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AiwUlar 4 QUOo � J UIV''F' U4 O . o r Hm i rH 2t o
<br />Project N. 1501
<br />FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />NATIONAL FLOOD INSURANCE PROGRAM
<br />O.M.B. No, 3067-0077
<br />Expires July 31, 2002
<br />ELEVATION CERTIFICATE
<br />Important: Read the Instructions on pages 1 - 7.
<br />SECTION A;- PROPERTY OWNER INFORMATION
<br />For Insurance Company use:
<br />BUILDING OWNER'S NAME
<br />Policy Number
<br />Fry & Mary VanDamme ----Addition to building
<br />....George
<br />BUILDING STREET ADDRESS (including Apt.. Unit, Suite, aridfor Bldg. No,) OR P.O. ROUTE AND BOX NO.
<br />Company MAIC Number
<br />59-1917 Puako l_o0_. -•-- _._._ _
<br />CITY STATE
<br />ZIP CODE
<br />Kamuela, Hawaii 96743
<br />_
<br />PROPERTY Ut:SGRiPTION (Lot and Block Numbers Tax P,-ticel Number, Legal Description, etc.)
<br />- -'-'
<br />Lot 148 Puako Beach Lots TM6-0-46t,:15., (3rd Division)
<br />BUILDING USF (e 9 ,,Residential, Non-residential, Addition, Accessory, etc, Use Commenis section if necessary.)
<br />___R. sidential
<br />LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: (_( GPS (Type).
<br />or J NAD t927 ! ) NAD 1983 („-) USGS Qued MaP
<br />L-1 Other.�,,,_�
<br />SECTION e - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />8l. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2. COUNTY NAME -_ B3. STATE
<br />Hawaii Hawaii Hawaii
<br />64. MAP AND PANEL f BS. SUFFV(' � BS. FIRM INDEX B7. FIRM PANEL, as. LOGO 89. BASE FLOOD ELEVATION(S1
<br />NUMBER DATE E• FFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding)
<br />155166 0278 C 7/16/90 9116/88 AE 7
<br />910. indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 89.
<br />I_I Ft$ Profile IFIRM (FIRM [ ) Commuriittr Determined [_XOther (Describe): USGS Data
<br />4311. Indicate the elevation datum used for the BFE in 69i INGVD 1929 L.[ NAVD 1988 [ 10 ther (Describe);
<br />B12. is the building located in a Coastal Barrier Resourccis System (CBRS) area or Otherwise Protected Area (OPA)? )-_,J Yes l_-1 No
<br />Designation Date'-- �_
<br />SECTION C - BUILDING. ELEVATION INFORMATION (SURVEY REQUIRED)
<br />C1. Building elevations are based on: (_[Construction Drawings' (_)Building Under Construction' # *inished Construction
<br />'A new Elevation Certificate will be required when construction of the building is complete.
<br />Building Diagram Number __I_ (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, V11430. V (with BFE), AR. AR/A, ARAE, AR/Al-A30. AR/AH, ARIAO
<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 thedatum to that used for the BFE. Show field measurements and datum conversion
<br />calculation, Use the space provided or the Comments area of Section 0 or Section G, as appropriate, to document the datum conversion.
<br />Datum _ Conversion/Comment's
<br />Elevation reference mark used oes the elevation reference mark used appear on the FIRM? )_.,j Yes LX No
<br />a) Top of bottom floor (including basement or enclosure) 7 1Z ft.*)
<br />O b) Top of next higher floor r ft.(m) A�5�� T. Yq�,
<br />O c) Bottom of lowest horizontal strurtural member (f✓ zones only) . - _ &(m) a Q-' 11CF rr
<br />U d) Attached garage (top of stab) _ R.(m) j> pF` -
<br />U e) Lowest elevation of machinery and/or equipment
<br />servicing the building _ . _- . ft -(M)
<br />f) Lowest adjacent grade (LAG) ��.6 ft)[») 2 %4
<br />X Highest adjacent rade (HAG) 5.7_._ flan) 4 f
<br />X g) 9h ! 9
<br />' U h) No. of permanent openings (flood vents) within '1 ft. above adjacent grade
<br />G i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) O uOust 11, 00
<br />SECTION Q - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICOION
<br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to car* elevation information.
<br />I certify that the information in Sections A, A. and C on this rertificate represents my best efioris to interpret the data avallabfe.
<br />I understand that any faise statement may be punishaWii by.fne_v_r imprisonment under 18 U.S. Code, Section 1001,
<br />CERTIFIER'S NAME I ICENSENUMBER'
<br />__ C_hrXs tal_�hotuas Yamas$ki...._..... _ _ _ _ is -4331 _.,.�
<br />TIT E COMPANY NAME
<br />.and SurvC�_0_r__ WES TH17MAS..,& ASSOCTA�!
<br />AD CITY -- STATE ZIP CODE
<br />ft iS 749 Kalawa Street ) ;lua-Ila
<br />E DATE ELEPHONE p -2353_ g
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