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FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. O.M.B. No. 3067-0077 Expires December 31, 2005 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME YUPolicy Number ni�' iCGm�� 7rK,5�' BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 4--57000 a w CITY STATE Zg CODE PG h.0 G` WI YG 7 7 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) L,I- 6� l�otio &cawti- 140f .571,)o Ag;Oo�-fm jec3� 1-4-��= zca BUILDING USE (e.g., Residential, Non-resideg', ' dditi n, Accessory, etc. Use a Comments area, if necessary.) }iA� LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_1 GPS (Type): ( ##° - ##' - ##.##" or ##.#####°) j_I NAD 1927 L_1 NAD 1983 1_1 USGS Quad Map 1_1 Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Hawaii County 155166 1 Hawaii County I Hawaii B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER 1406)-e- DATE 1 EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 155166 4/02/04 9116188 15" //0,00 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. 1_1 FIS Profile I t.<FIRM 1_1 Community Determined 1_1 Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: I t4 NGVD 1929 1_1 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 1X1 No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 1. Building elevations are based on: 1_1Construction Drawings* 1_113uilding Under Construction* i-*jFinished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number ti► (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, 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 1 vj"No ❑ a) Top of bottom floor (including basement or enclosure) 19 54ft. (m) ❑ b) Top of next higher floor ole, ft.(m) �NRIsr ❑ c) Bottom of lowest horizontal structural member (V zones only)�7�ft.(m) o o `5 Fiji ❑ d) Attached garage (top of slab) — ft.(m) I - LICENSED �FZ ❑ e) Lowest elevation of machinery and/or equipment w PROFESSK*M servicing the building (Describe in a Comments area.) .�� ft.(m) E r LAND ❑ f) Lowest adjacent (finished) grade (LAG) 37. 37 ft.(m) d SURVEYOR ❑ g) Highest adjacent (finished) grade (HAG)NO. 9077 ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade t zi '.• ❑ i) Total area of all permanent openings (flood vents) in C3.h t?/A sq. in. (sq. cm) �q Wq�l, X35 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. / certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. / understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME Mels 4�'G►ri5len ser, LICENSE NUMBER 90-7'7 TITLE COMPANY NAME sisrve yo►� DDRESS /244 ek : p1 �C' �iil o �1�" f ✓ CITY STATE ZIP CODE G 96 720 Q 5fr--036o FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions