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IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance ComDanv Use: II or P.O. Route and Box CityKamuela Stat%waii §g V I Company NAIC Number II SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) building owner. omm to op on wall 40 ft. seaward of dwelling and on property is 8.34 ft. GFI outlet servicing AC units and pool equipment at elevation 10.86 ft. On demand,49t water heater ayelevation 11.40 ft. ),.,,SCJ fi,Gr:&ss= 1-16-2009 E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR For Zones AO and A (without BFE), complete Items Et -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, If available. Check the measurement used. In Puerto Rico 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 ❑ 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 Sect l�4 Items 8 @�,Qlor 9 (see a e 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building Is _ ❑ feet L� meters L -J above or U below the HAG. E3. Attached garage (top of slab) is . _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery andlor 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. 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 -Issued or community -Issued BFE) y,Zone AO must sign here. The statements In Sections A, B, and E are eared to the best of my knowledge. Owner's or Owners Authorized Representauve's Name Address City State ZIP Code Signature Date Telephone Comments The local offidal who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sk and G of this Elevation Certificate. Complete the applicable Item(s) and sign below. Check the measurement used in Items G8. and G9. G7. ❑ The Information in Section C was taken from other documentabon 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 data 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 AO. G3. ❑ The following information (Items G4: G9.) Is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built 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 Local Official's Name Title Name Reviewed Telephone