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'' `. OF HOMELAND SECURITY ELEVATION CERTIFICATEI OMB No. 1660-0008 <br /> `' " 'Management <br /> AgencyExpires February 28.2009. <br /> ineurance Program Important: Read the instructions on pages 1-8. <br /> _ro„,,:,,,.. „,„ . . SECTION A-PROPERTY INFORMATION for insurance Company Use: <br /> Owners Name '�y- �( dam/ <br /> ^i/ yl ��t1�'l W A Policy!Number <br /> Building Street Addressniclud1. Unt Sua nd �°)NPQ/a ByNo. <br /> /o Company <br /> NA1G Number� 1e1' { <br /> il.;::` CitY rb� State 14 1ZIP Code G <br /> zAS <br /> A3. Property Description(Lot and Block `/�•�Nu�ei:Tax Parcel Number,Legal Description,etc.) <br /> 1�/� : 4-41 : 4 <br /> A4. Building Use(e.g.,Residential, on-Re idential,Addition,Accessoryetc.) AL <br /> A5. Latitude/Longitude:Lat. I f" Long. A�� <br /> V, � 5Y I y Horizontal Datum: 0 NAD 1927 [VNAD 1983 <br /> A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. <br /> A7. Building Diagram Number <br /> A8. For a building with a crawl space or enclosure(s),provide: <br /> A9. For a building with an attached garage,provide: <br /> aNo.of <br /> a) <br /> Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached ara <br /> permanent flood openings in the crawl space or 9 sq ft <br /> enclosure(s)walls within 1.0 foot above adjacent grade b) wal of permanent flood oin thegattached garage <br /> walls within 1.0 foot aboveeenings adjacent grade <br /> c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.bin <br /> sq <br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION <br /> B1.NFIP Community Name&Community Number <br /> I <br /> Hawaii County 155166 I B2.County Name <br /> Hawaii County I B3.State Hawaii <br /> B4.Map/Panel Number B5.Suffix B6.FIRM Index 87.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone <br /> 155166 G I Date Effecti Revised Date <br /> 4/02/04 6,I5/?o �i'6 S%'(s' Zone(s) <br /> AP <br /> AO,use base flood depth) <br /> We <br /> B10. Indicate the source o _19 Base Flood Elevation(BFE)data or base flood Ylepth entered in Item B <br /> FIRM 9. <br /> 0 FIS Profile <br /> ❑Community Determined ❑Other(Describe) <br /> B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 0 NAVD 1988 <br /> ❑Other(Describe) <br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes <br /> Designation Date 0 CBRS 0 OPA El <br /> No <br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRE <br /> Cl. Building elevations are based on: 0 Construction Drawl <br /> 'A new Elevation Certificate will be required when construction s'of the building is compleBuildinteeder Construction* Finished Construction <br /> C2. Elevations-Zones A1-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 <br /> below according to thrfdin d' ram specifedn Item A7. <br /> Benchmark Utilized (( Noti B .Tio.._ t, be. Vertical Datum tj7 <br /> LIConversion/Comments <br /> L`7 fCheckhethe measurement used. <br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor) 11 ,6 eet D <br /> meters(Puerto Rico only) <br /> b) Top of the next higher floor -•-► ❑feet 0 <br /> meters(Puerto Rico only) <br /> c) Bottom of the lowest horizontal structural member(V Zones only) ❑feet 0 <br /> d) Attached garage(top of slab) meters(Puerto Rico only) <br /> [� <br /> f et 0 meters(Puerto Rico only) <br /> e) Lowest elevation of machinery or equipment servicing the building feet ❑meters(Puerto Rico only) <br /> (Describe type of equipment in Comments) <br /> f) Lowest adjacent(finished)grade(LAG) vS .9 [�f et ❑meters(Puerto Rico only) <br /> g) Highest adjacent(finished)grade(HAG) A . feet 0 meters(Puerto Rico only) <br /> SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION <br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation <br /> information. /certify that the information on this Certificate represents my best efforts to interpret the data available. <br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code, Section 1001. <br /> 3 t�+C <br /> 0 Ch41140 <br /> her co mgnis�re provided on back of form. A <br /> IWw �//J, l t41- PR <br /> PROFESSIONAL <br /> Certifiersal .w 14� `iirrii 4044 `(/ <br /> Title G/,ri�I! ����� C..-'any -me %`'-t ? � ,,���"�1 SNEER <br /> Address / <br /> 6 , ", `i ka A� .1 's'ad6feg No.amn-c <br /> Signat e itlit/i� I J/lb �4� U. <br /> rr Telephon �p <br /> FEMA Form 81-31, Februa 2006 See reverse side for continuation. <br /> Replaces all previous editions <br />