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Home My WebLink About7-5-018:064DEPARTMENT OF HOMELAND SECURITY ral Emergency Management Agency ,net Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-8. OMB No. 1660-0008 Expires February 28. 2009 I SECTION A - PROPERTY INFORMATION I For Insurance Company Use: I A4. A5. A6. A7. A8. William & Shu -Tin Stirlen Apt., Unit, Suite, and/or or P.O. Route and Box No. Company NAIC nyKailuaKona ,are Hawaii `ieum0 96740 -5-018: 064 Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residentlal Latitude/Longitude:lat. 19 37' 35.67" Long. 155 59' 15.99" Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. Building Diagram Number 5 Horizontal Datum: L-1 NAD 1927 I ✓ I NAD 1983 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 It 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 I SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 155166 B4. Map/Panel Number B5. Suffix B6. FIRM Index 187. FIRM Panel B8. Flood - B9. Base Flood Elevation(s) (Zone ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) Dale EffectIlevised Date Zone(s) AO, use base flood depth) 0713 D 04/02/2004 05/16/1994 AE 10 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: [Z] NGVD 1929 ❑NAVD 1988 ❑Other (Describe) Blift the building located in a Coastal Barrier Resources System (CBRS) area r Otherwise Protected Area (OPA)T [3 Yes Q No IlWsignation Date ❑CBRS UFA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. 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/AII-A30, AR/AH, AR/AD. Complete Items C2.a-g below according to the building diagram specked in Item A7. Benchmark Utilized Fstahlichad Plevationc from Kailua Pier Vertical Datum Mean Spa Level Conversion/Comments none SECTION D - I nis certification is 10 be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify eler Information. I certify that the intonation 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. a.r�rlers rvame Chrystal T. Yamasaki License Numoer LS -4331 ' Nes Thomas Associates 1O"'pany Name Wes Thomas Associates Address 75-5749 Kalawa Street city Kailua-Kona state Hawaii ZIP Code 96740/1 329-2353 7, 2006 FEMA Form 81-31, February -2006 See reverse side for continuation. Replaces all previous editions Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor) 19.16 ❑✓ feel ❑ meters (Puerto Rico only) b) Top of the next higher floor 28.2—feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) n/ feet ❑ meters (Puerto Rico only) d) Attached garage (lop of slab) n/a I—Ifeet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 14.05 nfeet ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) Q Lowest adjacent (finished) grade (LAG) 5 1711 feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 9.9 nfeet ❑ meters (Puerto Rico only) SECTION D - I nis certification is 10 be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify eler Information. I certify that the intonation 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. a.r�rlers rvame Chrystal T. Yamasaki License Numoer LS -4331 ' Nes Thomas Associates 1O"'pany Name Wes Thomas Associates Address 75-5749 Kalawa Street city Kailua-Kona state Hawaii ZIP Code 96740/1 329-2353 7, 2006 FEMA Form 81-31, February -2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the cq• ponding Information from Section A. For Insurance Company Use: Policy Number IBulldin Street Address (including Apt., Unit, Suite, a�,uior Bldg. No.) or P.O. Route and Box No. 75-928 Alii Drive City State ZIP Code Company NAIC Number Kailua Kona Hawaii 96740 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. Comments Lowest Electrical machinery or equipment is an electrical receptacle on support Dost (photograph attached) Signature Date December 7, 2006 / 0 Check here if attachments SECTION E - BUILDING ELEVATION I O ATION (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, 8, 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_ Elfeet ❑ meters El above or El 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 Seaigp.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 LI meters ❑ above or L_J 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 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, 8, and E are coned to the best of my knowledge. Owners or Owners 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 ran 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 G8. and G9. Gt. ❑ 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. G4. Permit Number G5. Date Permit Issued G6. Dale Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-bulk 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 pts ❑ Check here if attachments Form 81-31. February 2006 Replaces all previous editions