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IMPORTANT- In these aneces. coot/ the cormoondina information from Section A. I For Insurance Company Use: I or P.O. BOX 1537 City KAMUELA State HI ZIP Code 96740 D - SURVEYOR ENGINEER, OR tiopy both sides of this Elevation Certificate for (1) community official, (2) insurance agenuoompany, and (3) building owner. Comments LOWEST EQUIPMENT IS A A/C UNIT ZONE AO 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 hems El -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, crawlspace, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A hems 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 ❑ abrnre 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 complain Sections A, B, and E for Zone A (without a FEMA4ssued or community -Issued BFE) or Zone AO must sign here. The statements in Sections A, A and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) and G of this Elevation Certificate. Complete the applicable dem(s) and sign below. Check the measurement used in Items G8 and G9. Gt. ❑ 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. Certificate G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-buih lowest floor (Including basement) of the building: _ _ ❑ feet ❑ meters (PR) Datum _ G9. BFE or (in Zone AO) depth of flooding at the building site: _ _ ❑ feel ❑ meters (PR) Datum G10. Communhy's design flood elevaTk* Department of Public Work ❑ feet ❑ meters (PR) Datum Engineering Division hor tevlu Title Local Official's Nam the fslovation Certificate and Community Name RT re[armmnn... Telephone Check here If attachments FEMA Form 81-31, Mar 09 Replaces all previous editions