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Home My WebLink About2-4-007:168U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 FEDERAL EMERGENCY MANAGEMENT AGENCY Expiration Date: July 31, 2015 National Flood Insurance Program IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Nikhil and Faith Inman-Narahari Policy Number: A2. BuildingStreet Address (includingApt, Unit, Suite, and/or 810g. No.) or RO. Route and Box No. Company NA1C Number: 221 Ainaola Drive aiakea Uka City Hilo State HI ZIP Code 96720 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) _ TMK (3) 24-07:168 A4. Building Use (e.g., Residential, Non -Residential, Addition. Accessory, etc.) Residential A5. Latitude/Longitude: Lat. Long. Horizontal Datum: ❑ NAD 1927 [g] 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 1 A 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 ft a) Square footage of attached garage 374 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 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. NRP Community Name & Community Number B2. County Name B3. State Hawaii County 155166 Hawaii County I Hawaii B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ 68. Flood Zone(s) B9. Base Flood Elevation(s) (Zone Revised Date AO, use base flood depth) 155166 C 04/0212004 09/16/1988 A 1312.0 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile ❑ FIRM ❑ Community Determined ® Other/Source: Er1gRleCf determined Bli. Indicate elevation datum used for BEE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 ® Other/Source: LTD B12.ls 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) C1. 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, Vi -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-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: Set by Paul Murray L.S. Vertical Datum: 1286.13 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑ NAVD 1988 ® Other/Source: LTD 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) 1315 , 9 ® feet ❑ meters b) Top of the next higher floor 1326. 8 ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) State ZIP Code ® feet ❑ meters d) Attached garage (top of slab) 1325. 4 ® feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 1320.4 ® feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 1315. 6 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 1325 . 3 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 1310. 6 ® feet ❑ meters structural support 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. t 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.E [heck here if comments are provided on back of form. Were latitude and longitude in Section A provided by a Check here if attachments. licensed land surveyor? ❑ Yes V No LWOW Certifier's Name , \ license Number PR OF P 'R ONAL 086-0-33 (Re-ftej7/12,f See reverse side for continuation. Replaces all pre%Xoyg editions. jJ Title 61 V1 I e.111.1-wjeo Com any Na e Address D . . C' State ZIP Code Signature Date1. Tel pho 086-0-33 (Re-ftej7/12,f See reverse side for continuation. Replaces all pre%Xoyg editions. ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding k0b mation 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 City — State ZIP Code' Company NAIL Number: Hilo HI 96720 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 Water heater located in crawl space under highest floor (elevation: 1320.4 Washer, dryer, refrigerator, all located on highest Signature '700" - �� ` Date ' ' SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT SFE) For Zones AO and A (without BFE), complete Items EI -E5. if the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, Band C. For Items E1 -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, crawispace, or enclosure) is []feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ 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 ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ 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? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's 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 or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ 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 G"10. In Puerto Rico only, enter meters. G1. 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. ❑ A community official completed Section E for a building located in Zone A (without a FEMA4ssued or community4ssued BFE) or Zone AO. G3. ❑ 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. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depti�f iio ing at the building site: 11 feet ❑ meters Datum G10.Community's design flood a fr'.P0rfMen Of Fy4(JC WOr6— — . ❑ feet ❑ meters Datum Engim-eeirin Di W_