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F ERAL EMERGENCY MANAGEMENT AG` .Y O.M.B. No. 3067-0077
<br /> NATIONAL FLOOD INSURANCE PROGRA, Expires December 31, 2005
<br /> ELEVATION CERTIFICATE
<br /> Important: Read the instructions on pages 1 -7.
<br /> SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
<br /> BUILDING OWNER'S NAME Susan C. LJ rS l ✓1 1 Policy Number
<br /> BUILDING STREET ADDRESS(Including A t,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
<br /> G►1 I ng
<br /> CITYRi h O `16778
<br /> STATE ' /� ZIP CODE n
<br /> PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) (-1
<br /> 1-4aPoho Vacufio.-r1c4.-tr,( 1-160wetirj Loo 73 7 - k'(3) 1- 4-G8 -G4
<br /> BUILDING USE(e.g.,Residential.Non-residential,Addition,Accessory.etc. Use a Comments area,if necessary.)
<br /> Re Si den-4-1 al
<br /> LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: Li GPS(Type):
<br /> ( ##°-##'-##.##' or ##.#####°) LI NAD 1927 LJ NAD 1983
<br /> Li USGS Quad Map Ll Other
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
<br /> B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME • 83.STATE
<br /> Hawaii County 155166 Hawaii County Hawaii
<br /> B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL 68.FLOOD B9.BASE FLOOD ELEVATION(S)
<br /> NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding)
<br /> 155166 `40o G 6/02/95 9 //678f3 A E /4.AO '
<br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 89.
<br /> I I FIS Profile Il FIRM LI Community Determined I I Other(Describe):
<br /> B11. Indicate the elevation datum used for the BFE in B9:Li NGVD 1929 I I NAVD 1988 I H Other(Describe): /l SL
<br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? I I Yes [II No
<br /> Designation Date:
<br /> SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: LlConstruction Drawings' LjBuilding Under Construction' IX'Finished Construction
<br /> 'A new Elevation Certificate will be required when construction of the building is complete.
<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 A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARAE,AR/A1-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 /77SL Conversion/Comments
<br /> Elevation reference mark used Does the elevation reference mark used appear on the FIRM? Li Yes I, I No
<br /> O a)Top of bottom floor(including basement or enclosure) /7 . 2 o ft.(m) 2
<br /> O b)Top of next higher floor /VA _ft.(m)
<br /> C,H RIS l
<br /> O c)Bottom of lowest horizontal structural member(V zones only) /G .15 ft.(m) "2 S Eys
<br /> ❑ d)Attached garage(top of slab) /VI ft(m) E 2� LICENSED Fy
<br /> ❑ e)Lowest elevation of machinery and/or equipment 'm PROFESSIONAL
<br /> servicing the building (Describe in a Comments area.) /7 Z0 ft.(m) E . LAND
<br /> ❑ f)Lowest adjacent(finished)grade(LAG) S- .88 ft.(m) min * SURVEYOR
<br /> O g)Highest adjacent(finished)grade(HAG) 5- .98 ft.(m) F • \ 9077
<br /> O h)No.of permanent openings(flood vents)within 1 ft. above adjacent grade /ye P•
<br /> ❑ i)Total area of all permanent openings(flood vents)in C3.h A./13 sq.in.(sq.cm) tom, y'WAIT, )•
<br /> SECTION D -SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATIOR . 4.4.....',:..04•,
<br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
<br /> /certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
<br /> I understand that any false statemen may b punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
<br /> CERTIFIER'S NAME .4 2,..., / I !i e/5 /- LICENSE NUMBER -n 5f vl q b 7
<br /> TITLE C T' COMPANY NAME
<br /> JUI✓L�C or- "Piz LidQp%ri d e.i ( "vu i l Sun✓c�c'r5
<br /> 4DDRESS / 4 Q,i �G CITY/ I//D STATE I'� ZIP CODE 76-7Z 0
<br /> SIGNATURE /1� - / r� DATER T LEPHNON 7
<br /> (�•✓L. if- Z 4-b3 og ss- 0360
<br /> FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
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