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Home My WebLink About1-4-027:035 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 4, Federal Emergency Management Agency Expires February 28, 2009 1/ Natio,ial Flood Insurance Program Important: Read the instructions on pages 1-8. 'o SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name JOY DILLON Policy Number '2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No. Company NAIC Number APAI POINT 14-5i SS -j)) Jt�)4o y PAHOA State HI ZIP Code 96778 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) TMK(3)-1-4-027:035 A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL A5. Latitude/Longitude:Lat. N19 29.722 Long.W 154 48.977' Horizontal Datum: 0 NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 7 A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage,provide: a) Square footage of crawl space or enclosure(s) 408 sq ft a) Square footage of attached garage 528 sq ft b) No.of permanent flood openings in the crawl space or , b) No.of permanent flood openings in the attached garage .a enclosure(s)walls within 1.0 foot above adjacent grade 9 , .w, walls within 1.0 foot above adjacent grade 10a t r. c) Total net area of flood openings in A8.b 648 sq in- '-n`''1, `t c) Total net area of flood openings in A9.b 720 of ,2'sq in T SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State HAWAII COUNTY 155166 HAWAII COUNTY HAWAII B4.Map/Panel Number B5.Suffix 86. FIRM Index 67.FIRM Panel 68. Flood B9. Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 155166-1400 C 4/02/04 9/16/88 AE 16.0 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. 0 FIS Profile ®FIRM 0 Community Determined 0 Other(Describe) 611. Indicate elevation datum used for BFE in Item B9: ®NGVD 1929 0 NAVD 1988 0 Other(Describe) 612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ®No Designation Date 0 CBRS 0 OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings' 0 Building Under Construction* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. 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 C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized USGS Vertical Datum Conversion/Comments Check the measurement used. a) Top of bottom floor(including basement,crawl space,or enclosure floor)- 6.63 ®feet 0 meters(Puerto Rico only) b) Top of the next higher floor 18.04 ®feet 0 meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N//1 . 0 feet 0 meters(Puerto Rico only) d) Attached garage(top of slab) 6.63 ®feet 0 meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 18.04 ®feet 0 meters(Puerto Rico only) (Describe type of equipment in Comments) ,e`ylo>J f) Lowest adjacent(finished)grade(LAG) 6.0 ®feet 0 meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 6.60 ®feet 0 meters(Puerto Rico only) 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 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. • 0 Check here if comments are provided on back of form. Certifiers Name RONALD D.NICKEL License Number 8846-C Title CIVIL ENGINEER Company Name RONALD NICKEL P.E. LLC dress 12-7109 KALAUNU ST City PAHOA State HI ZIP Code 96778 Signat ; ) Da4 I up i jog Telephone 808-965-9911 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 A ALAPAIPOINTRDD = lz)—S1S5 T'1 1-9 -oi7 035 `City PAHOA State HI ZIP Code 96778 Company NAIC Number SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) .;opy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments THE EQUIPMENT CONSIST OF WATER HEATER,WASHER,DRYER,ALL KITCHEN APPLIANCES AND EQUIPMENT TO RUN THE AEROBIC SEPTIC SYSTEM THE ELEVATION WAS TAKEN FROM A SURVEYOR SET BM BASED ON A USGS BM Signature ileeyviSkDate q 6 -1 ❑ Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQU ED) ibo R ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items El-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawl space,or enclosure)is 0 feet 0 meters 0 above or 0 below the HAG. b)Top of bottom floor(including basement,crawl space,or enclosure)is 0 feet 0 meters 0 above or 0 below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see page 8 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is 0 feet 0 meters 0 above or 0 below the HAG. E3. Attached garage(top of slab)is 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters 0 above or 0 below the HAG. E5. 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? 0 Yes 0 No 0 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. The statements in Sections A,B,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 Signature Date Telephone Comments 0 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. Check the measurement used in Items G8.and G9. G1.0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.0 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: 0 New Construction 0 Substantial Improvement G8.Elevation of as-built lowest floor(including basement)of the building: ❑feet 0 meters(PR)Datum G9.BFE or(in Zone AO)depth of flooding at the building site: 0 feet 0 meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date ':omments El Check here if attachments