6-4-024:017 - Laserfiche WebLink

Home

U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency I Expires March 31, 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. •SECTION A - PROPERTY INFORMATION For Insurance' Company Use Al. Building Owner's Name ,Policy Number Gordon Sakamoto r A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company,NAIC Number 64-951 Mamalahoa Highway City State ZIP Code Kamuela HI 96743 A3. Property De ription,,((LQQt and Block Numbers, Tax Parcel Number, Legal Description, etc.) T.M. K.l3F6-4-024-017 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential As. Latitude/Longitude: Lat. 20 01' 3 6 . 7 6 " Long. 1S5 39' 12.93" Horizontal Datum: ® NAD 1927 ❑ NAD 1983 A6. Attach at least 2 photographs of the building If the Certificate is being used to obtain flood Insurance. AT Building Diagram Number 5 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) NA sq ft a) Square footage of attached garage 400 sq fl b) No. of permanent good openings In the crawlspace or b) No. of permanent good openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade NA within 1.0 foot above adjacent grade Carport c) Total net area of good openings In A8.b NA sq In c) Total net area of flood openings In A9.b none sq in d) Engineered good openings? ❑ Yes ® No d) Engineered good openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION ii 4 2 - 04 Date Effective/Revised Date Zone(s) AO, use base good depth) 155166 0168E 0168E Sx�Sx79 5-16-94 AE 2771.5 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In Item B9. ❑ FIS Profile ® FIRM Community Determined ❑ Other (Describe) all. Indicate elevation datum used for BFE in Item B9: © NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) • B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date ❑ CBRS ❑ OPA SECTION C - Cl.. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, AR/AE, AR/Ai-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized RM16 Vertical Datum NGVD 1929 Elev.=2669.834 Conversion/Comments This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ®Yes ❑ No Certifier•sName Roger Dean Fleenor License Number TR 79.7E • i nie Owner company Name Roger Dean Fleenor LPLS LLC Address PO Box 383414 City Waikoloa State HI ZIP Code 96 Signature DateTelephone -880-9441 1-31-2011 808 FEMA�Forrrf �, Mar 09 LTA C-� See reverse side for continuation. c``g F�f ``+fib p LICENSED -p PROFESSIONAL LAND # SURVEYOR # No. 7276 Replaces all previous editions Check the measurement used. a) Top of bottom Floor (including basement, crawlspace, or enclosure floor) 2 7 7 5 . 4® feet a meters (Puerto Rico only) b) Top of the next higher floor NA feet meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) NA ❑ feet ❑ meters (Puerto Rloo only) d) Attached garage (top of slab) 2771 . 9 ® feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 2 7 74 . 4 ® feet ❑ meters (Puerto Rico only) (Describe type of equipment and location In Comments) 0 Lowest adjacent (finished) grade next to building (LAG) 2 7 7 0.. 8 ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) 2 7 71..7 ®feet ❑ meters (Puerto Rice only) h) Lowest adjacent grade at lowest elevation of deck or stairs, Including 277 . 9 ® feet ❑ meters (Puerto Rice only) structural support SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ®Yes ❑ No Certifier•sName Roger Dean Fleenor License Number TR 79.7E • i nie Owner company Name Roger Dean Fleenor LPLS LLC Address PO Box 383414 City Waikoloa State HI ZIP Code 96 Signature DateTelephone -880-9441 1-31-2011 808 FEMA�Forrrf �, Mar 09 LTA C-� See reverse side for continuation. c``g F�f ``+fib p LICENSED -p PROFESSIONAL LAND # SURVEYOR # No. 7276 Replaces all previous editions