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NG OWNER'S NAME <br />FEDERAL EMERGENCY MANAGEMENT AGENCY <br />NATIONAL FLOOD INSURANCE PROGRAM <br />ELEVATION CERTIFICATE <br />Important: Read the instructions on pages 1 - 7. <br />SECTION A - PROPERTY OWNER INFORMATION <br />LEE MORI <br />O.M.B. No. 3067-0077 <br />Expires December 31, 2005 <br />For Insurance Comoanv Use: <br />BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number I <br />1029 LELEPAU STREET <br />CITY STATE ZIP CODE <br />HILO HI 96720 <br />PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) <br />TMK:2-4-037:110'' <br />BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, N necessary.) <br />RESIDENTIAL <br />LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: L GPS (Type): <br />( ##° - ##' - #f.##' or ##.°) LJ NAD 1927 J_j NAD 1983 U USGS Quad Map U Other <br />SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION <br />B4. MAP AND PANEL <br />B5. SUFFIX <br />B6, FIRM INDEX <br />B7. FIRM PANEL <br />B8. FLOOD <br />89. BASE FLOOD ELEVATION(S) <br />NUMBER <br />�- <br />DATE <br />I <br />EFFECTIVE/REVISED DATE <br />1 <br />ZONE(S) <br />1 <br />(Zone -AO, use depth of flooding) <br />155166 <br />0890C <br />4/02/04 <br />9/16/88 <br />AH <br />606.0 <br />B10. Indicate the source of the Base -Flood Elevation (BFE) data or base flood depth entered.in B9. <br />" FIS Profile ( gj FIRM L�:.ommunity Determined LJ Other (Describe): <br />B11. Indicate the elevation datum used for the BFE in B9: L3 NGVD.1929 " NAVD 1988 LJ Other (Describe): <br />B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? LJ.Yes .jX I No <br />Designation Date: <br />SECTION C. - BUILDING•ELEVATION INFORMATION (SURVEY REQUIRED) <br />1. Building elevations are based.on: I lConstruction Drawings' LjBuilding Under Construction' . LJFinished Construction <br />•A new Elevation Certificate will be required when construction -of the building -incomplete. <br />C2. Building Diagram Number 5 (Select the building diagram most similar to the building for which this certificate is being completed - see <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 -V30, V (with BFE), AR, AR/A, ARAE, AR/Al-A30, AR/AH; AR/AO <br />Complete Items C3.a-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. Use the space provided or the Comments area of Section D or -Section G, as appropriate, to document the datum conversion. <br />Datum NGVD 1929 Conversion/Comments NONE <br />Elevation reference mark used USGS BM 5YY Does•the elevation reference mark -. used -appear on. the -FIRM? LJ -Yes Lac No <br />0 a) Top of bottom floor (including.basement_or: enclosure) • <br />606. <br />7 ft(m). <br />m <br />0 b) Top of next higher floor <br />615. <br />8 ft (m) <br />�- <br />0 c) Bottom of. lowest horizontal- structural --member (V zones only) <br />NA <br />ft.(m) <br />c o <br />0 d) Attached garage (top of slab) <br />606. <br />2 ft.(m) <br />E 0 <br />0 e) Lowest elevation of machinery and/or equipment <br />J m <br />servicing the building (Describe in a Comments area.) <br />606 <br />7 ft.(m) <br />E <br />❑ 0 Lowest adjacent (finished) grade (LAG) <br />602 <br />4 ft.(m) <br />z' <br />❑ g) Highest adjacent (finished) grade (HAG) <br />604. <br />1 ft.(m) <br />❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NA <br />❑ i) Total area of all permanent openings (flood vents) in C3.h NA <br />sq. in. (sq. cm) <br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION <br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. <br />I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available. <br />I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. <br />CERTIFIER'S NAME LICENSE NUMBER <br />ROBERT T. SHIRAI LS -5985 <br />LAND SURVEYOR <br />ISLAND SURVEY, INC. <br />- --- <br />P.O. [Bo:k- 4P.5 - HILO HI -- 96720 <br />SIGNATURE DATE TELEPHONE <br />09/23/04 808-935-9105 <br />FEMA Form 81-31, January 2003 See reverse side for continuation. . Replaces all previous editions <br />