The URL can be used to link to this page

Home My WebLink About6-6-004:124--------...-------------------_.-----.....--------------------+��y,->E•-( U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660.0008 Federal Emergency Management Agency Expires February 28, 2009 National Flood Insurance Program Important: Read the instructions on pages 1-6. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. BWlding Owner's Name Policy Number BARRON BERTELMANN A2. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 66-1747 ALANEO ST. (LOT 21) City State ZIP Code A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Lathude/Lorigitude: Let. 20-01-31.7 Long. 155-42-22.4 Horizontal Datum: ❑ NAD 1927 ❑Y 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 1 A8. For a building with a crew space or enclosure(s), provide: A9. For a building with an attached garage, provide: a) Square footage of crawl space or endosure(s) WA aq It a) Square footage of attached garage 612 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 WA walls within 1.0 foot above adjacent grade N/A c) Total net area of flood openings In A8.b WA eq In c) Total net area of flood openings in A9.b N/A sq In SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name 8 Community Number 82. County Name B3. Stale HAWAII COUNTY/ 155166 1 HAWAII HI 84. MaplPanel Number B5. SuffixB6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevatlon(a) (Zama 0164 D Date Effective/Revised Dale Zone(s) AO, use base flood depth) 2319._22_M feet ❑ meters (Puerto Rico only) 04/02/2004 07/16/1990 A 2314.6 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In Item B9. ❑ FIS Profile ❑ FIRM ❑ Community Determined ❑Q Other (Describe) CLOMR- I° fix, tJo 05 -09 -/r. z 4G Bill. Indicate elevation datum used for BFE in Item 89: Y❑ NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) •B12. Is the building located In a Coastal Barter Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes Q No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction- Q 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, V1430, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.& -g below according to the building diagram specified in Item A7. Benchmark Utilized HI DEPT OF TRANSP BM ON KAWAIHAE RDVertical Datum NGVD 1929 Converelon/Comments OR ARCHITECT CERTIFICATION i nis cemncaaon is to De slgnea ano seaiea oy a land surveyor, engineer, or architect authorized by law to certify elm information. I car* that the information on this Certificate represents my best eNorts to interpret the data avallab/e. I understand that any false statement may be punishable by fine or Imprisonment under 18 U.S. Code, Section 1001. W Check here If comments are provided on bade of form. Certifler's Name License Number FEMA See reverse side for continuation. K. A Licensedm Professional Engineer No.8336-C tGWAIL UA."- all tI.M all previous editions Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor) 2320. 221�1 feet ❑ meters (Puerto Rico only) b) Top of the next higher floor It�•❑�nn 2329 .amu feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) N/A ,_❑ feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) 2319._22_M feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servldng the building 2320 .-ZL❑M feet ❑ meters (Puerto Rico only) (Describe type of equipment In Comments) 0 Lowest adjacent (finished) grade (LAG) 2319. 38 X feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 2319.59 n feet ❑ meters (Puerto Rico only) OR ARCHITECT CERTIFICATION i nis cemncaaon is to De slgnea ano seaiea oy a land surveyor, engineer, or architect authorized by law to certify elm information. I car* that the information on this Certificate represents my best eNorts to interpret the data avallab/e. I understand that any false statement may be punishable by fine or Imprisonment under 18 U.S. Code, Section 1001. W Check here If comments are provided on bade of form. Certifler's Name License Number FEMA See reverse side for continuation. K. A Licensedm Professional Engineer No.8336-C tGWAIL UA."- all tI.M all previous editions IMPORTANT: In these spaces, copy the corresponding Information from Section A. For Insurance Company Use: Building Street Address (including Apt., Ung, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 66-1747 ALANEO ST. (LOT 21) City Slate ZIP Code Company NAC Number KAMUELA HI 96743 - SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) law Copy both sides of this Elevation Certificate for (1) community oftldal, (2) Insurance agent/company, and (3) building owner. Comments TMK• 6-8404124 -09 SECTION E - BUILDFNGrELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT HFE1 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, end C. For Items E1 -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 gra lowest adjacent grade (LAG). a) Top of bottom floor (Including basement, crawl space, or enclosure) Is — _ feel 1:1meters ❑above or ® below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) Is _ _ [IElafeet meters bove or below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided i Seclign.A gems 8 or 9 (see We 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ [n] feet L j meters LI above or LJ below the HAG. E3. Attached garage (top of slab) is _ ❑ feel ❑ 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 properly 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 statements in Sections A, B, and E are correct to the best of my knowledge. Property Owners or Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here If attect!menta 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 Si and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and GB. G1. ❑ The Information In Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or archllectwho is authorized by law to certify elevation Information. (Indicate the source and dale 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.-Gg.) is provided for community floodplain management purposes. G4. Permit Number I G5. Dale Permit Issued I G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G6. Elevation of as -bulk lowest floor (Including basement) of the building: ❑ feet ❑ meters (PR) Datum G9. BFE or (In Zone AO) W q0%" rr MbOTIrpj61iC Work, _[]feet ❑ meters (PR) Datum Local Official's Name Ell1cIS reviewed Title 1l ua Flevrit;o, rerfificcll w and Community Name f��Telephone Signature I I do fs n�t recommend Date FEMA Form 81-31, February 2006 Replaces all previous editions