Fillable 3200 Civic Center Circle NE Suite 130 Rio (City of Rio Rancho)

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3200 Civic Center Circle NE Suite 130 Rio (City of Rio Rancho)

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BROWSE CITY OF RIO RANCHO (NM) FORMS

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City of Rio Rancho
● 3200 Civic Center Circle NE ● Suite 130 ● Rio Rancho, NM 87144
DS-ENG-01 (E)
FLOODPLAIN PERMIT APPLICATION
Revised: July 2015 Page 1
Instructions and Applicant Information
This application is for residential and commercial development. Complete the sections as follows:
Section A: Complete for all work.
Section B: Complete for new structures and building sites.
Section C: Complete for alterations, additions, or improvements to existing structures.
Section D: Complete for non-residential flood proofed construction.
Section E: Complete for subdivisions and planned unit developments.
Property Address:
Address
City
State
Zip
Subdivision
Unit
Block
Lot
Owner Name:
Owner Phone:
Owner Address:
Address
City
State
Zip
Builder:
Builder Phone:
Builder Address:
Address
City
State
Zip
Section A: Description of Work
1. Proposed development description:
New Building
Improvement to Existing Building
Manufactured Home
Filling
Other
2. Size and location of proposed development.
Site plan attached
3. Is the proposed development in a Special Flood Hazard Area (Zones: A, AE, A1-A30, AH, or AO)?
Yes
No
4. Per the Flood Insurance Rate Map (FIRM), what is the zone and panel number of the area of
the proposed development?
Zone:
Panel Number:
5. Are other Federal, State, or local permits obtained?
Yes
No
Type:
City of Rio Rancho
● 3200 Civic Center Circle NE ● Suite 130 ● Rio Rancho, NM 87144
DS-EN-01
FLOODPLAIN PERMIT APPLICATION
Revised: July 2015 Page 2
Section A Continued
6. Is the proposed development in an identified floodway?
Yes
No
7. If yes to #6, is a “No Rise Certification” with supporting data attached?
Yes
No
Section B: New Structures and Building Sites
1. Base Flood Elevation at the site:
Feet NGVD 29
2. Required lowest floor elevation (including basement):
Feet NGVD 29
3. Elevation to which all attendant utilities, including all heating and electrical equipment will
be protected from flood damage: Feet NGVD 29
Section C: Alterations, Additions, or Improvements to Existing Structures
1. What is the estimated market value of the existing structure? (Attach documentation)
$
2. What is the cost of the proposed construction (Attach documentation)
$
3. If the cost of the proposed construction equals or exceeds 50% of the market value of the
structure, then the substantial improvement provisions shall apply.
The proposed construction = of the market value of the structure.
Section D: Non-Residential Flood Proofed Construction
1. Will the subdivision or other development contain 50 lots or 5 acres?
Yes No
2. If yes to #1, 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
Section E: Other Permits
1. Is a US Army Corps of Engineers 404 permit required? (Attach copy of Issued Permit)
Yes No
2. Is a Rio Rancho Endangered Species Act Categorical Exclusion Checklist (DS-ENG-02 (E))
required? (Attach copy of completed checklist)
Yes No
0%
City of Rio Rancho
● 3200 Civic Center Circle NE ● Suite 130 ● Rio Rancho, NM 87144
DS-EN-01
FLOODPLAIN PERMIT APPLICATION
Revised: July 2015 Page 3
Acknowledgement and Signature
The undersigned hereby makes application for a permit to develop in a designated floodplain area. The work
to be performed is described in this form and in attachments hereto. The undersigned agrees that all such
work shall be done in accordance with the requirements of the City of Rio Rancho Floodplain Ordinance and
with all other applicable local, State, and Federal regulations. This application does not create a liability on
the part of the City of Rio Rancho or any officer or employee thereof for any flood damage that results from
reliance on this application or any administrative decision made lawfully thereunder.
Applicant’s Signature:
Date:
The rest of this page is left intentionally blank.
FOR DEPARTMENT USE ONLY
Permit is:
Approved
Denied (Statement Attached)
Elevation Certificate Attached?
Yes
No
As-Builts lowest floor elevation?
Feet NGVD 29
Work inspected by:
Conditions:
Local Administrator Signature:
Date:
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3200 Civic Center Circle NE Suite 130 Rio (City of Rio Rancho)

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Completed 10 February 2021

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