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Home My WebLink About2-4-037:110NG OWNER'S NAME FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION LEE MORI O.M.B. No. 3067-0077 Expires December 31, 2005 For Insurance Comoanv Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number I 1029 LELEPAU STREET CITY STATE ZIP CODE HILO HI 96720 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) TMK:2-4-037:110'' BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, N necessary.) RESIDENTIAL LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: L GPS (Type): ( ##° - ##' - #f.##' or ##.°) LJ NAD 1927 J_j NAD 1983 U USGS Quad Map U Other SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B4. MAP AND PANEL B5. SUFFIX B6, FIRM INDEX B7. FIRM PANEL B8. FLOOD 89. BASE FLOOD ELEVATION(S) NUMBER �- DATE I EFFECTIVE/REVISED DATE 1 ZONE(S) 1 (Zone -AO, use depth of flooding) 155166 0890C 4/02/04 9/16/88 AH 606.0 B10. Indicate the source of the Base -Flood Elevation (BFE) data or base flood depth entered.in B9. " FIS Profile ( gj FIRM L�:.ommunity Determined LJ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: L3 NGVD.1929 " NAVD 1988 LJ Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? LJ.Yes .jX I No Designation Date: SECTION C. - BUILDING•ELEVATION INFORMATION (SURVEY REQUIRED) 1. Building elevations are based.on: I lConstruction Drawings' LjBuilding Under Construction' . LJFinished Construction •A new Elevation Certificate will be required when construction -of the building -incomplete. 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, V1 -V30, V (with BFE), AR, AR/A, 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 NGVD 1929 Conversion/Comments NONE Elevation reference mark used USGS BM 5YY Does•the elevation reference mark -. used -appear on. the -FIRM? LJ -Yes Lac No 0 a) Top of bottom floor (including.basement_or: enclosure) • 606. 7 ft(m). m 0 b) Top of next higher floor 615. 8 ft (m) �- 0 c) Bottom of. lowest horizontal- structural --member (V zones only) NA ft.(m) c o 0 d) Attached garage (top of slab) 606. 2 ft.(m) E 0 0 e) Lowest elevation of machinery and/or equipment J m servicing the building (Describe in a Comments area.) 606 7 ft.(m) E ❑ 0 Lowest adjacent (finished) grade (LAG) 602 4 ft.(m) z' ❑ g) Highest adjacent (finished) grade (HAG) 604. 1 ft.(m) ❑ 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) 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, 8, 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 LICENSE NUMBER ROBERT T. SHIRAI LS -5985 LAND SURVEYOR ISLAND SURVEY, INC. - --- P.O. [Bo:k- 4P.5 - HILO HI -- 96720 SIGNATURE DATE TELEPHONE 09/23/04 808-935-9105 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. I. For insurance Company Use: Apt., Unit, Suite, and/or Bldg. No.) OR P.O. RO STATE ZIP CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) y both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. MMENTS 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. 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.orenclosure) of the building is I I 1 -ft. (m) I I . I in. {cm) L- above or LI below (check one) the highest -adjacent -grade. (Use -natural grade, If available.) E3. For Building Diagrams 6-8 with openings (see page T), the next higher floor or -elevated floor (elevation°.b) of the building is I I 11. (m)_I I lin. (cm) above :the highest.adjacent.grade. Complete items C3.h.and C3.i-oni ont of -form. E4. The top of the. platform of machinery and/or equipment servicing the building is I I I ft. (m) l I I in. (cm)" above or LJ 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 I Yes I I .No .I 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 C3.i.oniy), and -E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, A C, and E are comact-to the best of my knoMedg�_ PROPERTY OWNER'S.OR OWNER'S AUTHORIZED REPRESENTATIVES NAME ,ADDRESS CITY - STATE ZJP CODE. ATURE DATE TELEPHONE COMMENTS I—I 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., B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 31. Ll 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.)_ 32. LI A community official con. pleted'Section E for a building located in Zone A (without a -FEMA -issued orcommunity-issued'BFE) or Zone AU. 33. L_1 The following information (Items G4 -G9) is provided,for community floodplain management purposes. G4. PERMIT NUMf3F R• G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED ;7. This permit has been issued for: �_I New Construction I_I Substantial Improvement �8. Elevation of as -built lowest floor (including basement) of the building is: —ft. (m) Datum: ;9: BFE or (in Zone AO) depth of flooding at the building site is: _ ft. (m) Datum: The Departmenf of Ptrhlir Wake LOCAL OFFICIAL'S NAME Engineering Division has reviewed TITLE COMMUNITY NAME f e Elevation Certificate cnd TELEPHONE SIGNATURE recorrirnes,dz DATE floes not re,corr mencl COMMENTS final approval Q.. C1 (244 04 1 1 Check here if =MA Form 81-31, January 2tSt5Ve ``' Replaces all previous editions