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IMPORTANT: In these spaces, copy the corresponding Information from Section A. I For Insurance Comoanv Use: ,Building Street Address (including Apt., Unit, burte, and/or Bldg. No.) or P.O. Route and Box No.I Policy Number M L WAI OPAE RD TII—L4—f7Gl: nl l HI ZIP Code 96778 OR ARCHITECT CERTIFICATION dopy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/oompany, and (3) building owner. Comments THE ELEVATIONS ARE BASED ON SURVEYOR SET BMS AVAILABLE THROUGH OUT THE SUBDIVISION. THE ELEVATION WAS CHECKED ON 12/1/07 AT 9:05 AM FOR A TIDE OF 2.20 FT ABOVE MSL. THE EQUIPMENT CONSIST OF ALL KITCHEN APPLIANCES AND THE WAftR HEATER. _ _ - , ; tVle ❑ Check here if attachments 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 El -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, if available. Check the measurement used. In Puerto Rico only, enter metals. Et. 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 floor (Including basement, crawl space, or enclosure) is — _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building Is —_ ❑ feet ❑ meters ❑ 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 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 orcommunity-Issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Owners or Owner's State ZIP Code Telephone ❑ 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 Ge. 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 AO. 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/Occupancy Issued G7. This permit has been Issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-bullt 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 ❑ meter@Rt of public Works Local Official's Name Title Division has revreWe the Fleymti.,p rertifieefe and CommunitynName n Telephone ® recommends recommend Vate `115 /V 7 ❑ Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions