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HomeMy WebLinkAbout6-4-024:017U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency I Expires March 31, 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. •SECTION A - PROPERTY INFORMATION For Insurance' Company Use Al. Building Owner's Name ,Policy Number Gordon Sakamoto r A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company,NAIC Number 64-951 Mamalahoa Highway City State ZIP Code Kamuela HI 96743 A3. Property De ription,,((LQQt and Block Numbers, Tax Parcel Number, Legal Description, etc.) T.M. K.l3F6-4-024-017 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential As. Latitude/Longitude: Lat. 20 01' 3 6 . 7 6 " Long. 1S5 39' 12.93" 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. AT Building Diagram Number 5 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) NA sq ft a) Square footage of attached garage 400 sq fl b) No. of permanent good openings In the crawlspace or b) No. of permanent good openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade NA within 1.0 foot above adjacent grade Carport c) Total net area of good openings In A8.b NA sq In c) Total net area of flood openings In A9.b none sq in d) Engineered good openings? ❑ Yes ® No d) Engineered good openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION ii 4 2 - 04 Date Effective/Revised Date Zone(s) AO, use base good depth) 155166 0168E 0168E Sx�Sx79 5-16-94 AE 2771.5 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In Item B9. ❑ FIS Profile ® FIRM Community Determined ❑ Other (Describe) all. Indicate elevation datum used for BFE in Item B9: © NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) • 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 - Cl.. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® 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, ARIA, AR/AE, AR/Ai-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized RM16 Vertical Datum NGVD 1929 Elev.=2669.834 Conversion/Comments 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 licensed land surveyor? ®Yes ❑ No Certifier•sName Roger Dean Fleenor License Number TR 79.7E • i nie Owner company Name Roger Dean Fleenor LPLS LLC Address PO Box 383414 City Waikoloa State HI ZIP Code 96 Signature DateTelephone -880-9441 1-31-2011 808 FEMA�Forrrf �, Mar 09 LTA C-� See reverse side for continuation. c``g F�f ``+fib p LICENSED -p PROFESSIONAL LAND # SURVEYOR # No. 7276 Replaces all previous editions Check the measurement used. a) Top of bottom Floor (including basement, crawlspace, or enclosure floor) 2 7 7 5 . 4® feet a meters (Puerto Rico only) b) Top of the next higher floor NA feet meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) NA ❑ feet ❑ meters (Puerto Rloo only) d) Attached garage (top of slab) 2771 . 9 ® feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 2 7 74 . 4 ® feet ❑ meters (Puerto Rico only) (Describe type of equipment and location In Comments) 0 Lowest adjacent (finished) grade next to building (LAG) 2 7 7 0.. 8 ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) 2 7 71..7 ®feet ❑ meters (Puerto Rice only) h) Lowest adjacent grade at lowest elevation of deck or stairs, Including 277 . 9 ® feet ❑ meters (Puerto Rice only) structural support 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 licensed land surveyor? ®Yes ❑ No Certifier•sName Roger Dean Fleenor License Number TR 79.7E • i nie Owner company Name Roger Dean Fleenor LPLS LLC Address PO Box 383414 City Waikoloa State HI ZIP Code 96 Signature DateTelephone -880-9441 1-31-2011 808 FEMA�Forrrf �, Mar 09 LTA C-� See reverse side for continuation. c``g F�f ``+fib p LICENSED -p PROFESSIONAL LAND # SURVEYOR # No. 7276 Replaces all previous editions In these spaces, copy the corresponding Information from Section A. For Insurance Company Use: 1P Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number i ,;+{ i i 51 Mamalahoa Highway c State ZIP Code Company NAIC Number ^' la HI 96743 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. --..........- C2e is Electric Hot Water Tank in carport _1.-31-2011 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 Et -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, crawlspam, 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 openingstprovided In Sectigo A Items 8 and/or 9 (seepages 8-9 of Instructions), the next higher floor (elevation C2.b In the diagrams) of the. building is _ [].feet u meters [:]above or Li below the HAG. - E3. Attached garage (top of slab) is _ [:]feet E] meters El 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 dommunRys Floodplain management" ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information In Section G. The property owner or owners 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 stafements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's 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 (a E) and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used In Items G8 and G9. 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 AO. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. 134. Permit Number I G5. Date Permit Issued I 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 (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site ❑ feel ❑ meters (PR) Datum G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name� � vrt.rart�r+n :7 p 'ublfc Works Title Community Name E5,tt; has ievisweZI Telephone FEMA Form 81-31, Mar 0.9 D Replaces all previous editions GIG 19 • 0 Building Photographs See Instructions for Item A6. 'roninsurance company user Building Street Address (including Apt., Unit, Suite, and/or Bldg. No jor P.O. Route and Box No. Policy Number 64-951 Mamalahoa Highway City State ZIP Code Cornpeny NMCNumber Kamuela HI 96743 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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." If submitting more photographs than will fit on this page, use the Continuation Page on the reverse. Northerly Side - - -Northerly and Westerly Side Facing Highway' Showing Entry Completed Waste Water System At Easterly Side Easterly Side