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Home My WebLink About7-5-022:081OurP;6]# 11989.2 U.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 t. Building owner's Name MENTAL HEALTH KOKUA OMB No. 1660-0008 Expires February 28. 2009 For Insurance Cbmpanv Use: A2. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.I Company MAIC Number I 75-5725 Alanoe Place city Kailua Kona State Hawaii ZIP code 96740 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, air- Lot ta Lot 89 Lono Kona Subdivision Tax Map Key: 3/7-5"MM. 081 A4. Building Use (e.g., Residential, Non -Residential, Addition; Accessory, etc.) Residential A5. Latitude/Longitude: Let. N 19 38' 22.4317" Long. W 155 59' 17.4554" Horizontal Datum: LJ NAD 1927 Q 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 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) n/a sq ft a) Square footage of attached garage n/a 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 walls 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 SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name 6 Community Number B2. County Name B3. State 155166 HAWAII I Hawaii Hawaii B4. Map/Panel Number B5. Suffix B8. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (ZorwV Date Effective/Revised Date I Zones AO, use base flood depth) I 0713 D 04/02/04 05/16/1994 4 L 00 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In Item B9. d '=• c47 r' s� ❑FIS Profile [DFIRM [-]Community Determined []Other (Describe) 811. Indicate elevation datum used for BFE in item B9: ❑d NGVD 1929 ❑NAVD 1988 ❑Other (Describe) �12. Is the building located in a Coastal Barrier Resources System (CBRS) arearwlse Protected Area (OPA)7 ❑ Yes Q No ❑ Designation Date CBRS LJOPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Ct. 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 Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.ag below according to the building diagram specified In Item AT Benchmark Utilized I ISr;S RM Flevatinn at Kailua Pier Vertical Datum r:nnuertert to MSI Converslon/Comments Check the measurement used. a) Top of bottom floor (Including basement, crawl space, or enclosure floor) 90.7l[!Z� ]-r feet 1:1 meters (Puerto Rico only) b) Top of the next higher floor LJ feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) feet ❑ meters (Puerto Rico onty) e) Lowest elevation of machinery or equipment servicing the building feet ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) _ 87.7 rnfeet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 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. ,� I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ;G� Q L CEeG .. i'� ❑✓ Check here If comments are provided on back of form. Certifiers Name Chrystal T. Yamasaki License Number LS -4331 Title Wes Thomas Associates Company Name Wes Thomas Associates Address 75-5749-Kalawa Street city Kailua-Kona stale Hawaii ZIPcode96740n _ Form 81-31, 17.2007 ,v,oyu.uc (808) See reverse May 17, Replaces all previous editions I IMPORTANT: In these spaces, copy the corresponding Information from Section A. ) For Insurance Company Use: or State OR ARCHITECT Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/oomparry, and (3) building owner. Comments No Attached Garaqp One Stay Building„ Lowest Flactrural EDLinm nt — Washer /Dryer May 17, 2007 SECTION E -13UILDING ELEVATION (NFOyt'MATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT SIFE) 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 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, crawl space, or enclosure) Is _ ❑ feet ❑ meters ❑ above or❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) Is _ _ 11 feet El meters 1:1 above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Sectlg[LA Items 8nd/or 9 (see e 8 of Instructions), the next higher floor pal (elevation C2.b In the diagrams) of the building is . _ ❑ feet U meters above or I�I 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 lop 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 communly4ssued BFE) or Zone AO must sign here. The statements /n Sections A, B, and E are correct to the best of my knowledge. or Owner's Authorized Signature Stale 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 Ga. and Gg. 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 oommuniy4ssued BFE) or Zone AO. G3. ❑ The following Information (items G4. -G9.) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G8. 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: ❑ feet ❑ meters (PR) , Datum Local Official's Name Title Community Name Telephone ❑ Check here If attachments FEMA Form 81-31, February 2006 Replaces all previous editions