HomeMy WebLinkAbout6-6-007:004Project No. 16119.1 FF—ERAL EMERGENCY MANAGEMENT AGI-- `-Y
,ATIONAL FLOOD INSURANCE PROGRr.
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION
BUILDING OWNER'S NAME
BUILDING STREET ADDRESS (Including Apt.. Unit. Suite, and/or Bldg. No.) OR P.O_ ROUTE AND BOX NO.
CITY
Kamuela, Hawaii 96743 _
PROPERTY DESCRIPTION (Lot and Block Numbers. T
STATE
Legal Description, etc.)
Division)
BUILDING USE (e.g., Residential, Non-residential. Addition, Accessory, etc. Use Comments section if necessary.)
Residential
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_1 GPS (Type).
( ##° - ##' - ##.##" or ##.##tt##°) I _I NAD 1927 1_1 NAD 1983 1_1 USGS Quad Map 1_1 Other:
O.M.B. No. 3067-0077
Expires July 31, 2002
For Insurance Company Use:
Policy Number
Company NAIC Number
ZIP
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2. COUNTY NAME B3. STATE
Hawaii Hawaii I Hawaii
134. MAP AND PANEL
65. SUFFIX
66. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
DATE
EFFECTIVE/REVISED DATE
ZONE(S)
(Zone AO, use depth of flooding) _
I
155166 0164
D
Ma 16 1994
Jul 16, 1990
A
2307 per Dept of Pub Wk
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
)_j FIS Profile 1_1 FIRM 1_1 Community Determined ) 4Other (Describe): Elev on Bridge from County DPW
B11. Indicate the elevation datum used for the BFE in B9: I_(NGVD 1929 )_) NAVD 1988 1_1 Other (Describe):
B12. is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? j_) Yes 1_1No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
401. Building elevations are based on: I_lConstruction Drawings` I_lBuikiing Under Construction' I )gFinished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
,2. Building Diagram Number _1 (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 C3a-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 usedIRM an Bridge /�pPWoes the elevation reference mark used appear on the FIRM? 1_j Yes )--X No
0( a) Top of bottom floor (including basement or enclosure) 2309.8_ ft.(iW -11%P� T. Yq
0 b) Top of next higher floor — ft.(m) a Z1,Q
❑ c) Bottom of lowest horizontal structural member (V zones only) ` ft.(m) IS .
A o Q- LICENSED
❑ d) Attached garage (top of slab) — ft.(m) 0 2
V PROFESSIO
❑ e) Lowest elevation of machinery and/or equipment- L
servicing the building + ft.(m) w
Ck f) Lowest adjacent grade (LAG) 2307.Q_ ft.00C z' .� * S OR r
0A g) Highest adjacent grade (HAG) 2309.0 ft.(d)( G N x331 SP'
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade it, V'
❑ i) Total area of all permanent openings (flood vents) in C311 sq. in. (sq. cm) ebrua , 001
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, 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 LICENSE NUMBER
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G1
LEPHONE
74
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