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P. 02
<br />O,M.B. NO. 3067.4077
<br />ELEVATION CERTIFICATE Expires May 31,1996
<br />FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />NATIONAL. FLOOD INSURANCE PROGRAM
<br />ATTENTION: use of this certificate does not provide a waiver of the flood Insurance purchase requirement. This form4s used only to
<br />provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
<br />detarmine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or --.OMR),
<br />Instructions for completing this form can be found on the following pages,
<br />SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
<br />BUILDING OWNER'S NAME POLICY NUM8ER _ _-
<br />T,ot, ? g.,., J . and He ena_.. C . Dae tmati _
<br />STREET ADDRESS (Including Apt., Unit, Sults and/or Bldg. Number) OR P.0, ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
<br />19A3 Kai,-Liaiananle Ave
<br />OTHER DESCRIPTION (Lot and Block Numbers, etc.)
<br />CITY STATE ZIP CODE
<br />Hawaii
<br />SECTION B FLOOD INSURANCe RATE MAP (FIRM) INFORMATION
<br />Provide the following from the proper FIRM (See Instructions):
<br />7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 ❑ Other (describe on back)
<br />S. For zones A or V. where no BPE is provided on the FIRM, and the community has established a BFE for this building sites, indicate
<br />the community's BFE: I I L..._IJ_I -L feet NGVD (or other FIRM datum -see Section B, Item 7),
<br />SECTION C BUILDING ELEVATION INFORMATION
<br />1. Using the Elevation Certificate Instructions, indicat the diagram number from the diagrams found on Pages 5 and 6 that best
<br />describes the subject building's reference leve] _ .
<br />2(a), FIRM Zones AI -ASO, AE, AH, and A (with BFI"). The top of the reference level floor from the selected diagram is at an elevation
<br />of Li _LLL . LJ feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />(b). FIRM Zones V1 -V30, VE, and V (with SFE). The bottom of the lowest horizontal structural member of the reference level from
<br />the selected diagram, is at an elevation of iI-l�I 161 feet NGVD (or other FiRM datum -see Section B, Item 7).
<br />(c). FIRM Zone A (without 8FE). The floor used as the reference level from the selected diagram is L j 1. iJ feet above U or
<br />below 0 (check one) the highest grade adjacent to the building.
<br />(d). FiRM Zone AO. The floor used as the reference level from the selected diagram is LJJ .H feet above ❑ or below U (check
<br />one) the highest grade adjacent to the building. It no flood depth number is available, is the building's lowest floor (reference
<br />level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No 0 Unknown
<br />3. indicate the elevation datum system used in determining the above reference level elevations: ❑ NGVD '29 ❑ Other (describe
<br />under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different then that used on
<br />the FIRM (see Section B, Item 71, them convert the elevations to the datum system used on the FIRM and show the conversion
<br />gqciation under CommOMS on Page 2.)
<br />4. Elevation reference mark used appears on FiRM: YJ Yes [3 No (See instructions on Page 4)
<br />5. The reference level elevation is based on. .gZ actual construction F] construction drawings
<br />(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
<br />case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
<br />will be required once constructiotl is complete.)
<br />6. The elevation of the lowest grade immediately adjacent to the building is: L1I 11.1L i . J,d feet NGVD (or other FIRM datum -see
<br />Section B, Item 7).
<br />SECTION D COMMUNITY INFORMATION
<br />t. if the community official responsible for verifying building elevations specifies that the reference level Indicated in Section C, atom 1
<br />Is not she "lowest floor" as defined In the community's floodplain management ordinance, the elevation of the building's "lowest
<br />floor" as defined by the ordinance is: L1 � _L—LJ.1L-. feet NGVD (or other FIRM datum -see Section 6, Item 7).
<br />r,,;- m tl,A --tart of construction or substantial improvement r $/
<br />t, COMMUNITY NUMBER
<br />2. PANEL NUMBER
<br />3, SUFFIX
<br />4. DATE OF FIRM INDEX
<br />5. FIRM ZONE
<br />S. BASE FLOOD ELEVATIoN
<br />(in AO Zones, use depth)
<br />15516
<br />0885
<br />G
<br />9116/88
<br />VE
<br />23
<br />7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 ❑ Other (describe on back)
<br />S. For zones A or V. where no BPE is provided on the FIRM, and the community has established a BFE for this building sites, indicate
<br />the community's BFE: I I L..._IJ_I -L feet NGVD (or other FIRM datum -see Section B, Item 7),
<br />SECTION C BUILDING ELEVATION INFORMATION
<br />1. Using the Elevation Certificate Instructions, indicat the diagram number from the diagrams found on Pages 5 and 6 that best
<br />describes the subject building's reference leve] _ .
<br />2(a), FIRM Zones AI -ASO, AE, AH, and A (with BFI"). The top of the reference level floor from the selected diagram is at an elevation
<br />of Li _LLL . LJ feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />(b). FIRM Zones V1 -V30, VE, and V (with SFE). The bottom of the lowest horizontal structural member of the reference level from
<br />the selected diagram, is at an elevation of iI-l�I 161 feet NGVD (or other FiRM datum -see Section B, Item 7).
<br />(c). FIRM Zone A (without 8FE). The floor used as the reference level from the selected diagram is L j 1. iJ feet above U or
<br />below 0 (check one) the highest grade adjacent to the building.
<br />(d). FiRM Zone AO. The floor used as the reference level from the selected diagram is LJJ .H feet above ❑ or below U (check
<br />one) the highest grade adjacent to the building. It no flood depth number is available, is the building's lowest floor (reference
<br />level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No 0 Unknown
<br />3. indicate the elevation datum system used in determining the above reference level elevations: ❑ NGVD '29 ❑ Other (describe
<br />under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different then that used on
<br />the FIRM (see Section B, Item 71, them convert the elevations to the datum system used on the FIRM and show the conversion
<br />gqciation under CommOMS on Page 2.)
<br />4. Elevation reference mark used appears on FiRM: YJ Yes [3 No (See instructions on Page 4)
<br />5. The reference level elevation is based on. .gZ actual construction F] construction drawings
<br />(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
<br />case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
<br />will be required once constructiotl is complete.)
<br />6. The elevation of the lowest grade immediately adjacent to the building is: L1I 11.1L i . J,d feet NGVD (or other FIRM datum -see
<br />Section B, Item 7).
<br />SECTION D COMMUNITY INFORMATION
<br />t. if the community official responsible for verifying building elevations specifies that the reference level Indicated in Section C, atom 1
<br />Is not she "lowest floor" as defined In the community's floodplain management ordinance, the elevation of the building's "lowest
<br />floor" as defined by the ordinance is: L1 � _L—LJ.1L-. feet NGVD (or other FIRM datum -see Section 6, Item 7).
<br />r,,;- m tl,A --tart of construction or substantial improvement r $/
<br />
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