FORM NO. 1
PRELIMINARY PLAT CHECKLIST
PRELIMINARY PLAT CHECKLIST
Date Application Number
Subdivision
The following item(s) (does, does not) conform to the requirements of the Shelby Subdivision Regulations. Those items not conforming are explained on the final page.
Does Does Not Item
1. Name of subdivision (no duplication permitted)
2. Description of location
3. Name and address of owner, subdivider, surveyor and engineer
4. Sheet size not larger than 24" x 36" (index sheet, if more than 1 sheet)
5. Proper scale
6. Date and north point
7. Vicinity map
8. Names of adjacent subdivisions and owners
9. Zoning classification of all major parcels and proposed changes
10. Topography at 2' intervals
11. Location, width and names of existing streets, rights of ways and easements
12. Location and dimensions of existing buildings and parks
13. Corporation, township, range and section lines
14. Location of existing utilities, including sewers, water lines and communication lines or poles
15. Layout, names and widths of proposed streets or easements and proper dedications
16. Layout and approximate dimensions of all lots
17. Building setback lines
18. Survey monuments of adjacent properties
19. Parks and open spaces and proper dedications
20. Proposed use of lots
21. Copy of proposed deed restrictions, if any
22. Sewage treatment and percolation test results
23. Adequate preliminary improvement plans
24. Construction estimates
25. Required certifications
Date
Title or Position
Signature
FORM NO. 2
FINAL PLAT CHECKLIST
FINAL PLAT CHECKLIST
Date Application Number
Subdivision
The following item(s) (does, does not) conform to the requirements of the Shelby Subdivision Regulations. Those items not conforming are explained on the final page.
Does Does Not Item
1. Submitted within 12 months of preliminary approval
2. Conform to preliminary plat and incorporates suggested changes
3. Name of subdivision
4. Proper scale
5. Date and north point
6. Description of location
7. Sheet size not larger than 24" x 36" (index sheet, if more than 1 sheet)
8. Name and address of owner, surveyor and engineer
9. Accurate survey data; seconds; linear dimensions to hundredths of feet; radii; internal angles; points of curvature; tangent bearing; lengths of arcs; lengths and bearings of chords
10. Closure
11. Bearings and distances to permanent monuments
12. Name, location, width and centerline of streets
13. Lot numbers and dimensions
14. Location and description of monuments
15. Building setback lines
16. Parks and open spaces and proper dedications
17. Final deed restriction
18. Final improvement plans
19. Installation or guarantee of installation of improvements
20. Required final certifications
Date
Title or Position
Signature
FORM NO. 3
TECHNICAL DESIGN AND IMPROVEMENT CHECKLIST
TECHNICAL DESIGN AND IMPROVEMENT CHECKLIST
The following item(s) (does, does not) conform to or does not apply (NA) to the requirements of Chapters 1246 and 1248 of the Shelby Subdivision Regulations. Those items not conforming are explained on the final page.
Does Does Not NA Item
GENERAL
1. Conformity with Major Street Plan
2. Conformity with zoning regulations, or if no zoning, § 1246.04(d) applies
3. Not located in flood plain
4. Acceptable natural drainage and erosion control
5. Steep slopes not limiting factor
6. Large trees and other significant natural features
7. Area of historical or cultural significance
STREETS
8. Right-of-way widths
9. Pavement widths
10. Radius of curvature
11. Horizontal visibility
12. Vertical alignment and visibility
13. Grades
14. Cul-de-sacs
15. Turn-around radius - ROW - and pavement
16. Dead-end streets
17. Dedication and addition of half streets
18. Marginal access streets, points of access and planting strips
19. Alleys
20. Alignment of intersections
21. Spacing of intersection relative to different road classifications
22. Avoidance of multiple intersections
23. Avoidance of 4-way intersections
24. Pavement and ROW of intersections
25. Streets for commercial subdivisions
26. Provisions for repair of pavement
27. Streets for industrial subdivision
28. Length of blocks
29. Crosswalks
30. Street monuments
31. Subgrade
32. Base course
33. Surface course
34. Curbs and gutters
35. Bridges
36. Sidewalks
37. Street names and numbers, signs
Does Does Not NA Item
LOTS
38. Size
39. Setback lines
40. Corner lot size
41. Avoidance of double frontage lots
42. Driveway culverts and grade
43. Monuments
44. Grading plan
45. Parks and open spaces
46. Type of water supply
47. Test wells
48. Type of sewage treatment
49. Percolation test results
50. Storm drainage system type
51. Manholes
52. Catch basins
53. Headwalls
54. Sufficient easements for utilities or open drainage
55. Other utilities
56. Underground utilities
Date
Title or Position
Signature
FORM NO. 4
APPLICATION FOR TENTATIVE APPROVAL OF PRELIMINARY PLAT
APPLICATION FOR TENTATIVE APPROVAL OF PRELIMINARY PLAT
Shelby, Ohio
Date Application Number
1. Name of applicant
Address
Phone
2. Name of surveyor or engineer
Address
Phone
3. Name of subdivision
4. Description of location: Section Township
Range Other
(In addition, please attach copy of legal description)
5. Proposed use
6. Present zoning district
7. Proposed zoning changes
8. Number of lots Area of parcel
9. Do you propose deed restriction? Yes No
(If yes, please attach a copy)
10. What type of sewage disposal do you propose?
If an "on lot" type of sewage disposal is proposed, include a letter from the City and/or County Board of Health approving a specific type of sewage disposal.
11. List all proposed improvements and utilities and state your intention to install or post a guarantee prior to actual installation.
Improvement Installation Guarantee
a.
b.
c.
d.
e.
f.
12. List other materials submitted with this application
Item No.
a.
b.
c.
d.
e.
f.
Applicant Surveyor or Engineer
- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
For Official Use
Date received
Date of meeting of City Planning Commission
Action of City Planning Commission
If plat rejected, reason(s) for rejection
Date
Chairperson
FORM NO. 5
APPLICATION FOR FINAL PLAT APPROVAL
APPLICATION FOR FINAL PLAT APPROVAL
Shelby, Ohio
Date Application Number
1. Name of applicant
Address
Phone
2. Name of surveyor or engineer
Address
Phone
3. Name of subdivision
4. Date preliminary plat approved
5. Was a zoning change requested? Yes No
6. If yes, the plat may not be approved until it conforms to local zoning. Include a certification of zoning compliance if a change is requested.
7. Have all required improvements been installed? Yes No
If no, include detailed estimates of cost and a statement relative to the method of improvement guarantee. All estimates must be approved by the responsible city official.
8. Do you propose deed restrictions? Yes No
(If yes, please attach a final copy.)
9. List other materials submitted with this application.
Item No.
a.
b.
c.
d.
e.
f.
g.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
For Official Use
Date received
Date of meeting of City Planning Commission
Plat fee $ Inspection fee $
Action by City Planning Commission
If plat rejected, reason(s) for rejection
Date
Chairperson
FORM NO. 6
APPLICATION FOR MINOR SUBDIVISION APPROVAL
APPLICATION FOR MINOR SUBDIVISION APPROVAL
Shelby, Ohio
Date Application Number
The undersigned applies for minor subdivision approval under Ohio R.C. 711.131 and certifies that all material submitted with this application is true and correct. Action must be taken within seven working days.
Signature
Address
Phone
Minor subdivision approval may be granted only under the following conditions:
1. The proposed subdivision is along an existing public road and involves no openings, widening or extension of any street.
2. No more than five lots are involved after the original parcel has been completely subdivided.
3. The subdivision is not contrary to applicable platting, subdividing or zoning regulations. A variance can only be requested before the entire Commission.
4. The property has been surveyed and a sketch and legal description are submitted.
Note: City Charter, § 98, requires a plat for any subdivision. The subdivider is advised to review the requirements of the Charter.
(Ord. 13-2019, passed 7-15-2019)
FORM NO. 7
APPLICATION FOR SUBDIVISION VARIANCE
APPLICATION FOR SUBDIVISION VARIANCE
Shelby Planning Commission
Shelby, Ohio
Date Application Number
Name
Address
Phone
1. Description of location
2. Nature of variance requested. Describe generally the nature of the variance.
3. Justification of variance. On a separate sheet, please attach a statement relative to why the variance from requirements of the Subdivision Regulations is requested. Address and include such items as:
a. Exceptional topographical or other conditions peculiar to this particular parcel of land;
b. Why a literal interpretation of the Regulations would deprive the applicant of rights enjoyed by other property owners;
c. That the peculiar conditions do not result from previous actions of the applicant;
d. That the requested variance is the minimum variance that will allow a reasonable division of the land;
e. A sketch of the area showing the location and characteristics of the requested variance.
I certify that all information contained in this application and its supplements is true and correct.
Signature
FORM NO. 9
CERTIFICATION FOR MAJOR SUBDIVISION
CERTIFICATION FOR MAJOR SUBDIVISION
Subdivision Plat Required Statement
The undersigned hereby certify that the attached plat correctly represents their " ", a subdivision of lots to dedicate to public use as such all of the streets, roads, boulevards, cul-de-sacs, parks, planting strips and the like, shown herein and not heretofore dedicated.
The dimensions of the lots and streets are shown on the plat in feet and decimal parts thereof. Easements are reserved where indicated on the plat for public utility purposes above and beneath the surface of the ground.
In witness whereof have set their hands this day of , 20 .
Witness: Signed:
We do hereby certify that we have surveyed the premises and prepared the attached plat and that said plat is correct; that all required survey monuments are correctly shown thereon; that those which are necessary for construction of improvements are in place on the site and that any remaining survey monuments will be properly placed upon completion of construction.
By:
Licensed Land Surveyor
STATE OF OHIO )
) SS
CITY OF SHELBY )
Before me a Notary Public in and for said city personally came who acknowledged the signing of the foregoing instrument to be their voluntary act and deed for the uses and purposes therein expressed.
In witness whereof I have hereunto set my hand and affixed my official seal this day of , 20 .
Notary Public
FORM NO. 10
APPROVALS FOR MAJOR SUBDIVISION
APPROVALS FOR MAJOR SUBDIVISION
Within the Three-Mile Limit of the City
Approved this day of , 20 .
Secretary, City Planning Commission,
Shelby, Ohio
Approved this day of , 20 .
City Engineer
Approved this day of , 20 .
Richland County Engineer
Approved this day of , 20 .
Richland County Sanitary Engineer
Approved this day of , 20 .
Richland County Department of Health
Approved this day of , 20 .
Director, Richland County Regional
Planning Commission
Approved and accepted this day of , 20 and the roads, boulevards, and the like, herein dedicated to public use are hereby accepted as such for the County of Richland, State of Ohio.
Richland County Commissioners
Transferred this day of , 20
Richland County Auditor
Filed for record this day of , 20
at _______M. Recorded this day of , 20 in Plat Book , Page Number .
Richland County Recorder
Within the City
Approved this day of , 20 .
Secretary, City Planning Commission
Approved this day of , 20 .
City Engineer
Approved this day of , 20 .
City Health Commissioner
NOTE: If public sewer and water are available, the plat need not be signed by the Richland County Health Department or the City Health Commissioner.
FORM NO. 10A
REQUIRED STATEMENTS AND SIGNATURES TO BE AFFIXED ON THE SUBDIVISION PLAN WITHIN THE CITY
REQUIRED STATEMENTS AND SIGNATURES TO BE AFFIXED ON THE SUBDIVISION PLAN WITHIN THE CITY
CITY OF SHELBY ENGINEER APPROVAL
I hereby approve the above plat and dedication. No acceptance of the dedicated streets upon the public road system is meant or implied.
Dated: _______________________ __________________________________________________
Name
Shelby City Engineer
CITY OF SHELBY HEALTH COMMISSIONER APPROVAL
I hereby approve the within plat and dedication.
Dated: _______________________ __________________________________________________
Name
City of Shelby Health Commissioner
CITY OF SHELBY PLANNING COMMISSION
I hereby certify that the within plat and dedication were duly approved by the Shelby Planning Commission at its regular meeting held on the _______ day of _________________________, 20______.
Dated: ________________________ __________________________________________________
Name
Chairperson
CITY OF SHELBY COUNCIL APPROVAL
I hereby certify that the within plat on dedication were duly approved by the Council of the City of Shelby, Ohio, at its regular meeting on _________ day of _________________________, 20______.
Dated: _________________________ __________________________________________________
Name
Clerk
Performance Guarantees-Amount
I hereby certify that a performance guarantee in the amount of ________________ for the construction of required improvements for the land contained in this plat have been provided and approved as to amount.
Dated: __________________________ __________________________________________________
Name
Shelby City Engineer
Performance Guarantees-Form
I hereby certify that a performance guarantee in the amount of ________________ for the construction of required improvements for the land contained in this plat have been provided and approved as to form.
Dated: ___________________________ ___________________________________________________
Name
Shelby Law Director
Auditor's Transfer
I hereby certify that these platted lands were transferred on the _________ day of __________________________, 20______.
Dated: ___________________________ ___________________________________________________
Name
Richland County Auditor
County Recorder
Filed for record this _________ day of __________________________, 20_____, at ________________(time). Recorded this ___________ day of ________________, 20_____, in Plat Volume ______________, Page ______________.
Dated: ___________________________ ___________________________________________________
Name
Richland County Recorder
Tax Certification
I hereby certify that there are no delinquent taxes or delinquent special assessments against the land contained in this plat.
Dated: ___________________________ ___________________________________________________
Name
Richland County Auditor
Tax Map Office Approval
I hereby certify that this plat has been approved.
Dated: ___________________________ _______________________ ___________________________
Name
Tax Map Office
(Ord. 1-2004, passed 2-2-2004)
FORM NO. 10B
REQUIRED STATEMENTS AND SIGNATURES TO BE AFFIXED ON THE SUBDIVISION PLAN WITHIN THE THREE-MILE LIMIT OF CITY
REQUIRED STATEMENTS AND SIGNATURES TO BE AFFIXED ON THE SUBDIVISION PLAN WITHIN THE THREE-MILE LIMIT OF CITY
CITY OF SHELBY ENGINEER APPROVAL
I hereby approve the above plat and dedication. No acceptance of the dedicated streets upon the public road system is meant or implied.
Dated: ___________________________ ___________________________________________________
Name
Shelby City Engineer
RICHLAND COUNTY ENGINEER APPROVAL
I hereby approve the above plat and dedication. No acceptance of the dedicated streets upon the public road system is meant or implied.
Dated: ___________________________ ___________________________________________________
Name
Richland County Engineer
CITY OF SHELBY HEALTH COMMISSIONER APPROVAL
I hereby approve the within plat and dedication.
Dated: ___________________________ ___________________________________________________
Name
City of Shelby Health Commissioner
RICHLAND COUNTY HEALTH COMMISSIONER APPROVAL
I hereby approve the within plat and dedication.
Dated: ___________________________ ___________________________________________________
Name
Richland County Health Commissioner
CITY OF SHELBY PLANNING COMMISSION
I hereby certify that the within plat and dedication were duly approved by the Shelby Planning Commission at its regular meeting held on the ____________ day of _______________________, 20_______.
Dated: ___________________________ ___________________________________________________
Name
Chairperson
RICHLAND COUNTY REGIONAL PLANNING COMMISSION
I hereby certify that the within plat and dedication were duly approved by the Richland County Regional Planning Commission at its regular meeting held on the _______ day of _____________________, 20_______.
Dated: ___________________________ ___________________________________________________
Name
Director
CITY OF SHELBY COUNCIL APPROVAL
I hereby certify that the within plat and dedication were duly approved by the Council of the City of Shelby, Ohio, at its regular meeting on __________ day of ________________________, 20______.
Dated: ___________________________ ___________________________________________________
Name
Clerk
COUNTY COMMISSIONERS APPROVAL
I hereby certify that the within plat and dedication were duly approved by the Board of Commissioners of Richland County, Ohio, at its regular meeting on the ________ day of ________________________, 20______.
Dated: ___________________________ ___________________________________________________
___________________________________________________
___________________________________________________
Richland County Commissioners
Performance Guarantees-Amount
I hereby certify that a performance guarantee in the amount of ________________ for the construction of required improvements for the land contained in this plat have been provided and approved as to amount.
Dated: __________________________ __________________________________________________
Shelby City Engineer
Performance Guarantees-Form
I hereby certify that a performance guarantee in the amount of ________________ for the construction of required improvements for the land contained in this plat have been provided and approved as to form.
Dated: ___________________________ ___________________________________________________
Shelby Law Director
Auditor's Transfer
I hereby certify that these platted lands were transferred on the ____________ day of __________________________, 20______.
Dated: ___________________________ __________________________________
Richland County Auditor
County Recorder
Filed for record this _________ day of __________________________, 20_____, at ________________(time). Recorded this ________ day of ________________, 20_____, in Plat Volume ______________, Page ______________.
Dated: ___________________________ __________________________________
Richland County Recorder
Tax Certification
I hereby certify that there are no delinquent taxes or delinquent special assessments against the land contained in this plat.
Dated: ___________________________ __________________________________
Richland County Auditor
Tax Map Office Approval
I hereby certify that this plat has been approved.
Dated: ___________________________ __________________________________
Tax Map Office
(Ord. 1-2004, passed 2-2-2004)
FORM NO. 11
EXTENSION AGREEMENT FOR APPROVAL OR DISAPPROVAL OF SUBDIVISION PLAT BY CITY PLANNING COMMISSION
EXTENSION AGREEMENT FOR APPROVAL OR DISAPPROVAL OF SUBDIVISION PLAT BY CITY PLANNING COMMISSION
Pursuant to § 1244.05(e) of the City of Shelby Subdivision Regulations and Ohio R.C. § 711.10, the time for approval or disapproval of the plat of submitted by is hereby extended to , 20 .
No plat shall be recorded until it is approved by the City Planning Commission and such approval is endorsed in writing on the plat. The approval of the Planning Commission or the refusal to approve shall be endorsed on the plat within 30 days after the submission of the plat for approval, or within such further time as the applying party may agree to.
This agreement constitutes the agreement of the applying party to an extension of time beyond the 30-day period for approval or disapproval.
Applying Party
Dated:
Date plat submitted to City
Planning Commission:
Extended Date:
(Ord. 17-83, passed 6-6-1983)