2-4-006:153 - Laserfiche WebLink

Home

IMPORTANT: In these spaces, copy the corresponding Information from Section A. Por+pr�V�ra',(p ). Bulidino Street Address (mcludina Apt., Unit, Suite, anwor Bdg. No.) or P.O. Route and Box No. "—Policy NSRtbes'7(1,%*,? 1 00 HOAKA ROAD CNy HIL(1State HI ZIP Code e6720 OR ARCHITECT Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agenVeompany, and (3) building owner. Comments MACHINERY REFFERED TO IN C2.E CONSISTS OF HOTWATER TANK AND LAUNDARY MACHINES. Sipnalure Date 37 JAN. 11 FOR. ZONE AO AND ZONE A For Zones AO and A (without BFE), complete Items EI -E5, If the Certificate Is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items Et -E4, use natural grade, R available. Check the measurement used. In F'uarto Rice only, enter maters. 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). s) Top of bottom floor (including basement, crewlspace, or enclosure) is _ ❑ feel ❑.meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, cmwlspace, 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 andror 9 (sea pages 8-9 of Instructions), the noxi higher floor (elevation C2.b in the diagrams) of the building is ,........ _ _ ❑ feet ❑ meters ❑ above or U below the HAG. E3. Attached garage (lop of slab) is ❑ feet ❑ motes ❑ above or ❑ below the HAG, E4. Top of platform of machinery andtor equipment servkkg the budding is —.—[I feet ❑ meters []above or ❑ below the HAG. Eb. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated In neeordance with the communitys 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 owners authorized representative who completes Sections A B, and E for Zone A (without a FEMA-tssued or community4asuad BFE) or Zone AO must sign here. The stalernanis in Sodlons A. B. and E am correct to rhe bas(of my knowledge. Property Owners or Owners Authorized Represenlattve's Name . Address --.. .----- ._.... ._.-.. City state ZIP Code Signature Comments Date Telephone SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local off cal who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A. B. C (or E), and G of this Elevation Certificate. Complete the applicable ilem(s) and sign below. Check the measurement used in items G8 and G9. G7. ❑ 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-iesuod or community -issued BFE) or Zone AO. G3. ❑ The following Information (nems G4 -G9) is providod for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G0. Date Carllhcale Of CompliancelOoeupancy 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 fldoding at the building site: G10. Community's design flnad elevation Local Official's Name Community Name Signature Comments ❑ feel ❑ motors (PR) Datum _ ❑ feet ❑ meters (PR) Datum _ Title .... Telephone Date ❑ Check here if Attachment FEMA Form 81-31, Mar 09 Replaces all previous editions