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Home My WebLink About1-4-010:021U.S.bEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program Building Street Address (including Apt., Unit, .LANE ELEVATION CERTIFICATE Important: Read the instructions on pages 1-8. OMB No. 1660-0008 Expires February 28 2009 SECTION A - PROPERTY INFORMATION I For Insurance Comoanv Use: and/or Bldg. No.) or P.O. Route and Box No. A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) REIDENTIAL A5. Latitude/Long@ude: Lat. N19 30.060' Long. W154 48.121Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A8. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 5 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) Ng sq ft a) Square footage of attached garage NA sq ft 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 - N/A walls within 1.0 foot above adjacent grade N6 c) Total net area of flood openings In AS.b N/A sq in c) Total net area of flood openings in A9.b N6 sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name 8 Community Number 82. County Name B3. State HAWAII COUNTY 155166 1 HAWAII COUNTY HAWAII B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone /A._ ❑ feet Date Effective/Revised Date Zone(s) AO, use base flood depth) 155166-1400 C 4/02/04 9/16/88 AE 15.5 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 (Describe) _ B11. 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)7 ❑Yea ®No Designation Date _ ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 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, Vt-V30, V (with BFE), AR, ARIA, ARAE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item AT Benchmark Utilized SURVEYOR SET Vertical Datum C_G_A LEVE 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) a) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grade (HAG) Check the measurement used. 19.2 ® feet N/A._ ❑ feet WA._ ❑ feet /A._ ❑ feet 19.2 ® feet ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) 8.85 ® feet ❑ meters (Puerto Rico only) 8.44 ® 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 data available. l 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 forth. Certifier's Name RONALD D. NICKEL License Number 8846-C G FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding Information from Section A. I For Insurance Company Use: I or TMK(3)1-"10:021 EWA LANE CityPAHOA State HI ZIP Code 96778 OR ARCHITECT CERTIFICATION ropy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/oompany, and (3) building owner. Comments THE AREA BELOW THE LIVING AREA IS AN OPEN CONCRETE SLAB AND WILL BE USED TO PARK A CAR THE EQ>))IPMENT CONSIST OF WATER HEATJt, WASHER, DRYER, ALL KITCHEN APPLIANCES AND THE EQUIPMENT TO RUN THE AEROBIC Check here if 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 Et -E5. If the Certificate Is Intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E7 -E4, use natural grade, If available. Check the measurement used. In Puerto Rico only, enter meters. Et. 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 spare, 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 (lop 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, A and E are correct to the best of my knowledge. or City State Signature Date Telephone ❑ Check here h 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 hem(s) and sign below. Check the measurement used in Items G8. and G9. G1. ❑ The information in Section Cwas 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 date 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. Date Permit Issued Date G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-buih lowest floor (including basement) of the building: _ _ -❑ feet ❑ meters (PR) Datum _ G9. BFE or (in Zone AO) depth of flooding at the building site pepatFment-of Qgiffl WnpVr (PR) Datum _ Local Official's Name EngineeringDivistolittil§as reviewe –........ . ....... recommends ._. _-.._.._ signetlLJ does not recollil0mnd /o 5W w rk__k __ _ By— Uk t✓l Issued FEMA Form 81-31, February 2006 Replaces all previous editions Building Photographs See Instructions for Item A6. Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and EWA City PAHOA State HI ZIP Code 96778 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, following.