6-6-004:137 - Laserfiche WebLink

Home

IMPORTANT: in these spaces, copy the corresponding Inf=SectlonFor Insurance Company Use: Building Street Address (including Apl., Unit, Suite, and/or Bldg. No.) Policy Number 66-1709 ALANEO ST. (LOT 34) City State Company NAIC Number KAMUELA HI 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. Comments TMK: 6-6-004137 ITEM C2.e - 50 GAL ELECTRIC WATER HEATER RELIANCE 606 SERIES Signature Date 08-1149 ❑ Check here if attachments SECTI E - BU)(61MG—RaVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zo s AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A. B, and C. For Items EI -E4, use natural grade, If available. Check the measurement used. In Puerto Rico only, enter meters. El. 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 El feet 1:1 meters 11 above or 11 below the HAG. b) Top o1 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! Item Items 8 /or 9 (see page 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building Is . _ ❑feel L� meters above or L_) 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 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 owners authorized representative who completes Sections A, B. and E for Zone A (without a FEMA -Issued or community -Issued BFE) or Zone AO must sign here. The statements /n Sections A, B. and E are correct to the best of my knowledge. loparty Owners or Owners Authorized Representative's Name dress City Stale ZIP Code Signature Date Telephone SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who Is authorized by law or ordinance to administer the communiys floodplain management ordinance can complete S, and G of this Elevation Certificate. Complete the applicable Item(s) and sign below. Check the measurement used in Items G8. and G9. 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 data In the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-fssued 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 Ga. Elevation of as -built lowest floor (including basement) of the building: ❑ feel ❑ meters (PR) Datum G9. BFE or On Zone AO) d'"0 n8r1bT8rtr fldi9g �IUG. iic — ❑ feet 11 meters (PR) Datum - WOr tri Local Official's Name gitv?ering UMSiOn hos revlevvG4 Title Ike Community Name Telephone rec=tnends Signature n pes r ;I reeor,irnend Date t ....,,,,,1.1.. ...... Fvr•r,... Form 81-31, February 2006 Replaces all previous editions