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IMPORTANT: In these spaces, copy the corresponding Information from Section A. B'Lilding Street -Address (including Apt., Unit, Suite, and/or Bldq. No.) or P.O. Route and Box No. r Insurance�Qompany Use: dicy. Number City State ZIP Code I Company NAIC Number I Kamuela Hawaii 96743 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) _y both sides of this Elevation Certificate for (1) community official, (2) Insurance agenUcompany, and (3) building owner. overhead cable utilitv on oolea- Signature ; 3-3-2010 SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) 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, antic. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. 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 Boor (Including basement, crawlspace, or enclosure) is []feet ❑meters ❑above or ❑below the HAG. b) Top of bottom Boor (Including basement, crawlspace, or enclosure) Is Deet [:]meters❑above or ❑below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in SectigILA Items 8n /or 9 (see p4es 8-9 of Instructions), the next higher Boor (elevation C2.b in the diagrams) of the building is _ [—]feet LJ meters n above or below the HAG. E3. Attached garage (top of slab) is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _ ❑ feel ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is avallable, is the top of the bottom Boor 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 completes Sections A, B, and E for Zone A (without a FEMA -Issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A. B, and E aro correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name state Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official 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 item(s) and sign below. Check the measurement used in Items GB and G9. G1. ❑ 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 A0. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. Permit Number I G5. Date Permit Issued I G6. Date Certificate Of Compliance/Occuoancv Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement I G8. Elevation of as -built lowest floor (including basement) of the building ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site ❑ feet ❑ meters (PR) Datum G10. Community's design flood el�atleonpaRQrtment Of FU5(IC E] feet ❑ meters (PR) Datum KS17 Local Official's Name Community Name does n,,Ii rz.,:omnlr It ,';'i Date ecce all pf_lou_,