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� <br /> I / <br /> U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 <br /> Federal Emergency Management Agency <br /> 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. Ming Owner's Name Policy Number <br /> -PtLAAc�Rs-� L L. <br /> A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. , Company NAIC Number <br /> 1%' 1 k t.�tt) 17R. S 01- 4- - 5 11 CZ <br /> I I..0A--e-=)-4� k17 •,SJ 1 (ig,o.R. MI)te ZIP, <br /> ode <br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) <br /> . 2 g ,` �� )55° '50 27.2-1 It • <br /> A4. Building Use(e.g.,Residential,Non-Residenti�f Addition,Accessory,etc.) T L.dG�1i') -rc V <br /> A5. Latitude/Longitude:Lat. N. I9.SSW Long.W. 155.996/ a Horizontal Datum: ❑NAD 1927 [NAD 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 I <br /> A8. For a building with a crawl space or endosure(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 a-awl space or b) No.of permanent flood openings in the attached garage <br /> endosure(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 /> B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone <br /> Date 155166A-12 - •� C. 4/02/04 q//'ve`/'saedaDate AZo�ne(s) AO, base flood depth) <br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89. <br /> ❑FIS Profile [I FIRM 0 Community Determined 0 Other(Describe) <br /> B11. Indicate elevation datum used for BFE in Item B9: 141 NGVD 1929 0 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 ❑CBRS 0 OPA <br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) <br /> Cl. Building elevations are based on: 0 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,ARAE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g <br /> below according to the building diagram specified in Item A7. v <br /> Benchmark Utilized R�6S _ Vertical Datum 1si‘ P`1 MI <br /> Conversion/Comments_ __ __ _ _- __ _ _ . , tt - GY•A• <br /> TGheck the measurement used. <br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor) to .91feet ❑r- meters(Puerto Rico only) <br /> b) Top of the next higher floor <br /> Ili <br /> feet 0 meters(Puerto Rico only) <br /> c) Bottom of the lowest horizontal structural member(V Zones only) feet 0 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 Iv .�Tf` [feet ❑meters(Puerto Rico only) <br /> (Describe type of equipment in Comments) <br /> f) Lowest adjacent(finished)grade(LAG) to 41 IN feet 0 meters(Puerto Rico only) <br /> g) Highest adjacent(finished)grade(HAG) 10 $S is feet ❑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. /certify that the information on this Certificate represents my best efforts to interpret the data available. <br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ,OQ,�. • ®F <br /> Check here if comments are provided on back of form. \ <br /> �RRD '� <br /> PROFESSION A l 1 t <br /> Cerifier's Name „i� Lice se Number J; <br /> `('� Al3��IifiECT <br /> Wit, 1.. t S <br /> Title Com any arpe__„ S y No. 5404 / <br /> Address ty State �Cc <br /> t'•o. �. =•'•- 1 .akt Kia kkc 77bFr` lip ll, V•`'p- <br /> Signature --' <br /> rite-: �.r D�t1Q: L <br /> t T I�. Qtzz) <br /> FEMA For81 1, February 2006 See reverse side for continuation. Replaces all previous editions <br />