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Home My WebLink About2-4-033:032' FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 ) NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: UILDING OWNER'S NAME Policy Number OMAR E & VICTORIA L ACOSTA . BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY STATE PROPERTY DESCRIPTION (Lot and Block Numbers Tax Parcel Number, Legal Description, etc.) TMK:2-4-035.032 'Lot 4 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) ZIP CODE LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_I GPS (Type): ##' - ##.##" or ##.#####) I_I NAD 1927 1_1 NAD 1983 1_I USGS Quad Map 1J Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Hawaii County 155166 1 Hawaii Count . Hawaii B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7, FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER 2 DATE EFFECTIVE/RVISED DATE ZONE(S) (Zone AO, use depth of flooding) I 155166 08900 6102,195 9/ 16788 AR As 564.0 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. 1_1 FIS Profile 134 FIRM 1_1 Community Determined 1_1 Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: I gl NGVD 1929 1_I NAVD 1988 1-1 Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1 Yes IX I No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Building elevations are based on: I_IConstruction Drawings' 1_113uilding Under Construction" l glFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number (P (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. re presents 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 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 Does the elevation reference mark used appear on the FIRM? 1_1 Yes I X I No ❑ a) Top of bottom floor (including basement or enclosure) 564. 4 ft.(m) d ❑ b) Top of next higher floor (LANAI) 564. 2 ft.(m) ul ❑ c) Bottom of lowest horizontal structural member (V zones only) NA. — ft.(m) o 0 ❑ d) Attached garage (top of slab) 561. 2 ft.(m) E ❑ e) Lowest elevation of machinery and/or equipment (ALL WITHIN DWELLING) servicing the building (Describe in a Comments area.) NA..0.2 ft.(m) E 2 ❑ 0 Lowest adjacent (finished) grade (LAG) 560 1 ft.(m) 25M ❑ g) Highest adjacent (finished) grade (HAG) 560. 7 ft.(m) rw ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NA ❑ i) Total area of all permanent openings (flood vents) in C3.h NA sq. in. (sq. cm) 3rttt��iNgt. `� IRAN SURVEYOR 7fi L 0&sm , 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, B, 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 ROBERT T. SHIRAI LICENSE NUMBER LS -5985 TITLE COMPANY NAME LICENSED LAND SURVEYOR ISLAND SURVEY, INC. DRESS P6 JOY., 4?r� CITY HILO STATE HI ZIP CODE 96720 SIGNATURE �_' DATE 03/04/04 TELEPHONE 808-935-9105 FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions 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 CITY STATE ZIP CODE I Company 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_j Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) :or Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevation Certificate is intended for use as supporting nformation 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 1_1_1 ft. (m) 1-1-1 in. (cm) I_I above or 1_1 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 1_1_1 ft. (m) 1-1_1in. (cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is 1_1_1 ft. (m) 1_1_1 in. (cm)1_1 above or 1_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 floodplain management ordinance? I_] Yes I I No 1 I 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, C (Items C3.h and C3J 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 ESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE 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. 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 offlcial 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. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: 1_1 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) dep4h of flooding at the building site is: _ft. (m) Datum: ,1,e Department of Public Works LOCAL OFFICIAL'S NAME Engineering Division has reviewed TITLE COMMUNITY NAME evaiOn er I ICOte and TELEPHONE SIGNATURE [foes not recommend DATE MENTS final approval FEMA Form 81-31, January`'��b�3 ` Replaces all previous editions