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HomeMy WebLinkAbout6-9-004:032 Addition above garageU.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program ELEVATION CERTIFICATE IMPORTANT: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION ( FOR INSURANCE COMPANY USE Al. Building Owner's Name Kelly Sheahan I Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No. I Company NAIC Number: 69-1757 PUAKO BEACH DRIVE City KAMUELA State HI ZIP Code 96743 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) (3) 6-9-004-032 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/ Longitude: Lat. 19 96755 Long. -155.84618 Horizontal Datum: ❑ NAD 1927 ❑x 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 1A 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 400 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 sFr_TInN R - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 11. Nqg, tgommunity Number B2. County Name I B3. State HaluvaQ COuntty TY AR/A0. Complete Items B4. Map/Panel Number Bb65. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) 89. Base Flood Elevation(s) (Zone 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) 7 . 2 feet ❑ meters Revised Date ❑ meters A0, use base flood depth) 0277 C APR 02, 2004 September 16, 1988 AO 2.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in item bu: ❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: Bll. Indicate elevation datum used for BFE in Item 139: x❑ 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 [E No Designation Date: / / ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ❑Q 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/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: RM 32 Vertical Datum: 6.59 Feet Indicate elevation datum used for the elevations in items a) through h) below. ❑x NGVD 1929 ❑ NAVD 1988 ❑ 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) 7 . 2 feet ❑ meters b) Top of the next higher floor 16 6 feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) ❑ feet ❑ meters d) Attached garage (top of slab) 7 2 0 feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 9 . 1 ❑x feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 6. 8 0 feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 9. 5 0 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 7. 4 ❑X 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. 1 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 ❑ Check here if attachments. licensed land surveyor? ❑ Yes ❑ No p. F�EF�o If PRLAM'I AL W * SWV Y0OR yt No. 7276 / vA I I, v5. FEMA Form 086-0-33 (7/12) 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 P0. Route and Box No. Policy Number, 69-1757 PUAKO BEACH DRIVE City State ZIP Code Company NAIC Number: KAM U E LA HI 96743 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 MULTIPLE PANELS APPLY: C-2-13 is addition above Garage; C-2-13 is pool pump; C -2-G is concrete lanai adjacent to structure Signature Date 6-2-2013 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 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, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, 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 G8—G10. 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 FEMA -issued or community -issued BFE) or Zone A0. G3. ❑ The following information (Items G4—G9) 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 depth of fl ie bu ding it El feet El meters Datum G10. Community's design flood elevation:,M. ❑ feet ❑ meters Datum mcirf1 e. ir'. LA Local Official's Name t('r? Flev tiilen CarflfirXte and Community Name re::orn ends Telephone Signature !._ 1 av_S n07 recommend "date Y "7 �ti CIpPC3T••f _ __ Comments Date DEC 117014 ❑ Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. t i ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. 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 P0. Route and Box No. Policy Number: 69-1757 PUAKO BEACH DRIVE City State ZIP Code Company NAIC Number: KAM U ELA HI 96743 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. View from Puako Beach Drive showing addition above garage Right side view showing stairway up to addition above garage Left side of garage showing addition above and existing structures to the rear FEMA Form 086-0-33 (7/12) Replaces all previous editions.