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69-1826 Puako Beach Drive City Puako State Hawaii ZIP Code 96743 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTII both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) building owner. lents Lowest eoutoment being an electrical meter SECTIOWE - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT SFE) For Zones AO and A (without BFE), complete Items E1 -E5. Hthe Certificate is Intended to support a LOMA or LOMR-F request, Complete Sections A B. and C. For Items E1 f4, use natural grade, 9 available. Check the measurement used. In Puerto Rion only, enter meters. Ell. Provide elevation Information for 90 following and check the appropriate booms to show whether the elevation Is above or below the highest adjacent grade (HAG) and the lowest adlIscant grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) Is — _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, 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 age 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building Is — _ ❑ feet ❑ maters ❑ above or ❑ below the WIG. E3. Attached garage (top of slab) is —.— ❑feel ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building Is _ _ ❑ fast ❑ 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 0. 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-lasued or cornmunttyaasued BFE) or Zone AO must sign here. The statements in Sections A. B, and E are correct to rhe best of my knowledge. Property Owner's or Owner's Authorized Represemadvds Name cess City State ZIP Code Signature Date Telephone Comments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who Is authorized by law or ordinance to adminlater the community* floodplain management ordinance can complete Sections A. B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used M Items G8. and Gil. 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 A0. G1 ❑ The following Information (Items G4. -Gil.) Is provided for community floodplain management purposes. Of Compliance/Ooarpancy lasted G7. This perch has been issued for: ❑ New Construction ❑ Substantial Improvement GB, Elevation of as-buia 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 _ Signature Rer4ewad Qum Data I&ments r-7 L7 APProved Not Approved [j Approved ns Noted ❑ Check here it attachments FEMA Form 81-31, February 2006 Replaces all previous editions