a. New Structure _______________________ ( 2b. Add to Structure _______________________ ( 2c. Renovations/repairs/maintenance ( 2d. Floodproofing ( 3. Accessory Structure _______________________ ( 4. Functionally Dependent Use: ( 4a. Dock _______________________ ( 4b. Pier _______________________ ( 4c. Boat Ramp _______________________ ( 4d. Other _______________________ ( 5. Paving _______________________ ( 6. Conditional Use (Lobster/Fish Shed seaward of mean high tide) Note: Conditional Use requires addl. information due to specific standards, public hearing, and Planning Board review.  Cubic Yards ( 7. Filling ________________________ ( 8. Dredging ________________________ ( 9. Excavation ________________________ ( 10. Levee ________________________ ( 11. Drilling Number of Acres ( 12. Mining ________________ ( 13. Dam: Water surface to be created ________________ ( 14. Water Course Alteration ________________ Note: Detailed description must be attached with copies of all applicable notifications, state and federal permits. ( 15. Storage of equipment or materials ( 16. Sewage Disposal System ( 17. Water Supply System ( 18. Other: Explain ________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________  Attach a Site Plan Drawn to scale with north arrow. Show property boundaries, floodway, and floodplain lines. Show dimensions of the lot. Show dimensions and location of existing and/or proposed development on the site. Show areas to be cut and filled. Attach Statement describing in detail how each applicable development standard in Article VI will be met. For New Construction or Substantial Improvement also show: Existing and proposed grade elevations adjacent to the walls of the structure done by a Professional land Surveyor, Architect, or Engineer. Location and elevation of temporary elevation reference marks on the site. Special Note: Substantial Improvement is defined as any reconstruction, rehabilitation, addition or other improvement of a structure, the cost of which equals or exceeds 50 percent of the market value of the structure before the start of construction of the improvement. Please refer to the floodplain management ordinance, Article XIV, for more complete definitions of New Construction and Substantial Improvement. The applicant understands and agrees that: The permit applied for, if granted, is issued on the representations made herein; Any permit issued may be revoked because of any breach of representation; Once a permit is revoked all work shall cease until the permit is reissued or a new permit is issued; Any permit issued on this application will not grant any right or privilege to erect any structure or sue any premises described for any purposes or in any manner prohibited by the ordinances, codes, or regulations of the municipality; The applicant hereby gives consent to the Code Enforcement Officer to enter and inspect activity covered under the provisions of the Floodplain Management Ordinance; If issued, the permit form will be posted in a conspicuous place on the premises in plain view; and, If issued, the permit will expire if no work is commenced within 180 days of issuance. I hereby certify that all the statements in, and in the attachments to this application are a true description of the existing property and the proposed development project. Owner: _________________________________________________________ Date: _____________________________________ Signature or Authorized Agent: _______________________________________________ Date: ______________________________________ Signature (This section to be completed by Municipal Official) Date: Submitted __________; Fee Paid __________; Reviewed by CEO __________; Reviewed by Planning Board _______ Permit # ___________________ Issued by ________________________________ Date _________________________________ 3 FLOOD HAZARD DEVELOPMENT PERMIT PART I ____________________, fb88 (For New Construction or Substantial Improvements) For New Construction or Substantial Improvement of any structure, this Flood Hazard Development Permit allows construction only up to the establishment of the lowest floor. This permit is issued based on documentation that the information provided in the Flood Hazard Development Permit Application is in compliance with the Floodplain Management Ordinance. Once the lowest floor is established, the permittee must provide an Elevation Certificate establishing the as built lowest floor elevation. When the Code Enforcement Officer finds the documentation in the Elevation Certificate to be in compliance with the Floodplain Management Ordinance, the Part II Flood Hazard Development Permit shall be issued. The Part II Permit must be issued in order for construction to continue. A Part I Flood Hazard Development Permit is hereby issued as provided under Article V.F. of the Floodplain Management Ordinance of , fb88, for development as defined in said ordinance. Tax Map: _________________________ Lot #: _______________ Project Description: ___________________________________________________________________________________________ The permittee understands and agrees that: The permit is issued on the representations made herein and on the application for permit; The permit may be revoked because of any breach of representation; Once a permit is revoked all work shall cease until the permit is reissued or a new permit is issued; The permit will not grant any right or privilege to erect any structure or use any premises described for any purposes or in any manner prohibited by the ordinances, codes, or regulations of the municipality; The permittee hereby gives consent to the Code Enforcement Officer to enter and inspect activity covered under the provisions of the Floodplain Management Ordinance; The permit form will be posted in a conspicuous place on the premises in plain view; and, The permit will expire if no work is commenced within 180 days of issuance. I hereby certify that all the statements in, and in the attachments to this permit are a true description of the existing property and the proposed development project. Owner: _________________________________________________________ Date: _____________________________________ Signature or Authorized Agent: ________________________________________________ Date: ______________________________________ Signature Issued by: ______________________________________________________ Date: ______________________________________ Permit #: _______________________________________________________ FLOOD HAZARD DEVELOPMENT PERMIT PART II ____________________, fb88 (For completion of New Construction or Substantial Improvements) The following information has been submitted and found compliant with the Development Standards of the Floodplain Management Ordinance: ( FEMA Elevation Certificate Form 81-31 A Part II Flood Hazard Development Permit is hereby issued as provided under Article V.F. of the Floodplain Management Ordinance of ______________________________, fb88, for development as defined in said ordinance. Tax Map: _________________________ Lot #: _______________ The permittee understands and agrees that: The permit is issued on the representations made herein and on the elevation certificate; The permit may be revoked because of any breach of representation; Once a permit is revoked all work shall cease until the permit is reissued or a new permit is issued; The permit will not grant any right or privilege to erect any structure or use any premises described for any purposes or in any manner prohibited by the ordinances, codes, or regulations of the municipality; The permittee hereby gives consent to the Code Enforcement Officer to enter and inspect activity covered under the provisions of the Floodplain Management Ordinance; The permit form will be posted in a conspicuous place on the premises in plain view; and, The permit will expire if no work is commenced within 180 days of issuance. I hereby certify that all the statements in, and in the attachments to this permit are a true description of the existing property and the proposed development project. Owner: _________________________________________________________ Date: _____________________________________ Signature or Authorized Agent: ________________________________________________ Date: ______________________________________ Signature Issued by: ______________________________________________________ Date: ______________________________________ Permit #: _______________________________________________________  Certain prohibitions apply in Velocity Zones 2     PAGE 1 3 2  FILENAME \p H:\Flood\Forms\FHD Application and Permit Forms\2- bpermit.doc  FILENAME \p H:\Flood\Forms\FHD Application and Permit Forms\2- bpermit.doc  DATE \@ "M/d/yyyy" 4/20/2018 , O | }   WX_`GHPQ]^hist  '(0h+ joh+ j2h+\rh'  joh+\r h+\r>* h+\r5CJ$ h+\r5h e> h+\rCJ$h+\rM,.;<=eopqz{ G   + O }  & F$a$  G Q R 1 2 h i FG$If$a$G~$%78"#TghHkd$$Ifl0* t4 la$If<=K#$45Z ^`JKt0$d%d&d'd-D M NOPQ`,$d%d&d'd-D M NOPQ/$$d%d&d'd-D M NOPQa$ K h |deoooooo0$d%d&d'd-D M NOPQ`,$d%d&d'd-D M NOPQ4P$d%d&d'd-D M NOPQ^P` 01>?HIvw@ALMWX`aijrs?ABopFGpqEFvw  /0UVjh+\r0JUh#+> h+\r5h+\r joh+\rYek@AEFoDu$If,$d%d&d'd-D M NOPQ -D M .TDTij !!! $If^$IfDEijj k !!""U$z$((`,,,,,,-l001127R7Y7Z7u7v7B8C899/?0?h?i?j?l?m?o?p?r?s?u?v?|?}?~?ûûûûñha(0JmHnHu ha(0Jjha(0JUjhpUhpha(jha(0JU h+\r6 h+\r>* h+\rCJ$ h+\r5CJ$hOt h+\r5 joh+\rh+\r?!!!! 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