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Home My WebLink About6-8-022:008n IT -RAL EMERGENCY MANAGEMENT AG' `:Y O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAm' Expires July 31, 2002 ELEVATION CERTIFICATE rtant: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number BUILDING STREET ADDRESS (including Apt.. Unit, Suite, and/or OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY STATE ZIP CODE South Kohala. Island and Countv of Hawaii. State of Hawaii 96743 Orchid at Mauna Lani BUILDING USE (e.g., Residential, Non- r ion, ccessory; a c. ction if necessary.) Commercial — Restaurant Relocation of Restuarant service station and storage addition LATITUDEILONGITUDE (OPTIONAL) ( Mf - ##' - ##.##" or ##.###/#f) HORIZONTAL DATUM: SOURCE: LI GPS (Type): i J NAD 1927 1_1 NAD 1983 Li USGS Quad Map IJ Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER Hawaii B2. COUNTY NAME Hawaii I 63. STATE Hawaii B4. MAP AND PANEL NUMBER 155166 0278 B5. SUFFIX C B6. FIRM INDEX DATE 9/18/88 I B7. FIRM PANEL EFFECTIVE/REVISED DATE 9/18/88 B8. FLOOD ZONE(S) AE B9. BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) 1 8 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. I_I FIS Profile L,) FIRM 1_1 Community Determined L_* Other (Describe): USGS Data 611. Indicate the elevation datum used for the BFE in B9: L(NGVD 1929 LJ NAVD 1988 1J Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1 Yes L_I No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based -on: i_(Construction Drawings' L{Building Under Construction* (X JFinished Construction *A new Elevation Certificate will be required when construction of the building Is complete. C2. 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, ARAE, 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 used Local Bench MarkDoes the elevation reference mark used appear on the FIRM? LJ Yes 13 N I a) Top of bottom floor (including basement or enclosure) 9.9 ft.(i* g 0 b) Top of next higher floor _ ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) ft.(m) � _fg 0 d) Attached garage (top of slab) r ft.(m) E 0 � ❑ e) Lowest elevation of machinery and/or equipment `U to servicing the building — ft.(m) r=„ C)A f) Lowest adjacent grade (LAG) ft.(w Z( DA g) Highest adjacent grade (HAG) 9.7--ft-OW '2_ No. 451 '-• 0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade y tq;�ti, VS 0 I) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) January .2001 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 anv false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. FFMA Fnrm A1.11 Al fr. 00 \ / SFF RF\/ERBF SIr1F Fr1R r.r)NTINI IATI0N PFPI Ar:FG Al 1 PRFmoi I.R ;:nITir)N.R aP.34-ub, copy rne, responding information from Section A. _ BUILDING STREET ADDRESS (Including Apt.. Unit, Suite, and/or Bldg. No.) OR P.O CITY AND BOX NO ZIP CODE For Insurance Company Policy Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. OMMENTS 1_1 Check here if attachme, 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 E4. 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 (_J_J ft.(m) 1_1_lin.(cm) 1_1 above or 1-1 belo (check one) the highest adjacent grade. 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_1^1 ft -(m) (_J_Iin.(cm) above the highest adjacent grade. E4. 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? 1-1 Yes 1_1 No 1_1 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, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE 1_1 Check here if attachment 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. 1_1 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.) G2. 1_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. 1-1 The following information (items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7. This permit has been issued for: 1_1 New Construction (_J Substantial Improvement G8. Elevation of as -built lowest floor �hclufflr*-bWi6Taemt}Wf&bWi)3jl;KZ3 _—ft.(m)Datum: G9. BFE or (in Zone AO) depth of flof5�i±)g•,at=t�j�#�udbing� ii�s r,:�'=yt3d _ �ft.(m)Datum: LOCAL OFFICIAL'S NAME 01 :1 y0 1:3-71 C i;1 -MC.' „ 4;illd TITLE COMMUNITY NAME TELEPHONE - ❑ces sof recerrmend - - SIGNATURE i uIciI D(,P ;.:,jai DATE IFO'nig; n:71- - Q+ia w Check here if attachment: GPhAA Pnr PI -11 &1 11'- 00 DFD) Ar`CC Al I DAF\/Ifll IC r:nJT1n?,1C