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U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program ELEVATION CERTIFICATE IMPORTANT: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: ,14-FRCY H4. C'/�15E r,PIJS i A2. Building Street Address (including Apt., Unit, Suite, and Bldg. No.) or D. Route and Box No. Com 7 s r/ P1 . n _ r ... _ r� - -- parry NAIC Numk)er: A3.6 Property Description (Lot 7-A4 e _ / 3 A4. A5. A6. A7. A8. L f 7 f -9 ib 7207 State Block Numbers, Tax Parcel Number, Legal Description, etc.) Z L-©19. 02./ ZIP Building Use (e.g., Reside2ti lbNon- gsidential, Addition, Accessory, etc. ♦ E$ I �Jt= Ut A i Latitude/Longitude: Lat. L '`- ! Long. .% n Horizontal Datum. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. 6 Building Diagram Number For a bu'!d' 'th ❑ NAD 1927 N RAD 1983 ng wI a crawlspace or enclosure(s): 6 A9. For a building with an attached garage: 6 a) Square footage of crawlspace or enclosure(s) 6 sq ft a) Square footage of attached garage s It b) No. of permanent flood o q p openings in the crawispace or b} Number of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade b c) Total net area of flood openings in A8.b h sq in c) Total net area of flood openings in A9.b s in d) Engineered flood openings? ElYes❑ No d) Engineered flood openings? ❑ Yes El No q SECTION B - FLOOD INSURANCE RATE MAP (FlRM) INFORMATION Bi. NAP Community ame.& om unity N B2. County Name B3. State I�awa11(%unly i66 Hawaii County Hawaii B4. Map/Panel Number B5. Suffix 66. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone Rev'sf d Dae AO, use base flood depth) 155166 0 04/02/2004 9! r b/ 9� �/F I -i n I B10.Indicate the source he Base Flood Elevation (BFE) data or base flood depth entered in Item 89: ❑ FIS Profile FlRM ❑ Community Determined ❑ Other/Source: Bll. Indicate elevation datum used for BFE in Item 89: >(NGVD 1929 ❑ NAVO 1988 ❑ Other/Source: 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No 6 Designation Date: / / ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ® Building Under Construction* finished Construction 6 *A new Elevation Certificate will be required when construction of the building is complete. 6 C2.6 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/A0. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters, Benchmark Utilized: Ilea 7 507K �//AMeQ� /� W- 1j�ertical Datum: J Indicate elevation datum used for the elevations in items a) through fMielow. ❑ NGVD 1929 L'I NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. 6 a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 6 f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 6 /0 �� Qfeet ❑ meters 6 �� • .�-- (feet ❑ meters 6 -10 • s - Ld feet ❑ meters ate; t IUM U - 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. I 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. [ I Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? EYYes 0 No Certifier's Name /� ?A JL A 2 Check the measurement used. 6 ,O r Company Name 'T`t-�4S E N 1 EEi�-1 �1 Lr • .3- Ofeet 0 meters 6 2 Date Te eph ne 2s- �S' 0 96 73 3r ❑ feet feet ❑ meters 6 ❑ meters 6 '� - 2 El (feet ❑ meters 6 --1 • Z - e feet ❑ meters 6 /0 �� Qfeet ❑ meters 6 �� • .�-- (feet ❑ meters 6 -10 • s - Ld feet ❑ meters ate; t IUM U - 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. I 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. [ I Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? EYYes 0 No Certifier's Name /� ?A JL A -�_ Lice urnbE� ( C. Title is N C� (na ,O r Company Name 'T`t-�4S E N 1 EEi�-1 �1 Lr Address © �A W City 1 ' L� State F4 ZIPCod ^� Signature 2 Date Te eph ne 2s- �S' 0 96 73 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions.