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U.S. DEPARTMENT OF HOMELAND SECURITY Ci -C Federal Emergency Management Agency National Flood Insurance Program Important: Read the'ihstructions on pages 1-8. Tax February 28. 2009 For Insurance Company Use: g Beach Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. I Company MAIC Number 828 PuI City, Puskc State Hawaii ZIP Code 98743 Division A4. Building Use (e.g., Residential. Non -Residential, Addition, Accessory, etc.) Residential A5, Lathude/Longitude: Let 19.58'01.29 North Long. 155'51'04.04' We Horizontal Datum: ❑ NAD 1927 X NAD 1983 A8. Attach at least photographs of the building if the Certificate Is being used to obtain flood Insurance. A7. Bulking Diagram Number ji A8. For a bulking with a crawl spew or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or anclosure(s) sq Ma) Square faotape of attached garage sq fl b) No. of permanent flood openings in the crawl apace or b) No. of permanent flood openings In the attached garage enclosure(s) wells within 1.0 foot above adjacent grade walls wkhdn 1.0W above adjacent grade c) Total rest area of flood openbgs in AB.b aq in c) Total nat,ama of Mod opeghgs In Aft b.._ eq In ��wwwo s 'O Mn ruQrrewY/�C YwTCYAO fC1OY�'.rYeMYbTflY E'. .. 155155 Hawait Hawaii B4. Map/Panel Number 65. SufRx I Be. FIRM Index B7. FIRM Panel B8: Flood B9. Beare Flood Elevadon(s) (Zone Date Effective/Revised Date Zone(s) AO, use tease flood depth) 277 C 4-2-04 4-2-04 VE 5-0' B10. Indicate the source of the Base Flood Elevation (BFE) data or base fiood depth entered In hem B9. ❑ FIS Profile X FIRM ❑ Community Determined ❑'Other (Describe) _ B11. Indicate elevation datum used for BFE In Item B9: X NGVD 1929 ❑ NAVD 1985 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 ❑Yes XNO Designation Date _ ❑ CBRS ❑ OPA mw SECTION C - WILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' X Finished Construction 'A new Elevation Certificate will be required when construction of the building Is complete. C2. Elevations —Zones AI *M, AE. AH, A (with BFE), VE. V1430. V (with BFE). AR ARIA, ARAE, AR/AVA30, AR/AH, AR/AO. Complete Moms C2.ag below according to the bugtlbeg diagram specified in Mom A7. Benchmark Utilized Local benchmark Vertical Datum NAVO 29 Conversion/Comments - Chealk the measurement used. a) Top of bottom floor (Including basement, crawl space, or unenclosure floor)- 10.QQ Xfeet (3 meters (Puerto Rico only) b) Top of the next higher floor hm feet IJ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) 2.,,Q X feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) N/A ❑ feet ❑ meters (Puerto Rio only) e) Lowest elevation of machinery or equipment servicing the building ]1.QQ X feet ❑ meters (Puerto Rioo only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) g.QQ X feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 7.§Q X 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 arcnrtea aumonzea oy caw to wr.ny rte. information. I car* that the information on this CeNYicate represents my best alrats to Interpret Hee data available. I understand that any false statement may be punishable by fine or Imprisonment under 18 U.S. Code, Section 1001. ❑ Check here 9 comments are provided on back of form. Certifier's Name Thomas G. Pattison License Number 10743 Hawaii FEMA Form 81-31, February 2008 See reverse side for continuation. Replaces all previous editions