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IMPORTANT: In these spaces, copy the corresponding Information from Section A. For Insurance C.ompatiy use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number WAI OPAE RD City PAHOA State HI ZIP Code 96778 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, 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 WATER HEATER. Signature Date i7 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 Rem E1 -E5, if the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items El -E4, use natural grade, if available. Check the measurement used. in Puerto Rico only, enter meters. E1. Provide elevation Information for the following and check the appropriate boxes to show whdher the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of wst+om floor ; tr_luding beserr!ent, oravA space, or enclosure) is 0 feet 0 ". - ere r,] above or ❑ bels the H.4G. b) Top of bottom floor (including basemen, 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 0 feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery andfor equipment servicing the building is ❑ fest ❑ 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 0 No 0 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. rhe statements In Sections A, 13, and E are corrad to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone 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 "a) and sign below. Check the measurement used in items G8. and G9. G1. a 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 G5. Date Permit issued ---f-G6. Date Certificate Of Comphance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: -© feet C3 meters (PR) Datum G9. BFE or (in Zone AO) depthr'lo @ittatW iirtpfs*,ublie Wow 0 feet ❑ meters (PR) Datum Engineeringja siee . _coal Official's Namethe Elevation CertificateTine CommunityName ..as reviewed recommends Telephone Signa?ure L—J r recommend Date _ final aPProval Commerits 8 Date n Check here if attachments