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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires February 28.2009 V t National Flood Insurance Program . Important: Read the instructions on pages 1-8. SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name 11 el A. Mod405 Policy Number A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number /04 1/4 i Id €r- >' ad• city A i State /„tic{X0.(1 I ZIP Code q6,7 2,0 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) J TMK; (3)a --s-4-g" 2,0 A4. Building Use(e.g.,Residential,oNon-Residential,Addition,Accessory,etc.) s PY1 s.1 - Fati 1 L F. (C e 11,C A5. Latitude/Longitude:Lat.i.I Iq 40 49 4 Long.k) 1550 081 3¢ •. Hori3ontal Datum: ❑NAD 1927 XNAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number I A A8. For a building with a crawl space or enclosure(s),provide: A9. For a building with an attached garage,provide: a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No.of permanent flood openings in the a-awl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State Hawaii County 155166 Hawaii County Hawaii B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 155166/76 G Date 4/02/04 Effective/Revised /Revised Date Zone(s) AO,use base flood depth) /1�/� r4 1170 ,-o B10. Indicate the source of the.Base Flood Elevation(BFE)data or base flood depth entered in Item B 0 FIS Profile 0 FIRM ❑Community Determined Other(Describe) �"I cod 54041 6y Keil Lot13 B11. Indicate elevation datum used for BFE in Item B9:Nr NGVD 1929 ❑NAVD 1988 0 Other(Describe) l B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ® No Designation Date CBRS OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction' Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized USt-I S B M r r 1/2 3 r i Vertical Datum ►141 E1\I ID 16/2-9 Conversion/Comments Check the measurement used. a) Top of bottom floor(including basement,crawl space,or enclosure floor) 1 17 O ®"feet 0 meters(Puerto Rico only) b) Top of the next higher floor ❑feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) ). ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) I I7 2- . S NI feet 0 meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 1173 0 feet 0 meters(Puerto Rico only) . (Describe type of equipment in Comments) f) Lowest adjacent(finished)grade(LAG) II é 4 .8feet 0 meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) II i t .y H feet 0 meters(Puerto Rico only) SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code, Section 1001. JOA-�1q L. Check here if comments are provided on back of form. X/ "/� 4t. Lietf ED O Certifiers Name License Number Ls_ i 13s PROS JONAL * Title CompanyfNa�me $ SURVEYOR Lq�� Sctr✓P7vY- l� G��I Am( et kkti i I Dept• 6t rdbli IV No. 11858 tG . Address �O' �� 5 i �+ • i _r .J City f i fD State /) mak[; ZIP Code?�7�� ilk ,Allefr e �P• Signature 1 jam_ '?Date 3//e/09 //e/0 Telephonneq 3 All V. ,6,/ �i � �-1�1- 8y 4- FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions