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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. (ding Owners Name. C - �r� Policy Number A2. Building Street Address(including t.,Unit, uite,and/or Bl. . No.)_gr P.O. Route and Box No.22 Company NAIC Number cityt Statt�4 63 Luc') ZIP�ode¢- A3. roperty Description(Lotand Block Numbers,Tax Parcel Number,Legal Description,etc.) --r• �K -Z- /CZ):14- r, 45 ' Qo,of „ IS5J A4. Building Use(e.g.,Residential,Non-Resider al,Addition,Accessory,etc.) L-ZZI` lJ6 , .7"- A5. Latitude/Longitude:Lat.Ni.19.aZ.125 Long. \A.1. (SS_ i j Z5 4 Horizontal Datum: 0 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 enclosure(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 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 Bi.NFIP Community Name&Community Number B2.County Name B3.State Hawaii County 155166 Hawaii County Hawaii 84.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel 88.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 155166 478 4., 4/02/04 9 ii 'IBS Ake '1. b B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑FIS Profile FIRM 0 Community Determined 0 Other(Describe) B11. Indicate elevation datum used for BFE in Item 89: [X 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 ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑Construction Drawings* 0 Building Under Construction* ixtFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. 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/A0. Complete Items C2.a-g below according to the building diagram specified in Item A7. � Benchmark Utilized R1� Vertical Datum N�7V(3 1121 21 Conversion/Comments - f V‘AC.0 Check the measurement used. a) Top of bottom floor(including basement,crawl space,or enclosure floor) LZ .43 f 4 feet 0 meters(Puerto Rico only) b) Top of the next higher floor 7 2 . . N feet 0 meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) feet ❑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 I2 .13S1 feet 0 meters(Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent(finished)grade(LAG) (L. . 7�feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) (2 .rs'oqi,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. I 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. 4374‘. g rti%Check here if comments are provided on back of form. REGISTERED Ceifier's Name License Num err *A' PROCESSIONAL � A61CHITECT * T Co ..a Na. e u_ A��i=fir t/�� -'�r�'r��y�1�� -� ��:C� P40. 5404 ress ,Ci - -i State ? ZIP ode +ddq Q•' 1� .ignature j ' / ate T phone -((' u S'' /' , 1 7`V� leCa . 43 - 7•?:?-'® ...�. FEMA For -31, February 2006 See reverse side for continuation. Replaces all previous editions