4-5-006:067 Second Structure - Laserfiche WebLink

Home

U.S. EELEVATION CERTIFICATE FEDERAL EMERGENCY OMB No. 1660-0008 National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Ronald L.Thiel and Barbara L.Franklin Policy Number: A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number. 45-3438 Mamane Street City Honokaa State HI ZIP Code 96727 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) (3)4-5-006:067 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude: Lat.20.07804 Long.-155.46433 Horizontal Datum: El NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 6 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 338 sq ft a) Square footage of attached garage 265 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes E No d) Engineered flood openings? ❑ Yes E No 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 66.FIRM Index Date B7.FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone 0205 C April 2,2004 Effective/Revised Date Zone(s) AO,use base flood depth) September 16, 1988 AH 1094.0 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. 0 FIS Profile E FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: E NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes E No Designation Date: ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* E Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. 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-h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters. Benchmark Utilized:Tr."Hula Moon" Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. E NGVD 1929 ❑ NAVD 1988 0 Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a)Top of bottom floor(including basement,crawlspace,or enclosure floor) 1093.2 ®feet ❑meters b)Top of the next higher floor 1102.4 ®feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet 0 meters d)Attached garage(top of slab) 1102.3 E feet ❑meters e) Lowest elevation of machinery or equipment servicing the building 1100.1 feet El meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 1088.5 Z feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 1102.3 E feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support 1096.0 E feet ❑meters 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.l 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. ��0� J04C,f. E Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a S� El Check here if attachments. licensed land surveyor? ❑ Yes E No AQ LICENSED 2 PROFESSIONAL Certifier's Name Trevor B.Jackson License Number LS-11858 * LAND SURVEYOR * Title Land Surveyor Company Name NO.11P8 Address P.O. Box 872 City Pahoa State HI ZIP Code 96778 Signature V Date /� Telephone 808-640-6057 y4WAII,U$P FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions.