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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 <br /> Federal Emergency Management Agency I Expires February 28.2009 (C <br /> National Flood Insurance Program Important:- Read the instructions on pages 1-8. <br /> SECTION A-PROPERTY INFORMATION For Insurance Company Use: <br /> Al.MAt <br /> l.MAga lame]rwrae- 'I 1...t.4. Policy Number . <br /> A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number <br /> c2--trio u9u 1rE( c7 tom, 5�r-r�E..* 1 (esa t [s 243) <br /> ity t uSa►-t.� ► to ZIPcoa_�., <br /> �. u1& t (P,Qe: lit t) 96- 9-i <br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) <br /> T' MJc., 7- 2-tc% 4 ' a3.t�," <br /> 10 i � 44‘1,111 <br /> 15 5 ./ <br /> A4. Building Use(e.g.,Residential,Non- side tial, dition,Accessory,etc.) - aO.- r <br /> A5. Latitude/Longitude:Lat.'1t.11.12a4:11. Long. - Horizontal Datum: ❑NAD 1927 ►,1 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 <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 garages9 ft <br /> b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage <br /> enclosures)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 scl 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 85.Suffix 86.FIRM Index B7.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone <br /> Date E ctive/Revised Date Zone(s) AO,use base flood depth) <br /> 1551664`0' . G 4/02/04 140/1 fP2e7 Ae ci.o <br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. <br /> . 0 FIS Profile EXFIRM 0 Community Determined 0 Other(Describe) <br /> B11. Indicate elevation datum used for BFE in Item B9:54 NGVD 1929 0 NAVD 1988 0 Other(Describe) <br /> 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)?• 0 Yes ® No <br /> 0 <br /> Designation DateCBRS OPA <br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) <br /> Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction' 14 Finished Construction <br /> •A new Elevation Certificate will be required when construction of the building is complete. <br /> C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE.V1-V30,V(with BFE),AR,AR/A,ARAE,AR/Al-A30.AR/AH,AR/AO. Complete Items C2.a-g <br /> below according to the building diagram specified in Item A7. `, <br /> Benchmark Utilized gm Vertical Datum NGV t7 ICY2 <br /> Conversion/Comments <br /> - - - - <br /> - -- - N.A. <br /> eCheck the measurement used. <br /> .�-s <br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor) (0 ` IN feet 0 meters(Puerto Rico only) <br /> b) Top of the next higher floor Zv .91181 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) 0 feet ❑meters(Puerto Rico only) <br /> e) Lowest elevation of machinery or equipment servicing the building. (Q . [ilfeet 0 meters(Puerto Rico only) <br /> (Describe type of equipment in Comments) <br /> f) Lowest adjacent(finished)grade(LAG) 10 III feet ❑meters(Puerto Rico only) <br /> g) Highest adjacent(finished)grade(HAG) 10 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. I certify that the information on this Certificate represents my best efforts to interpret the data available. <br /> I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S.Code, Section 1001. 0��, R. "`IB <br /> XCheck here if comments are provided on back of form. F\, <br /> • REGISTERED <br /> Certifiers Name * pQ3SIONAL i t <br /> . �_p�.p �.,,.�cr License Number <br /> T�GT� �L-�C� AiCffiTFCT } * 1 <br /> T' � C a Na a /` / <br /> �' - C L EI��L rt S. No.•34(14 <br /> Address , Z. Ci It.b [ttate 6 e� �;•ts• �_u s- ...: <br /> Signature 'l��i <br /> /�1� Telephone .'ts2-10 An •.. <br /> FEMA Foi 81- ,February 2006 See reverse side for continuation. Replaces allP revious editions <br />