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BUILDING OWNER'S NAME FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE nt: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION G�.1G O L- K • 'KrciG�LA r O.M.B. No. 3067-0077 Expires December 31, 2005 For Insurance Company Use: Policy Number BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.j Company NAIC Number I liMAe MO E1 67 -r I CITY 4% 1. G STATE ZIP CODE R 6i ZO }-41�.k1Al 1 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) DoT 4--o. Si-,otzrsmA.tz1c rAmADiss t•oTS Ju5w1 i 151 o1N 045 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) N >Gw r-Qz I vQNTI Atit. __ LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: I I GPS (Type): or ##.#####°) L—I NAD 1927 LJ NAD 1983 LI 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 County 155166 Hawaii County I Hawaii B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 155166-o'bq0 C 4/02/04 SEPT. 16, 19 lab AE 513.5 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. I—I FIS Profile I V1 FIRM I_I Community D9termined 1_1 Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: I_I NGVD 1929 I—I NAVD 1988 I_I Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I—I Yes IX I No Designation Date: NI SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) OC1. Building elevations are based on: 1—(Construction Drawings* 1—(Building Under Construction* I✓IFinished 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, ARAE, AR/A1-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 Conversion/Comments Elevation reference mark used BM r51'1y* Does the elevation reference mark used appear on the FIRM? I_I Yes I V No O a) Top of bottom floor (including basement or enclosure) r✓' 1 �1 q ft.(m) ❑ b) Top of next higher floor W A, — ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) N A. _ ft.(m) o O 'Q LICENSED ❑ d) Attached garage (top of slab) 5 12 3 ft.(m) W PROFESSIONAL ❑ e) Lowest elevation of machinery and/or equipment 5 1 3 S *LAND SURVEYOR servicing the building (Describe in a Comments area.) ft. (m) aD? i ❑ f) Lowest adjacent (finished) grade (LAG) 5 0 ft.(m) d �' > t4 No. LS -7589 ❑ g) Highest adjacent (finished) grade (HAG) ail S ft.(m) C h ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NIA, ❑ i) Total area of all permanent openings (flood vents) in C3.h 1� �, sq. in. (sq. cm)j 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. 1 certify that the information in Sections A, S, and C 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. CERTIFIER'S NAME 1=Aa1J L_ �A . MUR2AY L. pLS LICENSE NUMBER LS -1569 FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions I