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Home My WebLink About7-6-014:0084f QJ6V 77t4` FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION rrvcn a rwmc !�A/CG WCA-r fTi REE riDDRESvc-S (Including Apt., Unit, Suite, ES( ffTION (Lot and Block Numbers, Tax I —. —.. r / I �S.LC .. .O. ROUTE AND BOX NO. STATE O.M.B. No. 3067-0077 Expires December 31, 2005 For Insurance Company Use: ( till°- #p - p#.prP or pp.plYppp°) �r IJ NAD 1927 �L'_I NAD 1983 SOURCE: L_I GPS (Type): LI USGS Quad Map LJ Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION County I Hawaii B4. MAP AND PANEL I B5. SUFFIXFIRM B6.6 INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATIONS) NUMBER 155166 0�2 ' E DATE EFFECTIVE/REVISED DATE ZONE S) (Zone AO, use depth of flooding) 02 95 OG •- 02 � S Z. 00" .+v. Cole ore source or nie nese Flood Elevation (nrn) data or base flood depth entered In B9. LI FIS Profile JX FIRM LI community Determined LI Other (Describe): B11. Indicate the elevation datum used for the BFE in B9:A NGVD 1929 LI NAVD 1988 1-1 Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? LI Yes IX I No Designation Dale: _ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REOUIREDt Building elevations are based on: LlConstruction Drawings- LlBuilding Under Construction* LlFinished Construction 'A new Elevation Certificate will be required when construction of the building Is complete. C2. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, AR/Al-A30, AR/AH, AR/AO Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Cnnversinn/Cnmmcnte Elevation reference mark used -0(�Ya be" Mw't-Does the elevation reference mark used app O a)Top of bottom floor (including basement or enclosure) 13 _ . fl.(m) 15 ' Cl b) Top of next higher floor2'� _ . 3(O fl.(m) A O c) Bottom of lowest horizontal structural member (V zones only) ,1.Q ft.(m) o ❑ d)Attached garage (top of slab) , O ft.(m) w g ❑ e) Lowest elevation of machinery and/or equipment servicing the building (Describe in a Comments area.) I % ft.(m) 8 R ❑ f) Lowest adjacent (finished) grade (LAG) ft.(m) z N O g) Highest adjacent (finished) grade (HAG) ft.(m) O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade O 1) Total area of all permanent openings (flood vents) in C3.h M sq. In. (s cm) at on the FIRM? Ll Yes El No O�Pg G. Pq J, PROFESSIONAL SZ * LAND * 1„ SURVEYOR / ' Z No. 10743 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 in Sections A, B, and C 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. FEMA Form 81-31, January 2003 See reverse side Vor continuation. Replaces all previous IMPORTANT: In these spaces, copy the corresponding information from Section A. j For Insurance Company Use, BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number STATE 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 I _ I Check here If attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. El. Building Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. It no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (Including basement or enclosure) of the building is 1_I_I ft• (m) 1_L-1 in. (cm) L1 above or I_I below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is LI_I fL (rn) LL—lin. (cm) above the highest adjacent grade. Complete Items C3.h and C3.1 on front of form. E4. The top of the platform of machinery andlor equipment servicing the building is I_I_I ft. (n)1 _1_1 in. (cm) L1 above or I_1 below (check one) the highest adjacent grade. (Use natural grade, If available.) E5. For Zone AO only. If no flood depth number is available, Is the top of the bottom floor elevated in accordance with the community's n _..d�i..:� �.................. ....rinnnrne I I Vne I I Mn I I I fn4nnu,n Tho Inrel nffiri Al must rAAitu thio InfnrmAtinn In 3Artinn ra. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B. C (Items C3.h and C3.1 only), 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, C, and E are correct to the best of my knowledge PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME DRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE .KHu1,5l�ili-� 11 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 can complete Sections A, B. C (or E), and G of this Elevation Certificate. Complete the applicable hem(s) and sign below. G1. 1_1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 1_1 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. 1_1 The following information (Items G4 -G9) is provided for community floodplain management purposes. G5. DATE PERMIT ISSUED G7. This permit has been G8. Elevation of as -built I G9. BFE or (in Zone AO) Is: ISSUED LOCAL OFFICIAL'S NAME ° rdIUt1 el'IllGafe and TITLE COMMUNITY NAME- TELEPHONE does not recommend SIGNATURE final approval DATE _ ft. (m) Datum: —ft. (m) Datum: r E GIEV, i•Z , i 0 w4[rc i{� RZL"72 T uE; c� f�tt ,E MA Form 81.31, January 2003 Replaces all previous