HomeMy WebLinkAbout2-2-045:169wiJrA 1 `T 4AwQ1l I vrw�V)A . vrr-- -- AT*CN a
EDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. Nd. 3067-0Ow` 77 :1
NATIONAL FLOOD INSURANCE PROGRAM Expires July'31, 2002
ELEVATION Ci RTIFICATE -
Important: Read the instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION For Insurance Corgpany Use:
BUILDING OWNER'S NJAME ��� `, t� Poky Number
gKfAM
BUILDING STREET ADDRESS,(Inci ding Apt., UnJ),, ully and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
CITY ` STATE
etc.)
necessary
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: U GPS (Type)
#W, - ee.er 'or ##.###W) (_J NAD 1927 („( NAD 1983 (r( USGS Quad Map L J Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFiP COMMUNITY NAME 8 COMMUNITY NUMBER 1 82. COUNTY NAME 83. STATE
Hawaii County 155166 . Hawaii County Hawaii
NUMBER
1 (� I fi DATE
I EFFE TI JRDA R DATE I ZONE SS) � (Zone AO. � e d a h or blooding)
B10. Indicate the source of tt a Base Flood Elevation (BFE) data or base food depth entered in B9.
LJFIS Profile .LJ FIRM. lJ Communitylermined U (Describe):
(Dese):
B 11. Indicate the elevation datum used for the BFE In B9: [VNGVD 1929 j_ j NAVD 1988 U Other (Describe):
B12. Is the building located Ina Coastal Barrier Resources System (CBRS) area or dtherwise Protected Area (OPA)? "Yes LX ,( No
Designation Date:
SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations -are based on: LJConstruction Drawings• UBullding Under Construction' L_(Finished Construction
•A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number _Z;_ (Select the building diagram most similar to the building for which this certificate is being completed - ser
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 430, V (with BFE). AR, AR/A. ARAE. AR/A1-A30. AR/AH, AR/AO
Complete Items C3a-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. U e the $pace provided or the Comments area of Section D or Section G; as appro nate, to document the datum conversion
yDatum ,-Conversion/Comments 4ga, Ig -red LA fe — I 2Ar. 1Jr
Elevation reference mark used Does the elevation reference mark used appear on the FIRMT Yes (C Ni
❑ a) Top of bottom floor (including basement or enclosure) I - . 9 ft(m) g
❑ b) Top of next higher floor ft.(m) is d
❑ c) Bottom of lowest horizontal structural member (V zones only) _ ft. o LICENSED
O d) Attached garage (top of slab) .. mm) E E
Pt;4fEt3S4®NAL
O e) Lowest elevation of machinery and/or equipment w e ENG04EEP �
servicing the building 114 b fL(m) P � a •r
❑ 0 Lowest adjacent grade (LAG) D ft:(m) z'y
❑ g) Highest adjacent grade (HAG) •fir' . fL(m)
Q h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade
❑ i) Total area of all permanent openings (flood vents) in C3h _ 41g2!20 sq. in. (sq. cm)
SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION -1
f
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
1 certify that the information in Sections A, B. and C on this cerUhcate represents my best efforts to interpret the data available.
I understand that any false statement m� ay�b�e punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME �1�, l i It,{t 1 ^ /_ LICENSE NUMBER
TITLE ...�_ n wh .... 1 r . .�.. i.., COMPANY NAME lint IGr e b n e:1 i / 01 16�F� 1t.1