The URL can be used to link to this page

Home My WebLink About4-5-006:067 U.S.r1Pl1RTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 ,National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION " Al. Building Owner's Name Ronald L.Thiel and Barbara L.Franklin A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. 45-3438 Mamane Street City Honokaa State HI ZIP Code 96727 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description.etc.) (3)4-5-006:067 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.20.07796 Long.-155.46400 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 6 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or endosure(s) 87 sq ft a) Square footage of attached garage WA sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? 0 Yes ® No d) Engineered flood openings? 0 Yes 0 No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number C B2.County Name B3.State Hawaii County-155166 i Hawaii County Hawaii B4.Map/Panel Number 85.Suffix B6.FIRM Index Date B7. FIRM Panel I 88. Flood 1 89.Base Flood Elevation(s)(Zone 0205 C April 2,2004 Effective/Revised Date Zone(s) I AO,use base flood depth) i September 16, 1988 AH 1092.0 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89. ❑ FIS Profile ® FIRM 0 Community Determined 0 Other/Source: BI 1. Indicate elevation datum used for BFE in item 89: ® NGVD 1929 0 NAVD 1988 0 Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes ® No Designation Date: 0 CBRS 0 OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings' 0 Building Under Construction' ® 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 BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARAE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item A7 In Puerto Rico only,enter meters. Benchmark Utilized:Tr."Hula Moon" Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 0 NAVD 1988 0 Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used a)Top of bottom floor(including basement,crawlspace,or enclosure floor) 1100.1 ®feet 0 meters b)Top of the next higher floor 1105.3 ®feet 0 meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. 0 feet 0 meters d)Attached garage(top of slab) N/A. 0 feet 0 meters e)Lowest elevation of machinery or equipment servicing the building 1100.1 ®feet 0 meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 1099.4 ®feet 0 meters g) Highest adjacent(finished)grade next to building(HAG) 1103.5 ®feet 0 meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support 1100.1 ®feet 0 meters 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. OQl g•JAC l understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. fitSo Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a !.v LIQgt'1 . 0 Check here if attachments. licensed land surveyor? 0 Yes DD No PROF- ()NAL�MA Certifier's Name Trevor B Jackson License Number LS-11858 * • Title Land Surveyor Company Name No.19858 Address P.O.Box 872 City Pahoa State HI ZIP Code 96778 A�'AI1,U 5 SignaturetiV%.--44J Date /d Telephone 808-640-6057 FEMA Form 086-0-33(7112) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE,page 2 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 P.O. Route and Box No. Policy Number: 45-3438 Mamane Street City Honokaa State HI ZIP Code 96727 Company NAIC Number: 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 1. Type of Machinery servicing building at lowest elevation:washer and dryer 2. Tr."Hula Moon"bench mark utilized is from"As-Built"construction plan for the Wastewater Collection System For The Large Capacity �esspool Closure,Honokaa,Hawaii,Job No.WW-3675 Signatureti.z. ate SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C.For Items El-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is _ 0 feet 0 meters 0 above or 0 below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is 0 feet 0 meters 0 above or 0 below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is 0 feet 0 meters 0 above or 0 below the HAG. E3. Attached garage(top of slab)is . 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is . 0 feet ❑meters 0 above or 0 below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments 0 Check here if attachments. SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8-G10.In Puerto Rico only,enter meters. G1. 0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.0 The following information(Items G4-G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: 0 feet 0 meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: 0 feet 0 meters Datum G10.Community's design flood elevation: 0 feet 0 meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 086-0-33(7/12) Replaces all previous editions