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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. Ming Owner's Name Policy Number
-PtLAAc�Rs-� L L.
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. , Company NAIC Number
1%' 1 k t.�tt) 17R. S 01- 4- - 5 11 CZ
I I..0A--e-=)-4� k17 •,SJ 1 (ig,o.R. MI)te ZIP,
ode
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
. 2 g ,` �� )55° '50 27.2-1 It •
A4. Building Use(e.g.,Residential,Non-Residenti�f Addition,Accessory,etc.) T L.dG�1i') -rc V
A5. Latitude/Longitude:Lat. N. I9.SSW Long.W. 155.996/ a Horizontal Datum: ❑NAD 1927 [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 I
A8. For a building with a crawl space or endosure(s),provide: A9. For a building with an attached garage,provide:
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 a-awl space or b) No.of permanent flood openings in the attached garage
endosure(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 County 155166 Hawaii County Hawaii
B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
Date 155166A-12 - •� C. 4/02/04 q//'ve`/'saedaDate AZo�ne(s) AO, base flood depth)
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89.
❑FIS Profile [I FIRM 0 Community Determined 0 Other(Describe)
B11. Indicate elevation datum used for BFE in Item B9: 141 NGVD 1929 0 NAVD 1988 0 Other(Describe)
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes ® No
Designation Date ❑CBRS 0 OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* X Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations-Zones Al-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 C2.a-g
below according to the building diagram specified in Item A7. v
Benchmark Utilized R�6S _ Vertical Datum 1si‘ P`1 MI
Conversion/Comments_ __ __ _ _- __ _ _ . , tt - GY•A•
TGheck the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor) to .91feet ❑r- meters(Puerto Rico only)
b) Top of the next higher floor
Ili
feet 0 meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) feet 0 meters(Puerto Rico only)
d) Attached garage(top of slab) ��, ❑feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building Iv .�Tf` [feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
f) Lowest adjacent(finished)grade(LAG) to 41 IN feet 0 meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 10 $S is 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. ,OQ,�. • ®F
Check here if comments are provided on back of form. \
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PROFESSION A l 1 t
Cerifier's Name „i� Lice se Number J;
`('� Al3��IifiECT
Wit, 1.. t S
Title Com any arpe__„ S y No. 5404 /
Address ty State �Cc
t'•o. �. =•'•- 1 .akt Kia kkc 77bFr` lip ll, V•`'p-
Signature --'
rite-: �.r D�t1Q: L
t T I�. Qtzz)
FEMA For81 1, February 2006 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use:
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or .0.Route and Box No. Policy Number
{i t A► l s , L L-c. sctSok N ,tJ�. 11412
City State ZIP Code Company NAIC Number
- tL2 Nkt*UlIeffkl ha bakt 1(P. ti Li) 94-745
SECTION D-SURVEYOR,ENGINEER, OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments ALe Pi -. 1 t•16. fisW psikelizr •==.11Q --t-czil
Signature --VA t�/
Date i l
6 I �( o S .
❑ Check here if attachments
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