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wiJrA 1 `T 4AwQ1l I vrw�V)A . vrr-- -- AT*CN a <br />EDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. Nd. 3067-0Ow` 77 :1 <br />NATIONAL FLOOD INSURANCE PROGRAM Expires July'31, 2002 <br />ELEVATION Ci RTIFICATE - <br />Important: Read the instructions on pages 1 - 7. <br />SECTION A - PROPERTY OWNER INFORMATION For Insurance Corgpany Use: <br />BUILDING OWNER'S NJAME ��� `, t� Poky Number <br />gKfAM <br />BUILDING STREET ADDRESS,(Inci ding Apt., UnJ),, ully and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number <br />CITY ` STATE <br />etc.) <br />necessary <br />LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: U GPS (Type) <br />#W, - ee.er 'or ##.###W) (_J NAD 1927 („( NAD 1983 (r( USGS Quad Map L J Other. <br />SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION <br />81. NFiP COMMUNITY NAME 8 COMMUNITY NUMBER 1 82. COUNTY NAME 83. STATE <br />Hawaii County 155166 . Hawaii County Hawaii <br />NUMBER <br />1 (� I fi DATE <br />I EFFE TI JRDA R DATE I ZONE SS) � (Zone AO. � e d a h or blooding) <br />B10. Indicate the source of tt a Base Flood Elevation (BFE) data or base food depth entered in B9. <br />LJFIS Profile .LJ FIRM. lJ Communitylermined U (Describe): <br />(Dese): <br />B 11. Indicate the elevation datum used for the BFE In B9: [VNGVD 1929 j_ j NAVD 1988 U Other (Describe): <br />B12. Is the building located Ina Coastal Barrier Resources System (CBRS) area or dtherwise Protected Area (OPA)? "Yes LX ,( No <br />Designation Date: <br />SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) <br />C1. Building elevations -are based on: LJConstruction Drawings• UBullding Under Construction' L_(Finished Construction <br />•A new Elevation Certificate will be required when construction of the building is complete. <br />C2. Building Diagram Number _Z;_ (Select the building diagram most similar to the building for which this certificate is being completed - ser <br />pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) <br />C3. Elevations =Zones Al A30, AE, AH, A (with BFE), VE, V1 430, V (with BFE). AR, AR/A. ARAE. AR/A1-A30. AR/AH, AR/AO <br />Complete Items C3a-I below according to the building diagram specified in Item C2. State the datum used. If the datum Is different from <br />the datum used for the BFE In Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion <br />calculation. U e the $pace provided or the Comments area of Section D or Section G; as appro nate, to document the datum conversion <br />yDatum ,-Conversion/Comments 4ga, Ig -red LA fe — I 2Ar. 1Jr <br />Elevation reference mark used Does the elevation reference mark used appear on the FIRMT Yes (C Ni <br />❑ a) Top of bottom floor (including basement or enclosure) I - . 9 ft(m) g <br />❑ b) Top of next higher floor ft.(m) is d <br />❑ c) Bottom of lowest horizontal structural member (V zones only) _ ft. o LICENSED <br />O d) Attached garage (top of slab) .. mm) E E <br />Pt;4fEt3S4®NAL <br />O e) Lowest elevation of machinery and/or equipment w e ENG04EEP � <br />servicing the building 114 b fL(m) P � a •r <br />❑ 0 Lowest adjacent grade (LAG) D ft:(m) z'y <br />❑ g) Highest adjacent grade (HAG) •fir' . fL(m) <br />Q h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade <br />❑ i) Total area of all permanent openings (flood vents) in C3h _ 41g2!20 sq. in. (sq. cm) <br />SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION -1 <br />f <br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation <br />1 certify that the information in Sections A, B. and C on this cerUhcate represents my best efforts to interpret the data available. <br />I understand that any false statement m� ay�b�e punishable by fine or imprisonment under 18 U.S. Code, Section 1001. <br />CERTIFIER'S NAME �1�, l i It,{t 1 ^ /_ LICENSE NUMBER <br />TITLE ...�_ n wh .... 1 r . .�.. i.., COMPANY NAME lint IGr e b n e:1 i / 01 16�F� 1t.1 <br />