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Issue Date: Expiration Date: Permit # *Permit becomes void if there are changes to the effective Flood Insurance Rate Maps* The Floodplain Development Permit is the mechanism by which Millcreek utilizes to evaluate any and all impacts of activities proposed in the Millcreek regulated floodplains. All activities must be in compliance with the Millcreek Floodplain Damage Prevention Ordinance. The National Flood Insurance Program provides flood insurance to individuals at much lower premiums than could otherwise be purchased through private insurers, and makes certain federal funds 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 funds, the community must agree to meet minimum floodplain standards. This application packet is a tool to ensure that the Millcreek Floodplain Damage Prevention Ordinance is met. Any development that occurs within a designated floodplain must obtain a floodplain development prior to the work commencing. In FEMA defines development in Title 44 of the Code of Federal Regulations part 59.1 as: Any man-made change to improved or unimproved real estate, including but not limited to buildings or other structures, mining, dredging, filing, grading, paving, excavation or drilling operations or storage of equipment or materials. Other human activities that are considered development included but are not limited to: alterations of a structure through additions, demolition and remodeling, fences, retaining wall, moving/placement of remanufactured or mobile homes, campgrounds, storage of equipment, vehicles or materials (storage yards, salvage yards). General Provision of the Floodplain Development Permit Terms (applicant to read and sign): 1. No work may start until a permit has been issued. 2. The permit may be revoked if: a. Any false statements are made herein; b. The effective Flood Insurance Rate Map has been revised; c. The work is not done in accordance the Millcreek Floodplain Damage Prevention Ordinance or other local, state and federal regulatory requirements. d. The work is different than what is described and submitted to the Community as part of the Floodplain Development Permit application. 3. If revoked, all work must cease until permit is re-issued. a. If the permit cannot be re-issued, applicant acknowledges that they will be responsible to correct the issue which may require removal of any development that may have occurred. 4. Development shall not be used or occupied until the project has received final inspection, a final elevation and approval by the Community. 5. The permit will expire if no work is commenced within 3 months of issuance and by the expiration date noted on the permit. 6. Applicant is hereby informed that other permits may be required to fulfill local, state, and federal regulatory requirements and acknowledges that it is their responsibility to ensure that all necessary permits are obtained. a. This includes but is not limited to documentation showing compliance with the endangered species act. 7. Applicant hereby gives consent to the Local Floodplain Administrator and his/her representative (including state and federal agencies) 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. Furthermore, I have read and understand the Millcreek Floodplain Damage Prevention Ordinance and will adhere to the ordinance and will/have obtain all necessary state, federal and local permits for the proposed development. Applicant’s Name: Applicant’s Signature: Date: Millcreek Floodplain Development Permit Public Works Dan Drumiler [PHONE REDACTED] [EMAIL REDACTED] 1 of 4 SIGN ---PAGE BREAK--- Owner Address City State Zip Code Contractor/Developer Address City State Zip Code Telephone # Fax # Telephone # Fax # Contact Name Emergency Telephone # E-mail Contact Name Emergency # E-mail Project Address Latitude/Longitude # Description of Project: Estimated Cost of Project: If work is on, within or connected to an existing structure: Valuation of existing structure: Source of valuation: When was the existing structure built: * If the value of an addition, remodel or alteration to a structure equals or exceeds 50% of the value of the structure before the addition, remodel or alteration, the entire structure must be treated as a substantially improved structure and is required to comply with the {Community Floodplain Damage Prevention Ordinance. A relocated structure, including mobile homes, manufacture homes or cabins, must be treated as a new construction. CHANNEL IMPROVEMEMTS STRUCTURAL DEVELOPMENT MISCELLANEOUS TYPE Bank Stabilization New Construction Bridge Temporary Grade Control Residential Building Culvert Permanent Drop Structure Non-Residential Demolition Rehabilitation Outfall Manufactured Home Fence Emergency Repair Fill Rehabilitation Grading/ Parking Lot Maintenance Other Substantial Improvement Other Other Other TO BE COMPLETED BY FLOODPLAIN ADMINISTRATOR Watercourse Name: Effective FIRM Panel Number and Date: Is the development in or impacting a the development in the floodway?____________if yes, a No-Rise Certification is required. Special Flood Hazard Zone: Base Flood Method used to Determine Base Flood Vertical Datum: Must be either NGVD or NAVD 88 and the same vertical datum of the effective FIRM: Elevation of lowest floor, including basement or crawlspace*: Elevation of lowest, habitable floor*: Elevation of floodproofing (non-residential structures only)*: *Source of Elevation and/or floodproofing Information: Does the project require that a CLOMR be a LOMR 2 of 4 Floodplain Development Permit Checklist The following documents are required for all floodplain development permits: Legal Description: ☐Tax assessor map ☐Elevation Certificate: Both a constructional drawing Elevation Certificate and an As-built Elevation Certificate ☐Documentation showing compliance with the Endangered Species Act ☐Maps and/or plans showing the location, scope and extent of the development ---PAGE BREAK--- The following documents may be required: ☐Floodproofing Certificate: Certificate and supporting documentation used to provide the certification ☐No-Rise Certificate: Certificate and supporting documentation used to provide the certification ☐Grading plans ☐Detailed hydraulic and hydrology model for development in a Zone A ☐Conditional Letter of Map Revision (CLOMR) ☐Structure valuation documentation ☐Non-conversion agreement: Required for all structures that are constructed with an enclosure ☐Wetland Permit from the U.S. Army Corps of Engineers ☐Copies of all federal, local and state permits that may be required. ☐Manufactured home anchoring certificate: Certificate and supporting documentation used to provide the certification Permit Action PERMIT APPROVED: The information submitted for the proposed project was reviewed and is in compliance with approved floodplain management standards. PERMIT APPROVED WITH CONDITIONS: The information submitted for the proposed project was reviewed. In order for the proposed project to be approved, certain restrictions or conditions must be met. These restrictions or conditions are attached. PERMIT DENIED: The proposed project does not meet approved floodplain management standards (explanation on file). VARIANCE GRANTED: A variance was granted from the base (100 year) flood elevations established by FEMA consistent with variance requirements of Title 44 of the Code of Federal Regulations part 60.6 (Variance action documentation is on file). Signature of Community Print Name and Title of Community 3 of 4 SIGN ---PAGE BREAK--- Approvers Comments Only: 4 of 4