2-1-021:042 - Laserfiche WebLink

Home

IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: Building, Street Address (including Apt., Una, Sults, end/or Bldg. No.) or P.O. Route antl Box No. Policy Number T.J. & ELLY SPRINTZ/DHHL Cay HILO State HI ZIP Code 98720 Company NAIL Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ICONTINIIcnt isCopy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company. and (3) building owner. Comments THE ELEVATION IS BASED ON A SURVERYER SET ELEVATION IN THE SIDEWALK. THE ELEVATION IS FROM A USGS BM THERE IS NO EQUIPMENT a n auew,monm SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE1 For Zones AO and A (without BFE), complete Items E1 -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 Rioo only, enter meters. E1. 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 [I meters E3 above ar [:1 below the HAG. b) Top of bottom floor (including basement, crawl apace, 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 (ase 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. OWNER 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. The statements In Sections A, B, and E are aomec4 to the best of my knowledge. Property Owners or Owner's Authorized Representative's Name City State ZIP SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is= by low or ordinance to administer the community's floodplain management ordinance can complete Sections A, S, C (or E), and G of this Elevatlon Certificate. Complete the applicable aem(a) and sign below. Check the measurement used In Items G8. end 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 low 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 A0. G3. ❑ The following Information (Items G4. -G9.) is provided for community floodplain management purposes. G4. Perms Number - G5. Date Permit G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -bulk lowest floor (including basement) of the building: _ _ _❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of%9i1D@P .kM" Of: Public W-Q[LcS_ ❑ feet ❑ meters (PR) Datum _ Local Official's Name Title she FlPvation Certificate and --.,...._...., Telephone - - recommends Signature_ Date t•� t «lyarnvai Comments , FEMA Form 81-31, February 2006 Replaces all previous editions