Record Plat Application: Maryland-National Capital Park and Planning Commission

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An application will not be accepted for review unless all required information and fees are provided.
Record Plat Name: __________________________________________________Acres:________ (Acres=square feet/43,560)
Location: (Complete either A or B)
A. On ____________________________________, _______ feet ____________ of ___________________________
Street Name (N,S,E,W etc.) Nearest Intersecting Street
B. ________ quadrant, intersection of ________________________________ and _____________________________
(N,S,E,W etc.) Street Name Street Name
C. If Minor Subdivision box is checked, enter tax account number (8 digits): (a)_______________ (b)_________________
Applicant Information:
Applicant (Owner, Owners Representative, or Contract Purchaser check applicable; written verification required if not the owner.)

Name Contact Person
Street Address

City State Zip Code
Telephone Number ext. Fax Number E-mail
Surveyor/Engineer

Name Contact Person
Street Address

City State Zip Code
Telephone Number ext. Fax Number E-mail

Montgomery County Planning Department
Maryland-National Capital Park and Planning Commission

Effective: June 1, 2012
8787 Georgia Avenue Phone 301-495-4550
Silver Spring, Maryland 20910-3760 www.montgomeryplanning.org Fax 301-495-1306
RECORD PLAT APPLICATION

Minor Subdivision
Multiple Plat
Applications
M-NCPPC Staff Use Only

File Number
Date Application Received

2____________________
____________________
Fee (attach worksheet)
Fee Received by
Application Completed by
____________________
____________________
____________________

Record Plat Application 2 of 4

Pre-Preliminary, Preliminary and Site Plan Information:

Pre-Preliminary Plan File Number 7 _________________

Preliminary Plan File Number 1 _________________

Site Plan File Number 8 _________________

Plat Information:
Existing Zoning: ________________ , ________________ , ________________ , ________________
Area of Dedication ___________ Square Feet (SF=Acreage x 43,560) Plat is for ROW Dedication Only.
Plat is for Reservation of Public Land Only.
Development Type
Number of
Lots or Parcels
Number of
DUs
Square Footage MPDUs TDRs BLTs
RESIDENTIAL

NON-RESIDENTIAL

Attach Separate Sheet with TDR and BLT serial numbers (example 10-6222)
No. of non-development Parcels (e.g. open space) shown on plat _______ No. of Outlots shown on plat ______

Are there any legal restrictions (i.e. covenants or easements) other than shown on plat? Yes No
(If yes, describe in a separate document and submit)

Is this Application being filed under the Minor Subdivision Process (see Section 5)? Yes No
If yes, identify the sub-section of Sec. 50-35A that applies to your Minor Subdivision application. Sec 50-35A(a) [______]
Sanitary Facilities Information:
Public Water Public Sewer Well Septic Date of Septic Approval ____/____/____
Signature of Applicant (Owner or Contract Purchaser)
Applicant hereby certifies that he/she is the sole owner of the subject property, is otherwise legally authorized to represent the owner(s)
(written verification provided), or is a contract purchaser authorized to submit this application by the property owner (written verification
provided).

_______________________________________________________ _____________________
Signature Date

_______________________________________________________
Name (Type or Print)

Checklist
See Submission Requirements for more details about the items below: No.
Copies

Engineer/
Surveyor

M-NCPPC Staff
1. General Information
1.1 Completed application form and checklist!!!!!!!!!!!!!!!!!

1

Submitted or Waived By

Accepted or Not Accepted
1.2 Completed fee schedule and worksheet with fee!................!.!!!!!!.! 1
2. Subdivision

2.1 Copy of approved and signed Pre-Preliminary or Preliminary Plan and the
Resolution!!!!!!!!!!!!.!!!!!!.!...!!!!!!!!!.. 1

2.2 Copy of approved and signed Site Plan and the Site Plan Resolution (if
required)!!!!!!!!!!!!!!!!!!!!..!!!!!!!!!!. 1

2.3 Copy of approved Forest Conservation Plan or approved FCP Exemption !!.. 1
2.4 Identification of all Agreement and Easement documents that must be approved
and recorded with the Record Plat!!!!!..!!!!!!!!!!!!!! 1

3. TDR/BLT Requirements (submit prior to recordation)

3.1 Copy of TDR/BLT Easements!!.!!!!!!!!!!!!!!..................... 1
3.2 Copy of TDR/BLT Transfer!!!!!!!!!!!!!!!!!!!!!!!. 1
4. Child Lot Affidavit !!!!!!!!!!!!!!!!!!!!!!!..................... 1
5. Minor Subdivision

5.1 Previously approved record Plat!!!!!!!!!!!.!!!..!!!!!!.. 2
5.2 Approved sketch plan or approved Pre-Application Plan, if required!!!!!! 1
5.3 Approved Forest Conservation Plan, Approved Forest Conservation Exemption, or
an approved Natural Resources Inventory/Forest Stand Delineation plus a
Preliminary Forest Conservation Plan, if required (see section 5.3 for further
information) !!!!!!!!!!!!!!!!!!!!!!!!!!!!!. 1

5.4 Agreements, covenants, easement documents, or other
restrictions!!!!!!!!!!!!!!!!!!!!!!!!!!!!.!... 1

5.5 Appropriate Deed of Transfer, Abandonment Resolution, or Other Necessary
Documents (see section 5.5 for further information) !!!!!!!!!!!!.. 1

5.6 MCDEP record plat information form...!!!!!!!!!!!!!!!!!! 1
6. Record Plat (folded prints)

10

6.1 Title Block.!!!!!!!!!!!!!!!!.!!!..!!!!!!!!.!!.
6.2 Subdivision Plan Drawing!!!!!..!!!!..!!!!!!!!!!!!.!..
6.3 Surveyor/Engineer Certificate!!!!!!!!!...!.......!!!!!!!!!..
6.4 Owner(s) Certificate!!!...!!!!!!!!!!!!..!!!!!!!..!!.
6.5 Approval Box!!.!!!!!!!!!!!!!!!!!!!.!!.!!!..!..
7. List of Proposed Street Names 2
7.1 This list and the information specified in 8 below may also be submitted for
approval before the record plat application to DARC at mcp-
addresses@montgomeryplanning.org. If street names have been previously
approved, submit the list of approved names with the plat.

8. Information in Digital Form for an Address Plan
8.1 CAD file of the approved subdivision in format specified in submission
requirements. 1

8.2 EXCEL spreadsheet of properties to have assigned addresses 1
Please note that the record plat in digital form and the mylar original of the plat should not be submitted with the application. These items should be submitted after completion
of staff review.


Signature of Surveyor /Engineer
The surveyor or engineer or has read and understands the record plat submission requirements and hereby certifies that all required
information for the submission of a record plat has been included in this application
______________________________________________________ ______________________
Signature Date
______________________________________________________
Name (Type or Print)

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