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<br /> , , 'ELEVATION CERTIFICATE,page 2
<br /> IMPORTANT:in these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
<br /> Building Street Address(including Apt.,Unit,Suite.and/or Bldg.No.)or P.O.Route and Box No. Policy Number_
<br /> 4 69-1790 PUAKO BEACH DRIVE
<br /> City KAMUELA State HI ZIP Code 96743 Company NAIC Number
<br /> SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
<br /> Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner.
<br /> Comments AIR CONDITIONER COMPRESSOR IS LOVVEST EQUIPMENT
<br /> Signaturer---ei , ___
<br /> 4.4...____........., Date 12/1312013
<br /> SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
<br /> For Zones AO and A(without BFE),complete Items E1--E5.if the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B.
<br /> and C.For items E1-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters.
<br /> El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
<br /> grade(HAG)and the lowest adjacent grade(LAG).
<br /> a)Top of bottom floor(Including basement,crawlspace,or enclosure)is 0 feet 0 meters 0 above or 0 below the HAG.
<br /> b)Top of bottom floor(including basement,crawlspaoe,or enclosure)is 0 feet 0 meters 0 above or 0 below the LAG.
<br /> E2. For Building Diagrams 6-9 with permanent flood openings provided to Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor
<br /> (elevation C2.b in the diagrams)of the building is 0 feet 0 meters 0 above or 0 below the HAG.
<br /> E3. Attached garage(top of stab)is 0 feet 0 meters 0 above or 0 below the HAG.
<br /> E4. Top of platform of machinery and/or equipment servicing the building is • 0 feet 0 meters 0 above or 0 below the HAG.
<br /> E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management
<br /> ordinance? 0 Yes 0 No 0 Unknown.The local official must certify this information in Section G.
<br /> SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
<br /> The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-rued or community-issued BFE)
<br /> or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge.
<br /> '4'` Property Owner's or Owner's Authorized Representative's Name
<br /> Address City State ZIP Code
<br /> Signature Date Telephone
<br /> Comments
<br /> Ji Check here if attachments.
<br /> SECTION G-COMMUNITY INFORMATION(OPTIONAL)
<br /> The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B.C(or E),and G
<br /> of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8-G10.in Puerto Rico only,enter meters.
<br /> Cl.0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
<br /> is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
<br /> G2.0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
<br /> G3.0 The following information(Items G4-G10)is provided for community floodplain management purposes.
<br /> 1 G4.Permit Number j G5. Date Permit issued G6. Date Certificate Of Compliance/Occupancy Issued
<br /> a
<br /> G7. This permit has been issued for. 0 New Construction 0 Substantial Improvement
<br /> G8. Elevation of as-built lowest floor(including basement)of the building: 0 feet 0 meters Datum
<br /> G9. BFE or(in Zone AO)depth of flooding at the building site: 0 feet 0 meters Datum
<br /> G10.Community's design nadvaattforefrnsnt of Pubik 4 t,-rks —_,,, 0 feet 0 meters Datum
<br /> t,. 1,1° 0'ms C l (1res rev{!3V,!rd
<br /> Local Official's Name . .z. .',..., y. j (7,,:t:."=•;V . Title
<br /> tree'
<br /> Community Name NI a •- r «, , , Telephone
<br /> Signature L i 3',...., _.•.;:' t"`.:Orr:'tr : ) Date
<br /> Comments
<br /> 'almoi 5: "AA'«x ` �t
<br /> ~ ' ' J_ J,t 0 Check here if attachments.
<br /> FEMA Form 086-0-33(7/ 0 3 l4 2 Replaces all previous editions.
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