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• O.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No.188o-9998 Federal Emergency Management Agency Elmires February 28.2009 National Flood Insurance Program Important: Read the Instructions on pages 1-8 SECTION A • PROPERTY INFORMATION For Insurance Camp" U ie: Al. BUIWnpOwnsfsName Lauer e_ � 'PolkyNuINNW A2. BulWirp Street Address (indudkhp ApL, Unfl, uhs, andlor Bldg. No.) or P.O. Route and Box No. ''Company NAIC Number 263 elnaltkk �sf C' Me Stale LI I ZIP Code __ w •.—r�•rm>.r ar.r • s t}2 t -F Aa. Building Use (e9•, tN"ation. AopBBapy ac.) ht sl Aey^m-7o Aa. LatttlLogflnMe:Let b^ O" L02'2. Ldnd, ��e OS 3^ W Horizontal Daturn• uep1192' ❑NAD1983 A8. Attach at bast 2 photographs of the bufidthg if the Certificate Is being wed to obtain flood insurance. A7. Building Diagram Number A8. For a building with a crawl space or enclosure($), provide: A9. For a building with an etadmsd garage, provide: a) Square footage of crawl space or endosure(s) 14/A sq ft a) Square footage of attached garage 4{829 sq R b) No. of permanent flood openings In the crawl space orb) b) No. of permanent flood openinpa In to atlechod enclosure(s) walls within 1 A foot above adjacent grade walla within 1.0 foot above adjaoantgrade Q Total net area of flood openings in ABA, aq In c) Total net area of flood openings In A9.b sq rage in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B7. NFIP Community Name ti Community Number B2. Couny Name 83.yyele Hawaii Count 155166 Hawaii CountyHawaii 8s. MaplPanal Number 155166. 0�' 0 Bin Indbxb Iha .. M B5.Su@x C M o... 88. FIRM Index Date 4/02/04 B7. FIRM Panel E bete t b $ W. Flood Zonas) S 59. Base Flood Ebvetion(a) (Zone AO. use base flood depth) 22 t ' - - FI �1 99„ io..r u9w m cruse noon oepm emerea m item 89. ❑ FIS Preflb .IN FIRM ❑ Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE In Item 89: ® NGVD 1929 ❑ NAVD 1988 ❑ other (Describe) 612. Is 00 nabuilding� ted Ina Coastal Bonier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 ❑ Yes ® No Desigtion ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building ebva9ons are based on: ❑ Construction Drew Inge ❑ Bantling Under Construction- Finished Construction A new Elevation Certificate will be required when ConsWdbn of the building is complete. r C2. Elevations -Zones At -A30, AE, AH. A (with BFE). VE, V1430, V (width BFE), AR. AR/A, ARAE, AR/A1-A30, ARIAH, ARIAO, Complete Rama C2." below according to the building diagram specified in Item A7. Benchmark LUIM - Vertical Datum N W 29 CamrersksVCom rents 4t4r chAd Check One measurement used. a) Top of bottom floor (Including basement, crawl spcce, or enclosure Boor)2 (ret El maters (Puerto Rice only) b) Top of the next higher floor —r❑ -h feet El meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones any) N L� feet ❑ meters (Puerto Rao ordy) a) Attached garage (top d slab) .W® feet El meters (Puerto Rico only) e) Lowest elevation Of machinery or equipment servicing the building _ 228 , If o feet ❑ meters (Puerto Rico only) (Describe lype at equipment in Comments) 1) Lowest adjacent (finished) grade (LAG)_ �.�® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) gratia (HAG) 1'L� Q, feel ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or archted authorized by law to certty elevation Information. I certify met the information on this Certificate represents my beat ~a to Interpret the date available. 11 understand that any /else afatement maybe punishable by fine ormnpdadnmerd under 18 U.S. Code, Section 1001. bpm Check here ti comments are provided on bade o1 norm. 'EP L Certifiers Name PRO �JcW lteA !A License Number ^ l0'� (p0 * E�H Title Company Name ty1L +1r+�e__. No. 107WC� Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions