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Home My WebLink About1-4-068:073U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION Al. Building Owner's Name DOUGLAS & JOHNENE DEASY . Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. HI LOU City PAHOA State HI ZIP Code 96778 OMB No. 1660-0008 Expires February 28.2009 For Insurance Comoanv Use: A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latltude/Longitude: Lat. N19 29.355' Long. W154 49.289' Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the CertKcate Is being used to obtain flood insurance. AT Building Diagram Number D A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) NA sq It a) Square footage of attached garage NA sq 1t b) No. of permanent flood openings In the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade NA walls within 1.0 foot above adjacent grade NA c) Total net area of flood openings In A8.b NA sq in c) Total net area of flood openings in A9.b NE sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION HAWAII COUNTY 155166 1 HAWAII COUNTY I HAWAII 155166.1400 I C I 4 02/04 I Effeetiv916-88 d Date ZoAnE(s) I AO, use base 7ood 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 (Descdbe) 811. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) 612. Is the building located Ina Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)9 ❑Yes ®No Ih Designation Date _ ❑ CBRS ❑ OPA IV SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REOUIREDI 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 At -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, AR/Al-A30, AR/AH, ARIAD. Complete Items C2.a-g below according to the building diagram specified In Item A7. Benchmark Utilized USGS Vertical Datum Conversion/Comments a) Top of bottom floor (including basement, crawl space, 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 in Comments) 1) Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grade (HAG) 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 date available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. �,r,w� •,,,. ® Check here if comments are provided on back of forth. +rel C r �'•%,, Certifiers Name RONALD D. NICKEL License Number 8846-C Title CIVIL ENGINEER Company Name RONALD NICKEL P.E. LLC &- ; ✓� dress 12-7109 KALAUNU ST City PAHOA State HI ZIP Code 96778 Slgnatu ate Telephone 808-965-9911 FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous Check the measurement used. feet ❑ meters (Puerto Rico only) 6._ ❑ feet ❑ meters (Puerto Rico only) NA._ ❑ feet ❑ meters (Puerto Rico only) NA. _ ❑ feet ❑ meters (Puerto Rioo only) IN ® feet ❑ meters (Puerto Rico only) 5.23 ® feet ❑ meters (Puerto Rico only) ¢.2' ® feet ❑ meters (Puerto Rico only) 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 date available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. �,r,w� •,,,. ® Check here if comments are provided on back of forth. +rel C r �'•%,, Certifiers Name RONALD D. NICKEL License Number 8846-C Title CIVIL ENGINEER Company Name RONALD NICKEL P.E. LLC &- ; ✓� dress 12-7109 KALAUNU ST City PAHOA State HI ZIP Code 96778 Slgnatu ate Telephone 808-965-9911 FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous 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 KAHI LOU Tf`l Y�, 1— 4 o& •. O-7 CRv PAHOA State HI ZIP Code 96778 1 Comnanv NAIC Numher SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) opy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments THE EQUIPMENT CONSIST OF WATER HEATER, WASHER, DRYER, ALL KITCHEN APPLIANCES AND THE EQUIPMENT TO RUN THE AEROBIC SEPTIC SYSTEM. THE EV �TIO,N WAS TAKENF`oM A SURVE=YOR SET BM BASED O'd i UPSM 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 Rioo 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, crawl space, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) Is _ _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 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 information 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. ,Eroperty Owner's or Owner's Authorized Representative's Name Signature Date Telephone Comments The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Si and G of this Elevation Certificate. Complete the applicable Rem(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 G4.49.) is provided for community floodplain management purposes. G4. Permit Number I G5. Date Permit Issued I G6. Date Certificate Of Comoliance/Occuoancv Issued G7. This permit has been issued for: Cl 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: _ _ ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date mments ❑ Check here R attachments FEMA Form 81-31, February 2006 Replaces all previous editions I'M I