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IIMPORTANT: In these spaces. colov the corresponding Information from Section A. For Insureoee Comperry;UeSe: 1Building Street Address (Including Apt., Unit, Suite, and/or tndg. No.) or v.v. Koute ane max No. roeroyrrvwnuerr# 77.230 Ke Alohi Kai Place i,.-isn !.City Kellua KonaState HI ZIP Code 98740 Company'NAAICCNUMW, ,?�a s r. � u INV SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both aides of this Elevation Certificate for (1) community official, (2) Insurance agenticompany, and (3) building owner. abdV4- E - BUILDING For Zones AO and A (without BFE), complete Items EI -E5. If the Certificate Is intended to support a LOMA or LOMR-F request, complete Sections A_ B, and C. For Items E1 -E4, use natural grade, N available. Check the measurement used. In Puerto Rice only, enter meters. Ell. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest sdja cent 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, crewlspace, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6.9 with permanent flood openings provided In Section A Items 8 andfor 9 (seepages 8-9 of Instructions), the next higher floor (elevation C2.b In the diagrams) of the building Is _._ [3 feet [I motors [3 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 _ _ ❑ 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 mane®ement ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information In Section G. OWNER The property owner or owner's authorized representative who completes Sections A, 8, and E for Zone A (without a FEMA -Issued or communky4asued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the beat of my knowledge. Property Owners or Owners Authorized Representative's Name Stale Signature Date Telephone 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, E. C Cor E), and G of this Elevation Certificate. Complete the applicable Item(s) and sign below. Check the measurement used In Items G8 and Gil. 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 AO. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G7. This permit has been Issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (Includingant) of the building: _ _ ❑ feet [J meters (PR) Datum _ G9. BFE or (in Zone AO) depth of flooding at t but ing site: _ _ ❑ feet ❑ meters (PR) Datum _ G10. Community's design flood elgvaFd4GlNE t _C. VISION ❑ feet ❑ meters (PR) Datum _ Community Name ate _— Telephone Signature l:�l Appmveu -- " -p'-__ Date Fcr Work- Will .in the Cr,�'•;� Check here ti attachments FEMA Form 81-31, Mer 09 Replaces all previous editions