1021 Atlantic Blvd Floodplain Development :i..
r,l `' Jv` , CITY OF ATLANTIC BEACH
.,--,.,--, ;u_: 0 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
(904) 247-5800
'''''./,,05/19
Application# G 1'/Z 0 —Ce:›V 4—
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FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be tilled out in duplicate.
SECTION I: General Provisions(APPLICANT to read and sign):
I. No work of any kind may start until a permit is issued.
2. The permit may be revoked if any false statements are made herein.
3. If revoked, all work must cease until permit is re-issued.
4. Development shall not he used or occupied until a Certificate of Compliance is issued.
5. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may he required to fulfill local, state, and federal
regulatory requirements.
7. Applicant hereby gives consent to the Local Administrator or his/her representative to make
reasonable inspections required to verify compliance.
8. THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS
TO THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND
ACCURATE.
(APPLICANT'S SIGNATURE) DATE
SECTION 2: Proposed Development(To he completed by APPLICANT)
NAME ADDRESS TELEPHONE
APPLICANT
BUILDER
ENGINEER
PROJECT LOCATION:
• To avoid delay in processing the application, please provide enough information to easily identify the project
location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the
distance to the nearest intersecting road or well-known landmark. A sketch attached to this application
showing the project location would be helpful.
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DESCRIPTION OF WORK (Check all applicable boxes): Application# 611/20 -0oO4-
Page 2 of 4
A. STRUCTURAL DEVELOPMENT
ACTIVITY STRUCTURE TYPE
U New Structure U Residential (1-4 Family)
❑ Addition U Residential (More than 4 Family)
U Alteration U Non-residential (Floodprooting?U Yes)
U Relocation Li Combined Use (Residential&Commercial)
U Demolition U Manufactured(Mobile) Home(In Manufactured
❑ Replacement Home Park? U Yes)
ESTIMATED COST OF PROJECT$
B. OTHER DEVELOPMENT ACTIVITIES
U Clearing U Fill U Mining ❑ Drilling U Grading
U Excavation (Except for Structural Development Checked Above)
❑Watercourse Alteration(Including Dredging and Channel Modifications)
❑ Drainage Improvements (Including Culvert Work)
U Road, Street or Bridge Construction
U Subdivision(New or Expansion)
U Individual Water or Sewer System
❑Other(Please specify)
After completing SECTION 2, APPLICANT should submit form to the Local Administrator for review.
SECTION 3: Floodplain Determination(To he completed by the Administrator)
The proposed development is located on FIRM Panel NoelO&f Dated t 1/0 z/t 8
The Proposed Development:
U Is NOT located in a Special Flood Hazard Area(Notify the applicant that the application review is
complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
U Is partially located in the SFHA, but building/development is not.
• is located in a Special Flood Hazard Area •
FIRM zone designation is k E. . t4 AM?'
"100-Year" flood elevation at the site is: G•7 ft._NG V(MSL)
iJ Unavailable
❑ Is located in the tloodway.
FBFM Panel No. Dated
(if different from the FIRM panel and date)
U See Secf n 4 for additional instructions.
SIGNED (..---r—c4 DATE 6 `Z 47-4='2.-0
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Application II G I NJ 260- 7c4-
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SECTION 4: Additional Information Required(To be completed by Local Administrator)
The 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.
N` Development plans. drawn to scale, and specifications, including where applicable: details for
anchoring structures, proposed elevation of lowest floor (including basement), types of water-resistant
materials used below the first floor, details of floodprooting of utilities located below the first floor,
and details of enclosures below the first floor.
Also,
❑ Subdivision or other development plans. (If the subdivision or other development exceeds 50 lots or 5
acres, whichever is the lesser, the applicant must provide "100-year" flood elevations if they are not
otherwise available).
11 Plans showing the extent of watercourse relocation and/or landform alterations.
Change in water elevation(in feet) 0 Meets ordinance limits on elevation increases
❑ YES ❑ NO
IA.Top of new compacted till elevation ft. NGVD(MSL).
❑ Floodproofing protection level (non-residential only) ft. NGVD (MSL). For
floodproofed structures, applicant must attach certification from registered engineer or architect.
0 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 be submitted.
L] Other:
SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR)
I have determined that the proposed activity: A. ❑ Is
B. 0 Is not
in conformance with provisions of Local Law# , 19 . The permit is issued subject to the conditions
attached to and made part of this permit.
SIGNED DATE
If Box A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee.
If Box B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may
revise and resubmit an application to the Local Administrator or may request a hearing from Board of Appeals.
Application#
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LtNiZ0 — oc)04-
APPEALS: Appealed to Board of Appeals? U Yes U No
Hearing date:
Appeals Board Decision -Approved? U Yes LI No
Reasons/Conditions:
SECTION 6: AS-BUILT ELEVATIONS (To he submitted by APPLICANT before Certification of
Compliance is issued)
The following information must he provided for structures that are part of this application. This section must
be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this
application). Complete 1 and 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard
Areas, bottom of lowest horizontal structural member of the lowest floor, excluding piling(s) and
columns) is: ft. NGVD(MSL).
2. Actual (As-Built) Elevation of floodproofing protection is ft. NGVD(MSL).
SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project
to ensure compliance with the community's local law for flood damage prevention.
INSPECTIONS DATE: BY DEFICIENCIES? U Yes U No
DATE BY DEFICIENCIES? U Yes U No
DATE BY DEFICIENCIES? U Yes U No
SECTION 8: CERTIFICATE OF COMPLIANCE (To he completed by LOCAL ADMINISTRATOR)
Certificate of Compliance issued: DATE BY
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