HomeMy WebLinkAboutElevation Certificate Packet A (Fillable) A Zone Packet DEPARTMENT OF PUBLIC WORKS
COUNTY OF HAWAI‘I
Notice regarding ELEVATION CERTIFICATE (FEMA Form 086 -0-33)
The ELEVATION CERTIFICATE shall be certified (with signature and seal) twice: 1. Construction Drawings (Section C1 of Form) to provide the proposed elevation at the building permit approval stage. 2. Finish Construction (Section C1 of Form) to verify the actual as-built elevation. Upon request for Final Inspection of a structure with an ELEVATION CERTIFICATE, the applicant shall submit a certified ELEV ATION CERTIFICATE (Finished Construction) to the Engineering Division (Hilo: 961-8327 or Kona: 327-3530) for further processing with the Building Division. Note Section B item B11. of the ELEVATION CERTIFICATE. Technically , NGVD 1929 (National Geodetic Vertical Datum 1929) does not exist for the State of Hawai‘i . The current vertical datums in Hawai‘i are Local Tide Datum (LTD), which is based on tidal observations for each island. Add “LTD,” as shown above. Note: Section C item C2 .e) and Section D Comments of the ELEVATION CERTIFICATE . Section C2. E) must be completed by i ncluding the elevation of the Water Heater, Washer and/or Dryer, AC Unit , Electrical Panel, etc. -Whichever is lowest. In Section D Comments, i nclude a description of the Section C2. e ) related equipment type and location. Building above the minimum base flood elevation may reduce your flood insurance premium (if required by your mortgage company). Consult with your insurance agent. Attachments: Special Flood Hazard Area Certification Form Elevation Certificate (2 copies) Elevation Notation of Building Per mit Plans You can check either box, as follows : NGVD 1 929 -OR Other/Source: LTD .
SPECIAL FLOOD HAZARD AREA CERTIFICATION
ZONE A, AE, AH or AO
CH APTER 27 – FLOODPLAIN MANAGEMENT
HAWAI‘I COUNTY CODE
Project Description Address City State of Hawai‘i Z ip Code C ommunity No. Panel No. Suffix Date of FIRM FIRM Zone Base Flood Elevation (in Zone AO or AH, include depth) 155166 To the best available technical knowledge and information, the proposed project, plans and specifications: 1. c omply with the standards and requirements of the Hawai‘i County Code, Chapter 27, Floodplain Management; 2. are designed and constructed to not adversely affect the flooding of surrounding properties; 3. are designed and constructed to resist hazard forces. Project plans and specifications include: 1. certification of building plans by a structural engineer or architect; 2. the location of flood hazard boundaries as determined from the latest FEMA Flood Insurance Rate Map (FIRM); 3. t he certified lowest reference flood elevation; 4. the base flood elevations, velocity and other data from the latest FEMA FIRM/Flood Study and/or other studies; 5. existing and proposed elevations of the property grade; 6. existing and proposed structures, utilities and improvements. This certification is conditioned upon the actual construction of the project being in strict accordance with the plans and specifications as stamped and signed by me. Affix Seal Below Signature (Structural Engineer Or Architect) Name (print or type) Title Company Address Date County of Hawai‘i is an Equal Opportunity Provider and Employer
Elevation Certification of Building Permit Plans Each set of the building permit plans shall include the elevation of the "lowest fl oor" or the bottom of the lowest horizontal structural me mber, whichever is applicable. The applicable elevation notation, al ong with the Base Flood Elevation (BFE), shall be indicated on the plans' appropriate cross section. Refe r to the examples shown below. For Flood Zones A, AE, and AH : Base Flood Elevation = NGVD Finish Floor Elevation = NGVD For Flood Zone AO : Highest Adjacent Grade = NGVD FIRM Flood Depth = Feet Finish Floor Elevation = NGVD For Flood Zone VE : Lowest Horizontal Structure Member = NGVD Base Flood Elevation = NGVD Hawai‘i County is an Equal Opportunity Provider and Employer
U.S. DEPARTMENT OF HOMELAND SECURITY ElEvAtion CErtiFiCAtE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program 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 A1. Building Owner’s Name Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: City State ZIP Code A3. � Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. Long. Horizontal Datum: 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 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)
�sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawlspace 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 �
c) Total net area of flood openings in A8.b
�sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? Yes No � d) Engineered flood openings? Yes No SECtion B – FlooD inSUrAnCE rAtE MAP (FirM) inForMAtion B1. NFIP Community Name & Community Number B2. County Name B3. State B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ Revised Date B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone AO, use base flood depth) B10.Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: FIS Profile FIRM Community Determined Other/Source: B11. Indicate elevation datum used for BFE in Item B9: 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 No �
Designation Date: / /
CBRS OPA SECtion C – BUilDinG ElEvAtion inForMAtion (SUrvEY rEQUirED) a) Top of bottom floor (including basement, crawlspace, or enclosure floor) . feet meters � b) Top of the next higher floor . feet meters � c) Bottom of the lowest horizontal structural member (V Zones only) . feet meters � d) Attached garage (top of slab) . feet meters � e) Lowest elevation of machinery or equipment servicing the building . feet meters � (Describe type of equipment and location in Comments) � f) Lowest adjacent (finished) grade next to building (LAG) . feet meters � g) Highest adjacent (finished) grade next to building (HAG) . feet meters � h) Lowest adjacent grade at lowest elevation of deck or stairs, including . feet meters structural support � C1. Building elevations are based on: Construction Drawings* Building Under Construction* Finished Construction � *A new Elevation Certificate will be required when constr uction of the building is complete. � C2. � Elevations – Zones A1–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–h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: Vertical Datum: Indicate elevation datum used for the elevations in items a) through h) below. NGVD 1929 NAVD 1988 Other/Source: Datum used for building elevations must be the same as that used for the BFE. � Check the measurement used. � 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. 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. 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? Yes No PLACE
SEAL
HERE �
Certifier’s Name License Number Title Company Name Address City State ZIP Code Signature Date Telephone FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions.
ElEvAtion CErtiFiCAtE, page 2 iMPortAnt: in these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: City State ZIP Code Company NAIC Number: SECtion D – SUrvEYor, EnGinEEr, or ArCHitECt CErtiFiCAtion (ContinUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Signature Date SECtion E – BUilDinG ElEvAtion inForMAtion (SUrvEY not rEQUirED) For ZonE Ao AnD ZonE A (WitHoUt BFE) For Zones AO and A (without BFE), complete Items E1–E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items E1–E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is . feet meters above or below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is . feet meters above or below the LAG. E2. For Building Diagrams 6–9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8–9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is . feet meters above or below the HAG. E3. Attached garage (top of slab) is . feet meters above or below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is . feet meters above or below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community’s floodplain management ordinance? Yes No Unknown. The local official must certify this infor mation in Section G. SECtion F – ProPErtY oWnEr (or oWnEr’S rEPrESEntAtivE) CErtiFiCAtion The property owner or owner’s authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner’s Authorized Representative’s Name Address City State ZIP Code Signature Date Telephone Comments Check here if attachments. SECtion G – CoMMUnitY inForMAtion (oPtionAl) The local official who is authorized by law or ordinance to administer the community’s floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8–G10. In Puerto Rico only, enter meters. G1. The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone A O. G3. Th e following information (Items G4–G9) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: New Construction Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building: . feet meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: . feet meters Datum G10. Community’s design flood elevation: . feet meters Datum Local Official’s Name Community Name Signature Comments Title Telephone Date FEMA For m 086-0-33 (7/12) Check here if attachments. Replaces all previous editions.
ElEvAtion CErtiFiCAtE, page 3 B UilDinG PHotoGrAPHS See Instructions for Item A6. iMPortAnt: in these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: City State ZIP Code Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; “Front View” and “Rear View”; and, if required, “Right Side View” and “Left Side View.” When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. FEMA Form 086-0-33 (7/12) Replaces all previous editions.
ElEvAtion CErtiFiCAtE, page 4 B UilDinG PHotoGrAPHS Continuation Page iMPortAnt: in these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: City State ZIP Code Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; “Front View” and “Rear View”; and, if required, “Right Side View” and “Left Side View.” When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. FEMA Form 086-0-33 (7/12) Replaces all previous editions.