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HomeMy WebLinkAbout4-5-005:007 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires February 28. 2009 National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Policy Number /i f/%�e‘a Ai 2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route ao6 Box No. Company NAIC Number /19,i/17/9//4-'7- r_5'T. City State ZIP Code 4 m'A. 4%1 ? 7-7// A3. Property Description(Lot and Block Numbers,t Parcel Number,Legal Description.etc.) (3) 4-5--©s_1o7 A4. Building Use(e.g., Residential,Non-Residential.Addition,Accessory, etc.) Zr(' Sft, 'b A5. Latitude/Longitude: Lat. Long. Horizontal Datum: ❑ NAD 1927 0 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 A8. For a building with a crawl space or enclosure(s), provide NA A9. For a building with an attached garage,provide: /sJ4 a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b , sq in c) Total net area of flood openings in A9.b sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name&Community Number B2.County Name B3. State HAWAII C-OVA-'i-t- 15.57 Io,G //ycyiA-z,' GE' OAJTr -c7 B4. Map/Panel Number B5.Suffix B6. FIRM Index B7.FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone �S S 1/o 2 b Date Effective/Revised Date Zone(s) AO,use base flood depth) - z-p. ...( .. e-ell., /4,/9 ? . •i-i/ lo9So B10. Indicate the source of the Base Flood Elevation(BFE)data or base flbod depth entered in Item B9. ❑ FIS Profile gt FIRM ❑Community Determined ❑Other(Describe) 811. Indicate elevation datum used for BFE in Item B9 ®NGVD 1929 0 NAVD 1988 ❑ Other(Describe) 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ['Yes KNo Designation Date ❑CBRS ❑OPA SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑Construction Drawings* ❑ Building Under Construction' IN Finished Construction "A new Elevation Certificate will be required when construction of the building is complete. 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 below according to the building diagram specified in Item A7. Benchmark Utilized Vertical Datum _ee 7c77 iirt-�p//,f-j' PL,17V S' Sri°7 z PLv? Pe fit. Conversion/Comments Check the measurement used. a) Top of bottom floor(including basement,crawl space.or enclosure floor)_ //e9!)., [-feet ❑meters(Puerto Rico only) b) Top of the next higher floor //0 3. <) IE-feet ❑ meters(Puerto Rico only) c) Bottom of the lowest horizonta,structural member(V Zones only) 1+64 [Meet ❑ meters(Puerto Rico only) d) Attached garage(top of slab) /JA- ❑feet 0 meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building //Oc ,e_ [-feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent(finished)grade(LAG) 11 p 6. 3 Q'feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) //cf 4 0 ❑ feet ❑ 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.. ❑ Check here if comments are provided on back of form. Off? `yp .�o�E2 0. Fc ce--w0A LS 7276 �`� Y Certifiers Name f °ROF�SSiOiJAL //���� License Number f I AND� ` Title/62 C/ �X Company Name s.; SUKV,=:r,Un. /_.p V//9/ACO« �'/ 7‘t_i NO. 7276 / Dress City State ZIP Code N, Si nature r •':_'.1,------_-----;‘ ..; `,„. �`'71I 0 '• 9 ,,-2-.! 1 ate Telephone FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions