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IMPORTANT: In these spaces, copy the corresponding information from Section A. 1.'For )nsurenns crvrimnv I nunamg btreet Atioress (incwamg Apt., unit, suite, anmor bldg. No.) or P.O. Route and Box No. 4P.oliey Number','t-" WAI OPAE ROAD City PAHOAState HI ZIP Code 96778 .;Comoanv.NAM Nrrmhar, -i .dilk_ SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) 1W both sides of this Elevation Certificate for (1) community official, (2) insurance agent/cempany, and (3) building owner. Comments HE BENCH MARK USED IS A SURVEYOR SET BEANCH MARK BASED ON A USG5 BENCH MARK. THE EQUIPMENT CONSIS OD A HOT WATER HEATER, A SMALL COMPRESSOR AND THE CONTROLS FOR THE AEROBIC SEPTIC SYSTEM AND NORMAL KITCHEN APPLIANCES n Signature Date 3/31/2010 ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a.LOMA or LOMR-F request, complete Sections A. B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, erawlspaoe, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided In Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building Is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building Is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only. if no flood depth number is available, is the top of the bottom floor elevated In accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -Issued or community -issued BFE) or Zone AO must sign here. The statements In Sections A, B, and E are coned to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name as City State ZIP Code Signature Date Telephone Comments or and G of this Elevation Certificate. ❑ Check he it attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) �mmance, to aammrster me communnys n000pmm management ordinance can complete 5 the applicable item(s) and sign below. Check the measurement used In Items G8 and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. Permit Number I G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: _ _ ❑ feet ❑ meters (PR) Datum _ G9. BFE or (in Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters (PR) Datum _ G10. Community'e design flood elevation Us' DrepOrfinert of P:;bk—W*&9 ❑ feet ❑ meters (PR) Datum _ Local Official's Name i Tmir - __ _fiie Efevafion Corrificnfe and recommends Signature Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions