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Home My WebLink About2-4-020:039. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE O.M.B. No. 3067-0077 Expires July 31, 2002 Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: UILDING OWNER'S NAMEI Policy Number TERESITA GARCIA BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 103 Kupu_lau Street CITY STATE ZIP CODE Hilo, Hawaii 96720 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) TMK:2-4-20:39, Lot 5 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) Residential LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: L_I GPS (TypeZ or ##.#####°) t_J NAD 1927 " NAD 1983 L_I USGS Quad Map L_I Other. • SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Hawaii/155166 Hawaii Hawaii B9. BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. J_J FIS Profile . JXJ FIRM j_j Community Determined L_J Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: K NGVD 1929 JJ NAVD 1988 LJ Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? JJ Yes = No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY R P. Building elevations are based on: J-_JConstruction Drawings' JJBuilding Under Construction` JKXIFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 5 (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, V1430, V (with BFE), AR, AR/A, AR/AE, 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. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? J_J Yes J --J N( ❑ a) Top of bottom floor (including basement or enclosure) 638. 1 ft.(m) ❑ b) Top of next higher floor NA _ ft.(m)`� ��r1'iT T&- ❑ c) Bottom of lowest horizontal structural member (V zones only) NA_ ft.(m) o o ❑ d) Attached garage (top of slab) 633. 8 ft.(m) E a LICENSED ❑ e) Lowest elevation of machinery and/or equipment w Co PROFESSIONAL d LAND SURVEYOR servicing the building NA _ ft. (m) E ❑ f) Lowest adjacent grade (LAG) 632 9 ft.(m) z' � No. 5965: ❑ g) Highest adjacent grade (HAG)- 633 6 ft.(m) U) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NAk' ❑ i) Total area of all permanent openings (flood vents) in C3h NA sq. in. (sq. cm) 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-Dn this certificate represents my best efforts to interpret the data available. / understand that any false statement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001. TIFIER'S NAME ROBERT T. SHIRAI LICENSE NUMBER 85 TITLE LAND SURVEYOR COMPANY NAME ISLAND SURVEY, INC. ADDRESP . B X 4315 CITY HILO STATE HI ZIP CODE 96720 SIGNATOR DATE TELEPHONE 935-9105 IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 103 KUYu? ILT STK SET CITY HILO STATE HI 96720 ZIP Citompany NAIC Number 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 J 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 E3. If the Efevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is J—J_J ft.(m) J_J_Jin.(cm) J—J above or J_J below (check one) the highest adjacent grade. E3. 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 floodplain management ordinance? J_J Yes' J—J No J—J 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 community -issued BFE) or Zone AO must sign here. AMOPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TE4EPHONE COMMENTS 1_1 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 item(s) and sign below. G1. I,J 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. J—J 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. J—J The following information (Items G4 -G9) is provided for community floodplain management purposes. ERMiT NUMBER I G5. DATE PERMIT ISS ISSUED G7. This permit has been issued for: J_J New Construction 1_1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) depp& ARg6tf b9JIdgi#1S istYorkS _ ft.(m) Datum: ��ginnerir��--�i��isien htas r�view LOCAL OFFICIALS NAME e�dTITLE the Elevation Certificate and 04T COMMS -11 recommends does not re TELEPHO VVL By n -s_ Ll io1 Dl z I 1 r hor!( horn if attarhm4-nf1