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U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires February 28. 2009 National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION For Insurance Company Use: FA2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 17 BAKER ST City HILO State HI ZIP Code 95720 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Lathude/Longitude: Lat. N19 43.871' Long, W155 2.721' Horizontal Datum: ❑ NAD 1927 ® NAD 1983 AS. Attach at least 2 photographs of the building dthe Certificate is being used to obtain flood Insurance. AT Building Diagram Number 5 As. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or enciosure(e) sqft a) Square footage of attached garage sq ft en b) of permanent flood openings in the crawl apace or b) No. of permanent flood openings in the attached garage enclosure(s) wells within foot above adjacent grade walls within 1.0 foot above adjacent grade c) Total net area of flood openings In AB.b sq in c) Total net area of flood openings in A9.b sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION HAWAII COUNTY 155166' _' HAWAII COUNNTY HAWAII Date Effective/Revised Date Zones) AO, use base flood depth) 155166 -885 C 4/02/04 9-18-88 VE 15 B10. Indicate the source of the Base Flood Elevation (BFE) date or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) _ B11. Indicate elevation datum used for BFE in Item 89: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 ❑Yea ®No Designation Date _ ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction* ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations —Zones At -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item AT Benchmark Utilized USGS Vertical Datum _ Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ $Q.§ ® feet ❑ meters (Puerto Rico only) b) Top of the next higher floor NA,_ ❑ feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) 19.4 ® feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) NA._ ❑ feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building®feet ❑ meters (Puerto Rico only) (Describe type of equipment In Comments) 0 Lowest adjacent (finished) grade (LAG) 8.5 ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 2.5 Co feet ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. l certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.,p \ ® Check here if comments are provided on back of form. v Certifiers Name RONALD D. NICKEL License Number 6846-C e CIVIL ENGINEER Company Name RONALD NICKEL P.E. LLC AV dress 12-7109 KALAUNU ST Cky PAHOA State HI ZIP Code 96778 `� Signature Dates Zy O® Telephone 808-965.9911 FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all nrevinim ertitionc