BOROUGH OF HONESDALE
Application for Permit to Develop in a Floodplain Area
The undersigned hereby makes application for a permit to develop in a designated floodplain area. The work to be performed is described below and in attachments hereto. No work may start until a permit is issued. The undersigned agrees that all such work shall be done in accordance with the requirements of the Floodplain Ordinance and with all other applicable local, state, and federal regulations. This application does not create liability on the part of the Borough of Honesdale or any officer or employee thereof for any flood damage that results from reliance on this application or any administrative decision made lawfully thereunder.
Owner:
Contractor:
Address:
Address:
Telephone:
Format: (000) 000-0000.
Telephone:
Format: (000) 000-0000.
Address of Property:
Tax Map Number
A. Description of Work (Complete for All Work):
1. Proposed Development Description:
a. Structural Development
Activity
New Structure
Addition
Alteration
Relocation
Demolition
Replacement
Structure Type
Residential
Non-Residential
Commercial
Combined Use (Residential & Commercial)
Manufactured Home
b. Other Development Activities
Other Development Activities
Fill
Mining
Drilling
Grading
Excavation (except for structural development checked above)
Drainage Improvements (including culvert work), Stormwater Controls, Ponds
Watercourse Alteration
Road, Street, or Bridge Construction
Subdivision (New/Expansion)
Individual Water or Sewer System
Other (please specify)
Other
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2. Size and location of proposed development (attach site plan 1"- 100' or less):
3. Brief description of proposed work:
Anticipated Construction Start Date:
End Date:
4. Is the proposed development in a Special Flood Hazard Area (Zones A, AE, A1-A30, AH or AO)?
Yes
No
Zone:
Panel Number:
6. Are other federal, state, or local permits required?
Yes
No
If yes, type:
7. Is the proposed development in an identified floodway?
Yes
No
8. If yes, to #7, is a "No Rise Certification" with supporting data attached?
Yes
No
B. Complete for New Structures and Building Sites:
1. Is a Base Flood Elevation provided for the site
Yes
No
If yes, provide elevation: feet NAVD
2. Required lowest floor elevation (including basement): feet NAVD
3. Elevation to which all attendant utilities, including all heating and electrical equipment, will be protected from flood damage: Feet NAVD
C Complete for Alterations, Additions, or Improvements to Existing Structures:
1. What is the estimated market value of the existing structure: $
2. What is the cost of the proposed construction? $
3. If the cost of the proposed construction equals or exceeds 50 percent of the market value of the structure, then the substantial improvement provisions shall apply.
D. Complete for Non-Residential Floodproofed Construction:
1. Type of floodproofing method:
2. The required floodproofing elevation is: feet NAVD
Floodproofing certification by a registered engineer is attached:
Yes
No
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E. Complete for Subdivisions and Planned Unit Developments:
1. Will the subdivision or other development contain 50 lots or 5 acres
Yes
No
2. If, yes, does the plat or proposal clearly identify base flood elevations:
Yes
No
3. Are the 100-Year Floodplain and Floodway delineated on the site plan?
Yes
No
F. Complete for Manufactured Homes
1. Base flood elevation at the site:
2. Required lowest floor elevation:
3. Anchored to resist flotation, collapse, or lateral movement
Yes
No
4. Distance from top of bank of watercourse (if applicable)
ADMINISTRATIVE
1. Permit Approved
Permit Denied
2. Elevation Certificate Attached:
Yes
No
3. As-Built lowest floor elevation:
4. Work Inspected by:
5. Local Administrator Signature:
Date:
-
Month
-
Day
Year
Date
6. Applicant's Signature:
Date:
-
Month
-
Day
Year
Date
CONDITIONS:
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