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IMPORTANT: In these spaces, copy the corresponding Information from Section A. for Insurance ComparrylUse x`, ,; Building Street Address (Including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. Policy Number 167 KAPAA STREET City HILO State HI ZIPCode 96720 [.Compat)y,.,..,-CNum7tat;4t SECTION D - SURVEYOR. ENGINEER. OR ARCHITECT CERTIFICATION (CONTINUEDI Wy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) building owner. STORAGE ROOM IN THE GARAGE. SECTION E - BUILDING ELEVA"ON INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete hems E1 -E5. If the Certificate Is Intended to support a LOMA or LOMR-F request, complete Sections A, B, end C. For hems E1 -E4, use natural grade, If available. Check the measurement used. In Puerto Rk:o only, enter meters. 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, crewispace, or enclosure) Is _— ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (Including basement, craMspace, 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 and/or 9 (see pages 8.9 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. F - The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-lesued or community -Issued BFE) or Zone AO must sign here. The statements in Sections A, A and E are coned to the hest of my knowledge. Authorized Signature Date Telephone ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 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 date 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-buiit 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 flo%geva�ortment Of Public Works—•— ❑ feet ❑ meters (PR) Datum Local Official's Name Tide Community Name IEK recommends Telephone Signature LJ does not recommend Date By �%jti L2y ®tee Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions