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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
<br /> Federal Emergency Management Agency Expires February 28. 2009
<br /> National Flood Insurance Program Important: Read the instructions on pages 1-8.
<br /> SECTION A-PROPERTY INFORMATION For Insurance Company Use:
<br /> Al. wilding Owner's Name _ Policy Number
<br /> S _1.0 hSTbI S LL-G
<br /> A2. uilding Street Address(including Apt.,Unit,Suite,and/or Bldg,No.)or P.O.Route and Box No. Company NAIC Number
<br /> 72-k ? KfitJ/J L (id t-, st-t s - .zs 144-is .
<br /> City State ZIP Code •
<br /> uJA - ►J A, -k- ,�r�c �?�.g. t int) g4--74-
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> ' : 4 p�q
<br /> � , " 155.n 7J ! 2f 1(o0�r
<br /> 11
<br /> .411
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
<br /> A5. Latitude/Longitude:Lat. N. [C.5281 Long. W. 15,5.99('3" Horizontal Datum: NAD 1927 akNAD 1983
<br /> A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
<br /> A7. Building Diagram Number t
<br /> A8. For a building with a crawl space or enclosure(s),provide: A9. For a building with an attached garage,provide:
<br /> a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft
<br /> b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
<br /> enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade •
<br /> c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> B1.NFIP Community Name&Community Number B2.County Name B3.State
<br /> Hawaii County 155166 Hawaii County Hawaii
<br /> 84.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> 155166 e. .. G 4/02/04 4/I(.,/(9 z::.s RE 9.4
<br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood dhpth entered in Item B9.
<br /> ❑FIS Profile Ex FIRM ❑Community Determined ❑Other(Describe)
<br /> B11. Indicate elevation datum used for BFE in Item B9: DilNGVD 1929 ❑NAVD 1988 0 Other(Describe)
<br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes ® No
<br /> Designation Date 0 CBRS 0 OPA
<br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: ❑Construction Drawings' 0 Building Under Construction' [x] Finished Construction
<br /> ' 'A new Elevation Certificate will be required when construction of the building is complete.
<br /> C2. 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. Complete Items C2.a-g
<br /> below according to the building/ldiagram specified in Item A7. f t� q
<br /> Benchmark Utilized g,An 4P . Vertical Datum htGA/V I l2q
<br /> Conversion/Comments _ - - - _ N•A,
<br /> Check the measurement used.
<br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor) .1'L .413 feet ❑r�meters(Puerto Rico only)
<br /> b) Top of the next higher floor 7../5 feet 0 meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) feet ❑meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) ❑feet ❑meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building is .15K, feet ❑meters(Puerto Rico only)
<br /> (Describe type of equipment in Comments)
<br /> f) Lowest adjacent(finished)grade(LAG) 12- 43feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade(HAG) tZ .Go fleet ❑meters(Puerto Rico only)
<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
<br /> information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. 'I
<br /> I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. °' R. �9
<br /> \\
<br /> Check here if comments are provided on back of form. �O 4;4
<br /> REGISTERED\\
<br /> Certifier's Name License Number
<br /> PROFESSIONAL I
<br /> "---let -..L. �,,; i I ��Z�-�� �y . * ARCHITECT *f
<br /> fie � r C, _ , g, NA^ )
<br /> 1r L,. - c. NO. 540
<br /> dress r _ City State Z1 y �'A>'j' _U e_ r-1 I
<br /> �o. 5 . Z htkQLdf4 q P•�
<br /> Signature /�/�'' ate ,`� Telephone
<br /> FEMA Form . -31, February 2006 / I(See reverse side for continuation. Replaces all previous editions
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