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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 <br /> Federal Emergency Management Agency Expires February 28. 2009 <br /> National Flood Insurance Program Important: Read the instructions on pages 1-8. <br /> SECTION A-PROPERTY INFORMATION For Insurance Company Use: <br /> Al. Building Owner's Name Policy Number <br /> /i f/%�e‘a Ai <br /> 2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route ao6 Box No. Company NAIC Number <br /> /19,i/17/9//4-'7- r_5'T. <br /> City State ZIP Code <br /> 4 m'A. 4%1 ? 7-7// <br /> A3. Property Description(Lot and Block Numbers,t Parcel Number,Legal Description.etc.) <br /> (3) 4-5--©s_1o7 <br /> A4. Building Use(e.g., Residential,Non-Residential.Addition,Accessory, etc.) Zr(' Sft, 'b <br /> A5. Latitude/Longitude: Lat. Long. Horizontal Datum: ❑ NAD 1927 <br /> 0 NAD 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 NA A9. For a building with an attached garage,provide: /sJ4 <br /> a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft <br /> b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage <br /> enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade <br /> c) Total net area of flood openings in A8.b , sq in c) Total net area of flood openings in A9.b sq in <br /> SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION <br /> B1. NFIP Community Name&Community Number B2.County Name B3. State <br /> HAWAII C-OVA-'i-t- 15.57 Io,G //ycyiA-z,' GE' OAJTr -c7 <br /> B4. Map/Panel Number B5.Suffix B6. FIRM Index B7.FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone <br /> �S S 1/o 2 b Date Effective/Revised Date Zone(s) AO,use base flood depth) <br /> - z-p. ...( .. e-ell., /4,/9 ? . •i-i/ lo9So <br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flbod depth entered in Item B9. <br /> ❑ FIS Profile gt FIRM ❑Community Determined ❑Other(Describe) <br /> 811. Indicate elevation datum used for BFE in Item B9 ®NGVD 1929 0 NAVD 1988 ❑ Other(Describe) <br /> 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ['Yes KNo <br /> Designation Date ❑CBRS ❑OPA <br /> SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) <br /> Cl. Building elevations are based on: ❑Construction Drawings* ❑ Building Under Construction' <br /> IN Finished Construction <br /> "A new Elevation Certificate will be required when construction of the building is complete. <br /> C2. Elevations-Zones A1-A30,AE,AH,A(with BEE).VE.V1-V30,V(with BFE),AR,ARIA.ARAE.AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g <br /> below according to the building diagram specified in Item A7. <br /> Benchmark Utilized Vertical Datum _ee 7c77 iirt-�p//,f-j' PL,17V <br /> S' Sri°7 z PLv? Pe fit. <br /> Conversion/Comments <br /> Check the measurement used. <br /> a) Top of bottom floor(including basement,crawl space.or enclosure floor)_ //e9!)., [-feet ❑meters(Puerto Rico only) <br /> b) Top of the next higher floor //0 3. <) IE-feet ❑ meters(Puerto Rico only) <br /> c) Bottom of the lowest horizonta,structural member(V Zones only) 1+64 [Meet ❑ meters(Puerto Rico only) <br /> d) Attached garage(top of slab) /JA- ❑feet 0 meters(Puerto Rico only) <br /> e) Lowest elevation of machinery or equipment servicing the building //Oc ,e_ [-feet ❑meters(Puerto Rico only) <br /> (Describe type of equipment in Comments) <br /> f) Lowest adjacent(finished)grade(LAG) 11 p 6. 3 Q'feet ❑meters(Puerto Rico only) <br /> g) Highest adjacent(finished)grade(HAG) <br /> //cf 4 0 ❑ feet ❑ 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 /> ❑ Check here if comments are provided on back of form. Off? `yp <br /> .�o�E2 0. Fc ce--w0A LS 7276 �`� Y <br /> Certifiers Name f °ROF�SSiOiJAL <br /> //���� License Number f I AND� ` <br /> Title/62 C/ �X Company Name s.; SUKV,=:r,Un. /_.p <br /> V//9/ACO« �'/ 7‘t_i NO. 7276 <br /> / <br /> Dress City State ZIP Code N, <br /> Si nature r •':_'.1,------_-----;‘ ..; <br /> `,„. �`'71I 0 '• <br /> 9 ,,-2-.! 1 ate Telephone <br /> FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions <br />