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U.a DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 Notional Flood Inrumrn Progmm Important: Read the Instructions on pages 1-9. Expiration Date: Juy31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owners Name Jon Hall and Edward Grant Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number. 59-1703 Puako Beach Road A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) TMK 6-0-003: 035 (3b Division), Puako Beach Lots. Lot 35, Lelamllo. South Kohab, Howell A4. Building Use (e.g., Residential, Non-Residenl(al, Addition, Accessory, etc.) ResWemiel A5. LalidMe(Longil Lat. 19-50-11.1 N Long. 155-30.34.5 W Horizontal Datum: ❑ NAD 1927 ® HAD 1983 AS. Attach at batt 2 photographs of the building ff the Certificate Is being used to obtain flood Insurance. A7. Building Diagram Number 5 AS. For a building with a craaeepece or enclosure(s): A9. For a bulking with an attached garage: a) Square footage of crawbpece or enclosures) NA sq It a) Square footage of attached garage eq It b) Number of permanent flood openings in the crewlepace b) Number o/ permanent flood openings In Me attached garage or encbsure(s) within 1.0 foot above adjacent grade N,B, within 1.0 foot above adjacent grade e) Total net area of flood openings in A8.b NA aq In Q Total net area of flood openings in A9.b So In d) Engineer ed food openings? ❑ Yes ❑ No NA d) Engineer atl flood openings? ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name 8 Community Number 82. County Name B3. State Howell County 155 166 0277 C I Hewell HI 84. MSPIPRW Number 85. Suffix 88. FIRM Index Data 87. FIRM Panel B8. Flood 69. Base Flood Elevation(s) (Zone 155166 0277 C 1 4/2/2004 Date EftacthrelR ave Zone(s) AO, use ba food depth) a 7.664' ® feet ❑ meters 0 34 OW ❑ maters BID. Indicate the source of the Babe Flood Elevation (BFE) data or hese flood depth entered In Item 89. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Olher/Souroe: 811. Indicate elevation datum used for BFE in Item 89: ® NGVD 1929 ❑ NAVD 1988 ❑ OthedSource: 812. Is the building located in a Coastal Barder Resources System (CSRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: ❑ CSRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction` ® Finished Conaftotlon 'A new Elevalbn Certificate will be required when construction of the building Is complete. C2. Elevations - Zones At -A30, AE, AH, A (with BFE), VE, VI -V30, V (with SFE), AR, ARIA, ARAE, AR/AI-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram epecfied in Item A7. In Puerto Rico only, amour meters. Benchmark Utilized: "PUAKO" USCSG Bross Disk Vertical Datum: NGVD 1629 Indicate elevation datum used for the elevatlom in #am a) through h) below. ® NGVO 1929 ❑ NAVD 1088 ❑ Other/Source: Datum used for bulkkg elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (Including basement, aawlapace, or enclosure floor) b) Top of the next higher floor C) Bottom of the kwvast horizontal structural member (V Zones any) d) Attached garage (top of slab) a) Lowest elevatkm of machinery or equipment servicing the building (Describe type of equipment and location In Comments) 4 Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to bulking (HAG) III Lowest adjacent grade at lowest elevation of deck or stairs. Including structural support 17.1112 ® feet ❑ meters NL.-.__ ® feet ❑ meters NA. ® feat ❑ meters 7.45 ® bat ❑ meters 7.664' ® feet ❑ meters 0 34 OW ❑ maters Z-42 ® feet ❑ meters 7.41 ® feet ❑ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This Cerofcalbn is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to car* elevation I wralarstinformatia rd run y see slotethat ft ��r�may pmt byrtificate finerepresents my t beat pInterpret s u s 1the dateCoode, Section ,moot.LICENS Lt rFPROFCESSICN!L McMI(�y® Check here if comments are provided on back ofform. Were latitude and longitude in Sectio+ A provided bya ® Check here tt attachments. Licensed land surveyor? ®Vee ❑ No ICE Cenifor's Name NGVD 1929 License Number Hawaii LS 9040 I �� Title Owner - Principal Company Name KKM Surveys Address PO Box 2494 City Koilua Kona State HI ZIP Code 88745 LAND SURVEYOR NO. 9040 FEMA Form 086-0.33 (7/12) See reverse side for cominuafbn. Replaces of previous editions.