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Home My WebLink About2-4-079:032FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD -INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages l - 7. SECTION A - PROPERTY OWNER INFORMATION klll>1, lAM V. bKILH,M TQ BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 1194 +-t 1 A, t_.. 0 A. -S7 R EQ—r CITY i 4 1 L— D STATE O.M.B. No. 3067-0077 ? Expires December 31, 2005 For Insurance Company Use: Policy Number Company PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) WT Z , KAk1Al LAN l G: ROVQ %SQWPIV IS 10M , LIAIT ! tii�i BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) NSkl XGStt7WTI&I - ( W - ##'- ##.##" or ##. 0) iJ NAD 1927 U NAD 1983 SOURCE: 1J GPS (Type): )_( USGS Quad Map L_i Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME 83. STATE Hawaii Cowlity 155166 Hawaii Count Hawaii 96120 B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE 1 ZONE(S) (Zone AO, use depth of flooding) I 155166 0$80 C 4/02%04 1G-1SGrT,- S5 JR4+ ++7.,-1 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. jJ FIS Profile I_✓J FIRM I Community Determined 1_j Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: L_1 NGVD 1929 1J 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 j X { No Designation Date: N/A SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: jJConstruction Drawings' 1J13uilding Under Construction' j (Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. 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.) 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 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 �fhe WMUffi i)sed'For#}ietBFE-•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 M 1- M OW s Does the elevation reference mark used appear on the FIRM? 1_1 Yes {_ No ❑ a) Top of bottom floor (including basement or enclosure) •% ft.(m) m ❑ b) Top of next higher floor u/A _ ft.(m) 'Mo H• - H• MV ❑ c) Bottom of lowest horizontal structural member (V zones only) ft.(m) o o Q�� — — LICENSED ❑ d) Attached garage (top of slab) -S .3 ft.(m) E _ u, m 1J)PROFESSIONAL ❑ e) Lowest elevation of machinery and/or equipment D �Ir LAND SURVEYOR Ar servicing the building (Describe in a Comments area.) �9'� ft.(m) E I cD N ❑ 0 Lowest adjacent (finished) grade (LAG) +41 .3 fl.(m) z' S V ' No. LS•7589 ❑ g) Highest adjacent (finished) grade (HAG) ¢ ft.(m) W ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade, J ay''�{1r�it U Cj P O i) Total area of all permanent openings (flood vents) in C3.h WA 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. l 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 1:'ik1)L 14 ' MU2 RAY L PLA LICENSE NUMBER (,S -T981 LINO Sa MYO R COMPANY NAME MOL A. MoRrew � ASSOCIATI s , L1•G IL CITY i O MOL STATE W I ZIP CODE 94; 1? r SO -OCT -0 868.959-esgs FEMA Form 81-31, January 2003 "3ee 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 1156 +4IALOA STRQr.:.T CITY 141Lo +4 gb�2o STATE ZIP CODE Company NAIC Number 1 , SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) py both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. —COMMENTS Li)OG67 Eovipmr.QT darmt"Ilir, Tic: 1k MLt)I#J6 iS TH-Q Oh"Tr.,z It. CAR Mg, 4TvRA-40. tZg0 , 1 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 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_I_I ft. (m) 1_I_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�I ft. (m) IJ_j in. (cm) 1_-j 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 J Yes 1 J No I l 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 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 ADDRESS CITY STATE ZIP CODE Aft GNATURE 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 A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. I_I The information 16 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. I_1 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. 1J 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: 1J New Construction 1_1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft. tm) Datum: G9. BFE or (in Zone AO) deD14 g fjQeodina enbui�ldir�u$it�Cs.WOtk3 —ft. (m) Datum: LOCAL OFFICIAL'S NAME sneering ivision hcs reviewed TITLE the ilevation COMMUNITY NAME r" TELEPHONE SIGNATURE M does not recommend DATE COMMENTS final cipprovall FEMA Form 81-31, January OCT 2 D 2005 1 1 Check here if attachments Replaces all previous editions