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U.S. DEPARTMENT OF HOMELAND SECURITY redefal Emerg6ncy Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. A - PROPERTY INFORMATION Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. OMBNo. 1660-0008 Expires March 31, 2012 or Insurance Company Use: oltcy'Number ompany NAIC Number . City State ZIP Code Kamuela Hawaii 96743 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) T.M.K. 3-6-9-006-027 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential AS. Latitude/Longitude: Lat. 1-9-.-945446 19.57.524,Long. -379rn ASA SF, Horizontal Datum: [-]NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certl icate is being use too Wirt food insurance. AT Building Diagram Number 5 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: NO Garage a) Square footage of crawlspace or enclosure(s) sqft a) Square footage of attached garage sq ft b) No. of permanent flood openings In the crawlspace or b) No. of permanent flood openings In the attached garage enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.1b sq In d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name 8 Community Number B2. County Name B3. State Hawaii count - 155166 Hawaii County I Hawaii 84. Map/Panel Number B5. Suffix 86. FIRM Index B7. FIRM Panel B8. Flood Bg. Base Flood Elevation(s) (Zone Date Effeelive/Revised Date Zone(s) AO, use base flood depth) 155166 0278C C 4-2-2004 9-16-1988 VE 6 B10. 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) B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) 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 - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. 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, V1430, V (with BFE), AR, AR/A, AR/AE, AR/A1-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 RM 34 Vertical Datum NGVD 1929 Elev.=9.49' Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 108 ® feet ® 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) 9 .2 ® feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) NA _❑ feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 10 feet ❑ meters (Puerto Rico only) (Describe type of equipment and location in Comments) j f) Lowest adjacent (finished) grade next to building (LAG) 6_._4__[Z feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) 7.B - X❑ feet ❑ meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including 7 .0 &eet ❑ meters (Puerto Rico only) structural support SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATIO This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevatip 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 LPLS 7276 r is i"", r";- 1. „ '' "ei OF slue ii!(Ad", 10- /p. Fi fF�o o LICENSED �S Ct PROFESSIONAL LAND # SURVEYOR # No. 7276 Fc-pr.ce: t.,preVrt.ub ec,