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Home My WebLink About1-4-068:064 F ERAL EMERGENCY MANAGEMENT AG` .Y O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRA, Expires December 31, 2005 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Susan C. LJ rS l ✓1 1 Policy Number BUILDING STREET ADDRESS(Including A t,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number G►1 I ng CITYRi h O `16778 STATE ' /� ZIP CODE n PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) (-1 1-4aPoho Vacufio.-r1c4.-tr,( 1-160wetirj Loo 73 7 - k'(3) 1- 4-G8 -G4 BUILDING USE(e.g.,Residential.Non-residential,Addition,Accessory.etc. Use a Comments area,if necessary.) Re Si den-4-1 al LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: Li GPS(Type): ( ##°-##'-##.##' or ##.#####°) LI NAD 1927 LJ NAD 1983 Li USGS Quad Map Ll Other SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME • 83.STATE Hawaii County 155166 Hawaii County Hawaii B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL 68.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) 155166 `40o G 6/02/95 9 //678f3 A E /4.AO ' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 89. I I FIS Profile Il FIRM LI Community Determined I I Other(Describe): B11. Indicate the elevation datum used for the BFE in B9:Li NGVD 1929 I I NAVD 1988 I H Other(Describe): /l SL B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? I I Yes [II No Designation Date: SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: LlConstruction Drawings' LjBuilding Under Construction' IX'Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2.Building Diagram Number 5 (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 A1-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 C3.a-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 /77SL Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? Li Yes I, I No O a)Top of bottom floor(including basement or enclosure) /7 . 2 o ft.(m) 2 O b)Top of next higher floor /VA _ft.(m) C,H RIS l O c)Bottom of lowest horizontal structural member(V zones only) /G .15 ft.(m) "2 S Eys ❑ d)Attached garage(top of slab) /VI ft(m) E 2� LICENSED Fy ❑ e)Lowest elevation of machinery and/or equipment 'm PROFESSIONAL servicing the building (Describe in a Comments area.) /7 Z0 ft.(m) E . LAND ❑ f)Lowest adjacent(finished)grade(LAG) S- .88 ft.(m) min * SURVEYOR O g)Highest adjacent(finished)grade(HAG) 5- .98 ft.(m) F • \ 9077 O h)No.of permanent openings(flood vents)within 1 ft. above adjacent grade /ye P• ❑ i)Total area of all permanent openings(flood vents)in C3.h A./13 sq.in.(sq.cm) tom, y'WAIT, )• SECTION D -SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATIOR . 4.4.....',:..04•, 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 in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statemen may b punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME .4 2,..., / I !i e/5 /- LICENSE NUMBER -n 5f vl q b 7 TITLE C T' COMPANY NAME JUI✓L�C or- "Piz LidQp%ri d e.i ( "vu i l Sun✓c�c'r5 4DDRESS / 4 Q,i �G CITY/ I//D STATE I'� ZIP CODE 76-7Z 0 SIGNATURE /1� - / r� DATER T LEPHNON 7 (�•✓L. if- Z 4-b3 og ss- 0360 FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces,copy th Tresponding information from Section A. For Insurance Company Use: BUILDING STREET ADRR SS(Including Apt.,Unit,Suite,and/or Bldg.No. ORP.O.ROUTE AND BOX NO. Policy Number ...[_ Kahl t1 Mt -0(5, ` ac4 CITY �)Q 04,_ � STATE p� ZIP COVE Company NAIC Number Pei 77 j SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED)f Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. COMMENTS LI Check here if attachments 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 El.through E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,Section C must be completed. El. 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 .I_I I ft. (m)! I I in.(cm)I I above or I I below (check one)the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is I I I ft.(m)I I lin.(cm)above the highest adjacent grade. Complete Items C3.h and•C3.i on front of form. E4.The top of the platform of machinery and/or equipment servicing the building is I I I ft.(m)I II in.(cm)I I above or I I below (check one)the highest adjacent grade. (Use natural grade, if available.) E5. 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?I I Yes I I No I I 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,C(Items C3.h and C3.i only),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, C, 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 I I 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. Gl. II 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. I I 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. I—I 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. I_I New Construction II Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building is: _ft.(m) Datum: G9.BFE or(in Zone AO)depth of flooding at the building site is: ft.(m) Datum: • The nopnrftnont of Euklic Works LOCAL OFFICIAL'S NAME TITLE Engineering Division has reviewed COMMUNITY NAME the Elevation Certificate and TELEPHONE SIGNATURE 0 recommends DATE COMMENTS 0 dopc not turn=, d final approval By I I Check here if attachments FEMA Form 81-31,January 20cpate�-0 3 Replaces all previous editions