|
U .DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
<br /> Federal Emergency Management Agency Expires March 31,2012
<br /> National Flood Insurance Program Important Read the instryctions on pages1-9.
<br /> SECTION A-PROPERTY INFORMATION For Insurance Company Use
<br /> Al. Building Owner's Name f Policy Number
<br /> T>�2 E 2rA/pA .4/9vae4.ivc
<br /> E.
<br /> .2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
<br /> 'Z5- ‘5'9<3 Koiv4 & 97' Peeve
<br /> c'tYgia, ZIP Code ien/11/i}_'/411t/4 / , t/ 9‘ 71t9
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) 7� /31 ��,�--,,,0��3�
<br /> RES 10 a6 , /Coir,4 -13.9), .esr9"7-Es 1(U:C J .,
<br /> A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) /ti 14 re9 '3e'26`8/,
<br /> A5. Latitude/Longitude:LaL I Long./.S6"OD' Horizontal Datum: 0 NAD 1927 ( NAD 1983 10.445. /S4 a 'c" / F. 8
<br /> A6. Attach at least 2 photographs/the building if the Certificate is being used to obtain flood insurance.
<br /> A7. Building Diagram Number
<br /> A8. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage:
<br /> a) Square footage of crawispace or enclosure(s) 4/.4 sq ft a) Square footage of attached garage 4" sq ft
<br /> b) No.of permanent flood openings in the crawispace or / b) No.of permanent flood openings in the attached garage
<br /> enclosure(s)within 1.0 foot above adjacent grade ~. within 1.0 fod above adjacent grade NlV
<br /> �
<br /> c) Total net area of flood openings in A8.b A�/�} sq in c) Total net area of flood openings in A9.b sq in
<br /> d) Engineered flood openings? 0 Yes %No d) Engineered flood openings? 0 Yes J,No
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> 81.NFIP Community Name&Community Number 82.County Name B3.State
<br /> Hawaii County 155166 Hawaii County Hawaii
<br /> -
<br /> B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> D Z 77G Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> 155166 4/02/04 s�fO7" E/6, 88 , 915" F7.
<br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
<br /> 0 FIS Profile 1St FIRM 0 Community Determined is,Other( tbe) Go./199F)
<br /> 611. Indicate elevation datum used for BFE in item B9: ISNGVD 1929 0 NAVD 1988 0 Other(Describe)
<br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes ® No
<br /> Designation Date 0 CBRS 0 OPA
<br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction' $'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 BFE),VE,V1 V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30.AR/AH,AR/AO. Complete Items C2.a-h
<br /> below according to the building diagram specified in Item A7. Use the same datum as the BFE.
<br /> Benchmark Utilized M?A6 Vertical Datum /451..
<br /> Conversion/Comments
<br /> Check_ the measurement used.
<br /> a) Top of bottom floor(including basement,crawlspace,or enclosure floor) /2. 43 t 0 meters(Puerto Rico only)
<br /> b) Top of the next higher floor 13.....f._.5- ,(. /feet 0 meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) 23.50 ( feet 0 meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) _,L.3. DD firpet 0 meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building 13 . 36- ('feet 0 meters(Puerto Rico only)
<br /> (Describe type of equipment and location in Comments)
<br /> f) Lowest adjacent(finished)grade next to building(LAG) !Z. 4 4- offeet 0 meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade next to building(HAG) �._*.. Zvi" [ Jeet 0 meters(Puerto Rico only)
<br /> h) Lowest adjacent grade at lowest elevation of deck or stairs,including /2. 04- Meet 0 meters(Puerto Rico only)
<br /> structural support
<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 44
<br /> information. I certify that the information on this Certificate represents my best efforts to interpret the data available./ asoill
<br /> understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001.0 +
<br /> Check here if comments are provided on back of form. Were latitude and longitude iron A provided by a O LICENSED y
<br /> POW/94.4)C, di c-,L-IV 7ds1-1 licensed land surveyor? Yes 0 No •
<br /> /
<br /> Certife's Name License l bei �iwX918 'A .SS."O*AL
<br /> pie,55 /6v,4 .Sv0¢ v6ypas,_TA-t.
<br /> le PG- 7ox 3---8CompanyName '
<br /> /t.04'/VA T / 74 7�( No.4968
<br /> jTy
<br /> Address C' State �r„gP C 41,44,W'.
<br /> r+4Ol3
<br /> Signature ' e Telephones.. '3 gr-27 Aro 8 33 f?)-.07
<br />
|