6-6-004:130 - Laserfiche WebLink

Home

For Insurance Company Use: ALANEO ST. ccry State ZIP Code Company NAIL Number KAMUELA HI 96743 Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) building owner. TMK: 6.6-004130 ITEM C2.e - 50 GAL ELECTRIC WATER HEATER RELIANCE 606 SERIES CCU I I n c - =W1s 1Mo.csavRnvey INrUNINA I IVN SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zo s AO and A (without SFE), complete Items Ei-E5. If the Certificate is Intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items Et -E4, use natural grade, d avaflable. Check the measurement used. In Puerto Rico 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 pnduding basement, crawl space, or enclosure) Is _ ❑ feet ❑ meters ❑ above orbelow the HAG. b) Top of bottom floor (including basement, crawl apace, or enclosure) Is _ _ ❑feet 11 meters ❑above Of ®he1WM ti18 LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided In Sedigp/1 Items 8 for 9 (see ggga 8 of Instructions), the next higher floor (elevation C2.b In the diagrams) of the building Is . _ ❑feet LJ maters LJ above or LJ 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 She 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 communllys floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local offldal must certify this Infomhation in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representative who completes Sections A, 8, and E for Zone A (without a FEMA -Issued or communfly-lesued SFE) or Zone AO must sign here. The statements In Sections A, B, and E are correct to Me best of my bawledge. _Property Owners or Owners Authorized Representative's Name _Address City State ZIP Code Signature Data Telephone Comments . G - h ne hocak omaal Wro hs aumonzeo Dy mw or ordinance to adnunister the community's 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 In Items G8. and G9. Gt. ❑ The Information In Sedion 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 dale of the elevation data In the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMAAssued or community -Issued 8FE) or Zone AO. G3. ❑ The following information (Items G4. -G9.) is provided for community floodplain management purposes. G4. Permit Number 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 Gg. SIZE or (In Zone AO) ddpWf ( uIWVP6f((c Woks ❑ feet ❑ meters (PR) Datum Local Official's Name Jhluumillv_ Title communcry Name Telephone [., recommends Date Comments Dclto 4/6404 ❑ Check here 11 attachments FEMA Form 81-31, February 2006 Replaces all previous editions