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Project N. 1501
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
O.M.B. No, 3067-0077
Expires July 31, 2002
ELEVATION CERTIFICATE
Important: Read the Instructions on pages 1 - 7.
SECTION A;- PROPERTY OWNER INFORMATION
For Insurance Company use:
BUILDING OWNER'S NAME
Policy Number
Fry & Mary VanDamme ----Addition to building
....George
BUILDING STREET ADDRESS (including Apt.. Unit, Suite, aridfor Bldg. No,) OR P.O. ROUTE AND BOX NO.
Company MAIC Number
59-1917 Puako l_o0_. -•-- _._._ _
CITY STATE
ZIP CODE
Kamuela, Hawaii 96743
_
PROPERTY Ut:SGRiPTION (Lot and Block Numbers Tax P,-ticel Number, Legal Description, etc.)
- -'-'
Lot 148 Puako Beach Lots TM6-0-46t,:15., (3rd Division)
BUILDING USF (e 9 ,,Residential, Non-residential, Addition, Accessory, etc, Use Commenis section if necessary.)
___R. sidential
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: (_( GPS (Type).
or J NAD t927 ! ) NAD 1983 („-) USGS Qued MaP
L-1 Other.�,,,_�
SECTION e - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
8l. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2. COUNTY NAME -_ B3. STATE
Hawaii Hawaii Hawaii
64. MAP AND PANEL f BS. SUFFV(' � BS. FIRM INDEX B7. FIRM PANEL, as. LOGO 89. BASE FLOOD ELEVATION(S1
NUMBER DATE E• FFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding)
155166 0278 C 7/16/90 9116/88 AE 7
910. indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 89.
I_I Ft$ Profile IFIRM (FIRM [ ) Commuriittr Determined [_XOther (Describe): USGS Data
4311. Indicate the elevation datum used for the BFE in 69i INGVD 1929 L.[ NAVD 1988 [ 10 ther (Describe);
B12. is the building located in a Coastal Barrier Resourccis System (CBRS) area or Otherwise Protected Area (OPA)? )-_,J Yes l_-1 No
Designation Date'-- �_
SECTION C - BUILDING. ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: (_[Construction Drawings' (_)Building Under Construction' # *inished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
Building Diagram Number __I_ (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, V11430. V (with BFE), AR. AR/A, ARAE, AR/Al-A30. AR/AH, ARIAO
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 thedatum to that used for the BFE. Show field measurements and datum conversion
calculation, Use the space provided or the Comments area of Section 0 or Section G, as appropriate, to document the datum conversion.
Datum _ Conversion/Comment's
Elevation reference mark used oes the elevation reference mark used appear on the FIRM? )_.,j Yes LX No
a) Top of bottom floor (including basement or enclosure) 7 1Z ft.*)
O b) Top of next higher floor r ft.(m) A�5�� T. Yq�,
O c) Bottom of lowest horizontal strurtural member (f✓ zones only) . - _ &(m) a Q-' 11CF rr
U d) Attached garage (top of stab) _ R.(m) j> pF` -
U e) Lowest elevation of machinery and/or equipment
servicing the building _ . _- . ft -(M)
f) Lowest adjacent grade (LAG) ��.6 ft)[») 2 %4
X Highest adjacent rade (HAG) 5.7_._ flan) 4 f
X g) 9h ! 9
' U h) No. of permanent openings (flood vents) within '1 ft. above adjacent grade
G i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) O uOust 11, 00
SECTION Q - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICOION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to car* elevation information.
I certify that the information in Sections A, A. and C on this rertificate represents my best efioris to interpret the data avallabfe.
I understand that any faise statement may be punishaWii by.fne_v_r imprisonment under 18 U.S. Code, Section 1001,
CERTIFIER'S NAME I ICENSENUMBER'
__ C_hrXs tal_�hotuas Yamas$ki...._..... _ _ _ _ is -4331 _.,.�
TIT E COMPANY NAME
.and SurvC�_0_r__ WES TH17MAS..,& ASSOCTA�!
AD CITY -- STATE ZIP CODE
ft iS 749 Kalawa Street ) ;lua-Ila
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