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U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1880-0008
<br />Federal Emergency Management Agency I Expires March 31, 2012
<br />National Flood Insurance Program Important: Read the instructions on pages 1-9.
<br />SECTION A - PROPERTY INFORMATION For Insurance Company Use:..
<br />Al. Building Owner's Name Policy Number "
<br />AMATO-BAISLEY TRUST
<br />A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIL Number
<br />69-1866 PUAKO BEACH DRIVE
<br />City Stale ZIP Code
<br />KAMUELA HI 98743
<br />A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
<br />A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.)
<br />A5. Latitude/Longitude: Lat. 19.96529 Long. -155.85369 Horizontal Datum: ❑ NAD 1927 0 NAD 1983
<br />A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
<br />A7. Building Diagram Number 5
<br />A8. For a building with a crawlspace or enclosumis): A9. For a building with an attached garage:
<br />a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq H
<br />b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage
<br />enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade
<br />c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
<br />d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No
<br />SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />Bl. NFIP Community Name & Community Number B2. County Name B3. State
<br />HAWAII COUNTY -155168 HAWAII COUNTY I HAWAII
<br />B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
<br />❑ FIS Profile Q FIRM ❑ Community Determined ❑ Other (Describe)
<br />B11. Indicate elevation datum used for BFE in Item B9: x❑ NGVD 1929 ❑ NAVD 1988 [:)Other (Describe)
<br />812. Is the building located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes x❑ No
<br />•
<br />Designation Date ❑ CORS ❑ OPA
<br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br />Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction* ❑x Finished Construction
<br />'A new Elevation Certificate will be required when construction of the building is complete.
<br />C2. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, ARIA, AR/AE, AR/A7-A30, AR/AH, AR/AO. Complete Items C2.a-h
<br />below according to the building diagram specified in Item A7. Use the same datum as the BFE.
<br />Benchmark Utilized LOCAL BENCHMARK VeAicel Datum NGVD 1929
<br />Conversion/Comments
<br />B4. Map/Panel Number
<br />B5. Suffix
<br />B8. FIRM Index
<br />B7. FIRM Panel
<br />B8. Flood
<br />B9. Base Flood Elevation(s) (Zone l
<br />b) Top of the next higher floor
<br />-N.LJ A -
<br />Dale
<br />Effective/Revised Dale
<br />I
<br />Zone(s)
<br />AO, use base flood depth)
<br />❑ meters (Puerto Rico only)
<br />0278
<br />C
<br />APR 02, 2004
<br />SEPTEMBER 16, 1988
<br />VE
<br />8 FEET
<br />B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
<br />❑ FIS Profile Q FIRM ❑ Community Determined ❑ Other (Describe)
<br />B11. Indicate elevation datum used for BFE in Item B9: x❑ NGVD 1929 ❑ NAVD 1988 [:)Other (Describe)
<br />812. Is the building located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes x❑ No
<br />•
<br />Designation Date ❑ CORS ❑ OPA
<br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br />Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction* ❑x Finished Construction
<br />'A new Elevation Certificate will be required when construction of the building is complete.
<br />C2. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, ARIA, AR/AE, AR/A7-A30, AR/AH, AR/AO. Complete Items C2.a-h
<br />below according to the building diagram specified in Item A7. Use the same datum as the BFE.
<br />Benchmark Utilized LOCAL BENCHMARK VeAicel Datum NGVD 1929
<br />Conversion/Comments
<br />SECTION D - SURVEYOR. ENGINEER. OR ARCHITECT CERTIFICATION
<br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify eleA
<br />information. I certify that the information on this Certificate represents my bast efforts to interpret the date available.
<br />I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Semon 1001.
<br />x❑ Check here if comments are provided on back of forth.
<br />•Address city
<br />88-1125 NO.rKANIKU41OE UNIT 906 KAMUELA
<br />Were latitude and longitude in Section A rovided by a
<br />licensed land surveyor? El Yes (No _
<br />[W-00141111 Z1111:ViCIrl I.IHI
<br />FEMA Form 81-31, MNr 09 See reverse side for
<br />U
<br />Check the measurement used.
<br />a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
<br />13.30
<br />x feel
<br />Q meters (Puerto Rica only)
<br />b) Top of the next higher floor
<br />-N.LJ A -
<br />meters (Puerto Rico only)
<br />c) Bottom of the lowest horizontal structural member (V Zones only)
<br />12, 52
<br />❑x feet
<br />❑ meters (Puerto Rico only)
<br />d) Attached garage (top of slab)
<br />N.A
<br />❑ feet
<br />❑ meters (Puerto Rico only)
<br />e) Lowest elevation of machinery or equipment servicing the building
<br />10,15
<br />x❑ feet
<br />❑ meters (Puerto Rim only)
<br />(Describe type of equipment and location in Comments)
<br />I) Lowest adjacent (finished) grade next to building (LAG)
<br />5 05
<br />x❑ feet
<br />❑ meters (Puerto Rico only)
<br />g) Highest adjacent (finished) grade next to building (HAG)
<br />6, 35
<br />x❑ feet
<br />❑ meters (Puerto Rim only)
<br />h) Lowest adjacent grade at lowest elevation of deck or stairs, including
<br />6,61TE
<br />feet
<br />❑ meters (Puerto Rim only)
<br />SECTION D - SURVEYOR. ENGINEER. OR ARCHITECT CERTIFICATION
<br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify eleA
<br />information. I certify that the information on this Certificate represents my bast efforts to interpret the date available.
<br />I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Semon 1001.
<br />x❑ Check here if comments are provided on back of forth.
<br />•Address city
<br />88-1125 NO.rKANIKU41OE UNIT 906 KAMUELA
<br />Were latitude and longitude in Section A rovided by a
<br />licensed land surveyor? El Yes (No _
<br />[W-00141111 Z1111:ViCIrl I.IHI
<br />FEMA Form 81-31, MNr 09 See reverse side for
<br />U
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