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U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program IMPORTANT: Follow the instructions on pages 1-9. 1Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or F0. Route and Box No. Company MAIC Number: City KAMUELA State HI ZIP Code 96743 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) (3) 6-6-007-006 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/ Longitude: Lat. 90 02549 Long. -155.70783 Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs off the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) sq It a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawlspace or b) Number of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade 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 d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number HAWAII nijNTy_v;,x;1AA B2. County Name HAWAII COUNTY B3. State I HAWAII B4. Map/Panel Number B5. Suffix 66. FIRM Index Date B7. FIRM Panel Effective/ 68. Flood Zone(s) 89. Base Flood Elevation(s) (Zone ❑ feet ❑ meters 2308.3 Revised Date A & X A0, use base flood depth) 155166 0164D APR 02, 2004 9-16-1988 ❑ meters 2306.3 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ AS Profile ® FIRM ❑ Community Determined ❑ Other/Source: Bll. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: / / ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® 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, AR/AE, AR/Al-A30, AR/AH, AR/A0. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: RM -4 Vertical Datum: 2413. 822 Indicate elevation datum used for the elevations in items a) through h) below. ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 2309.2 Check the measurement used. ® feet ❑ meters I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ❑ feet ❑ meters IR Check here if attachments. ❑ feet ❑ meters ❑ feet ❑ meters 2308.3 ® feet ❑ meters 2301.8 ® feet ❑ meters 2307.6 ® feet ❑ meters 2306.3 ® feet ❑ 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. 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. Were latitude and longitude in Section A provided by a IR Check here if attachments. licensed land surveyor? ® Yes ❑ No Certifier's Name Roger D. Fleenor License Number LS -7276 Title Owner Company Name Ro er Dean Fleenor LPLS LLC Address PO Box 383414 cit Tnlyaikoloa state I ti Z9 Code 7 3 8 Signature Date Telephone 9-4-2014 808-989-2640 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Ft PROF€LMAL $ * S(WR1yOR No. 7276 / PA II,vS/ Replaces all previous editions.