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FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />NATIONAL FLOOD -INSURANCE PROGRAM
<br />ELEVATION CERTIFICATE
<br />Important: Read the instructions on pages l - 7.
<br />SECTION A - PROPERTY OWNER INFORMATION
<br />klll>1, lAM V. bKILH,M TQ
<br />BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
<br />1194 +-t 1 A, t_.. 0 A. -S7 R EQ—r
<br />CITY i 4 1 L— D STATE
<br />O.M.B. No. 3067-0077 ?
<br />Expires December 31, 2005
<br />For Insurance Company Use:
<br />Policy Number
<br />Company
<br />PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
<br />WT Z , KAk1Al LAN l G: ROVQ %SQWPIV IS 10M , LIAIT ! tii�i
<br />BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
<br />NSkl XGStt7WTI&I -
<br />( W - ##'- ##.##" or ##. 0)
<br />iJ NAD 1927 U NAD 1983
<br />SOURCE: 1J GPS (Type):
<br />)_( USGS Quad Map L_i Other
<br />SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME 83. STATE
<br />Hawaii Cowlity 155166 Hawaii Count Hawaii
<br />96120
<br />B4. MAP AND PANEL
<br />B5. SUFFIX
<br />B6. FIRM INDEX
<br />B7. FIRM PANEL
<br />B8. FLOOD
<br />B9. BASE FLOOD ELEVATION(S)
<br />NUMBER
<br />DATE
<br />EFFECTIVE/REVISED DATE
<br />1
<br />ZONE(S)
<br />(Zone AO, use depth of flooding)
<br />I
<br />155166 0$80
<br />C
<br />4/02%04
<br />1G-1SGrT,- S5
<br />JR4+
<br />++7.,-1
<br />B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
<br />jJ FIS Profile I_✓J FIRM I Community Determined 1_j Other (Describe):
<br />B11. Indicate the elevation datum used for the BFE in B9: L_1 NGVD 1929 1J NAVD 1988 1_1 Other (Describe):
<br />B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1 Yes j X { No
<br />Designation Date: N/A
<br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br />C1. Building elevations are based on: jJConstruction Drawings' 1J13uilding Under Construction' j (Finished Construction
<br />'A new Elevation Certificate will be required when construction of the building is complete.
<br />C2. Building Diagram Number,_ (Select the building diagram most similar to the building for which this certificate is being completed - see
<br />pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
<br />C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, ARIA, ARAE, AR/A1-A30, AR/AH, AR/AO
<br />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
<br />�fhe WMUffi i)sed'For#}ietBFE-•in-Section B, convert -the -datum to that used for the BFE. Show field measurements and datum conversion
<br />calculation. Use the space .provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
<br />Datum Conversion/Comments
<br />Elevation reference mark used M 1- M OW s Does the elevation reference mark used appear on the FIRM? 1_1 Yes {_ No
<br />❑ a) Top of bottom floor (including basement or enclosure) •% ft.(m) m
<br />❑ b) Top of next higher floor u/A _ ft.(m) 'Mo H• -
<br />H• MV
<br />❑ c) Bottom of lowest horizontal structural member (V zones only) ft.(m) o o Q��
<br />— — LICENSED
<br />❑ d) Attached garage (top of slab) -S .3 ft.(m) E _
<br />u, m 1J)PROFESSIONAL
<br />❑ e) Lowest elevation of machinery and/or equipment D �Ir LAND SURVEYOR
<br />Ar
<br />servicing the building (Describe in a Comments area.) �9'� ft.(m) E I cD N
<br />❑ 0 Lowest adjacent (finished) grade (LAG) +41 .3 fl.(m) z' S V
<br />' No. LS•7589
<br />❑ g) Highest adjacent (finished) grade (HAG) ¢ ft.(m) W
<br />❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade, J ay''�{1r�it U Cj P
<br />O i) Total area of all permanent openings (flood vents) in C3.h WA sq. in. (sq. cm) '
<br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
<br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
<br />l certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
<br />i understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001,
<br />CERTIFIER'S NAME 1:'ik1)L 14
<br />' MU2 RAY L PLA LICENSE NUMBER (,S -T981
<br />LINO Sa MYO R COMPANY NAME MOL A. MoRrew � ASSOCIATI s , L1•G
<br />IL
<br />CITY i O MOL STATE W I ZIP CODE 94; 1? r
<br />SO -OCT -0
<br />868.959-esgs
<br />FEMA Form 81-31, January 2003 "3ee reverse side for continuation. Replaces all previous editions
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