HomeMy WebLinkAbout1-4-067:008 '' `. OF HOMELAND SECURITY ELEVATION CERTIFICATEI OMB No. 1660-0008
`' " 'Management
AgencyExpires February 28.2009.
ineurance Program Important: Read the instructions on pages 1-8.
_ro„,,:,,,.. „,„ . . SECTION A-PROPERTY INFORMATION for insurance Company Use:
Owners Name '�y- �( dam/
^i/ yl ��t1�'l W A Policy!Number
Building Street Addressniclud1. Unt Sua nd �°)NPQ/a ByNo.
/o Company
NA1G Number� 1e1' {
il.;::` CitY rb� State 14 1ZIP Code G
zAS
A3. Property Description(Lot and Block `/�•�Nu�ei:Tax Parcel Number,Legal Description,etc.)
1�/� : 4-41 : 4
A4. Building Use(e.g.,Residential, on-Re idential,Addition,Accessoryetc.) AL
A5. Latitude/Longitude:Lat. I f" Long. A��
V, � 5Y I y Horizontal Datum: 0 NAD 1927 [VNAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number
A8. For a building with a crawl space or enclosure(s),provide:
A9. For a building with an attached garage,provide:
aNo.of
a)
Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached ara
permanent flood openings in the crawl space or 9 sq ft
enclosure(s)walls within 1.0 foot above adjacent grade b) wal of permanent flood oin thegattached garage
walls within 1.0 foot aboveeenings adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.bin
sq
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number
I
Hawaii County 155166 I B2.County Name
Hawaii County I B3.State Hawaii
B4.Map/Panel Number B5.Suffix B6.FIRM Index 87.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
155166 G I Date Effecti Revised Date
4/02/04 6,I5/?o �i'6 S%'(s' Zone(s)
AP
AO,use base flood depth)
We
B10. Indicate the source o _19 Base Flood Elevation(BFE)data or base flood Ylepth entered in Item B
FIRM 9.
0 FIS Profile
❑Community Determined ❑Other(Describe)
B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 0 NAVD 1988
❑Other(Describe)
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes
Designation Date 0 CBRS 0 OPA El
No
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRE
Cl. Building elevations are based on: 0 Construction Drawl
'A new Elevation Certificate will be required when construction s'of the building is compleBuildinteeder Construction* Finished Construction
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
below according to thrfdin d' ram specifedn Item A7.
Benchmark Utilized (( Noti B .Tio.._ t, be. Vertical Datum tj7
LIConversion/Comments
L`7 fCheckhethe measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor) 11 ,6 eet D
meters(Puerto Rico only)
b) Top of the next higher floor -•-► ❑feet 0
meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) ❑feet 0
d) Attached garage(top of slab) meters(Puerto Rico only)
[�
f et 0 meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
f) Lowest adjacent(finished)grade(LAG) vS .9 [�f et ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) A . 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. /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.
3 t�+C
0 Ch41140
her co mgnis�re provided on back of form. A
IWw �//J, l t41- PR
PROFESSIONAL
Certifiersal .w 14� `iirrii 4044 `(/
Title G/,ri�I! ����� C..-'any -me %`'-t ? � ,,���"�1 SNEER
Address /
6 , ", `i ka A� .1 's'ad6feg No.amn-c
Signat e itlit/i� I J/lb �4� U.
rr Telephon �p
FEMA Form 81-31, Februa 2006 See reverse side for continuation.
Replaces all previous editions