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Project No. 16119.1 FF—ERAL EMERGENCY MANAGEMENT AGI-- `-Y <br />,ATIONAL FLOOD INSURANCE PROGRr. <br />ELEVATION CERTIFICATE <br />Important: Read the instructions on pages 1 - 7. <br />SECTION A - PROPERTY OWNER INFORMATION <br />BUILDING OWNER'S NAME <br />BUILDING STREET ADDRESS (Including Apt.. Unit. Suite, and/or Bldg. No.) OR P.O_ ROUTE AND BOX NO. <br />CITY <br />Kamuela, Hawaii 96743 _ <br />PROPERTY DESCRIPTION (Lot and Block Numbers. T <br />STATE <br />Legal Description, etc.) <br />Division) <br />BUILDING USE (e.g., Residential, Non-residential. Addition, Accessory, etc. Use Comments section if necessary.) <br />Residential <br />LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_1 GPS (Type). <br />( ##° - ##' - ##.##" or ##.##tt##°) I _I NAD 1927 1_1 NAD 1983 1_1 USGS Quad Map 1_1 Other: <br />O.M.B. No. 3067-0077 <br />Expires July 31, 2002 <br />For Insurance Company Use: <br />Policy Number <br />Company NAIC Number <br />ZIP <br />SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION <br />81. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2. COUNTY NAME B3. STATE <br />Hawaii Hawaii I Hawaii <br />134. MAP AND PANEL <br />65. SUFFIX <br />66. FIRM INDEX <br />B7. FIRM PANEL <br />B8. FLOOD <br />B9. BASE FLOOD ELEVATION(S) <br />NUMBER <br />DATE <br />EFFECTIVE/REVISED DATE <br />ZONE(S) <br />(Zone AO, use depth of flooding) _ <br />I <br />155166 0164 <br />D <br />Ma 16 1994 <br />Jul 16, 1990 <br />A <br />2307 per Dept of Pub Wk <br />B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. <br />)_j FIS Profile 1_1 FIRM 1_1 Community Determined ) 4Other (Describe): Elev on Bridge from County DPW <br />B11. Indicate the elevation datum used for the BFE in B9: I_(NGVD 1929 )_) NAVD 1988 1_1 Other (Describe): <br />B12. is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? j_) Yes 1_1No <br />Designation Date: <br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) <br />401. Building elevations are based on: I_lConstruction Drawings` I_lBuikiing Under Construction' I )gFinished Construction <br />'A new Elevation Certificate will be required when construction of the building is complete. <br />,2. Building Diagram Number _1 (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, AR/AE, 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. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. <br />Datum Conversion/Comments <br />Elevation reference mark usedIRM an Bridge /�pPWoes the elevation reference mark used appear on the FIRM? 1_j Yes )--X No <br />0( a) Top of bottom floor (including basement or enclosure) 2309.8_ ft.(iW -11%P� T. Yq <br />0 b) Top of next higher floor — ft.(m) a Z1,Q <br />❑ c) Bottom of lowest horizontal structural member (V zones only) ` ft.(m) IS . <br />A o Q- LICENSED <br />❑ d) Attached garage (top of slab) — ft.(m) 0 2 <br />V PROFESSIO <br />❑ e) Lowest elevation of machinery and/or equipment- L <br />servicing the building + ft.(m) w <br />Ck f) Lowest adjacent grade (LAG) 2307.Q_ ft.00C z' .� * S OR r <br />0A g) Highest adjacent grade (HAG) 2309.0 ft.(d)( G N x331 SP' <br />❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade it, V' <br />❑ i) Total area of all permanent openings (flood vents) in C311 sq. in. (sq. cm) ebrua , 001 <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, B. and C on this certificate represents my best efforts to interpret the data available. <br />/ 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 />Chrvstal Thnmac VmmnenV4 T_S_6'4Q1 <br />G1 <br />LEPHONE <br />74 <br />FFMA Fnrm R1A1 Al Ir; UA qFF RF\/Fr7SF RlnP FOR (.nNTINI IATIr)N RFPI Ar.FG Al I PRF1/Irll ICjFnITInNC <br />