HomeMy WebLinkAbout2-2-043:082 updateA NO SE-7,CT-f�M' ELEVATION CERTIFICATE
�iJDERA
L CM13 No. 1660-0008
Important: Read the instructions on pages i -q. j EXI-,1Q-fi011 Date JLI)v 31, 2016
SECTION A - PROPERTY INFORMATION FOR INSURANCE CirUIPANY USE
Policy Number:
A -Z r"; �3u;te an.:.u' 81o_ N,- o. P Company MAIC Ntjr.,,bzr
290 O'L St-&-;
Ta-,
3 C:'. 7-2-�4--
A- LIS= !e .c F',
oa r r �_,re S: Au F, -r bu,ldvic Fm zG2ch c ga,age
a! Scuz;- 5 C of at7ncherj G-rac
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sq in
g -......:d f, 001 C, N,
(Lr Engt-ieerec, fz:)d, U,,r.7 Yes 7 No
SECTION B -FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED!
7`7
K State
C -j Finislied
cnmn:t!,
Hawaii
C, E ZDre� Af' A TEFE: VE Vi -,; j SFE AR ARZ,i, 4RAF
F0,11 index D3te
R-FV� , i,S Pane.
Be, , Zhood 89 Baoe Eievafio,,(s) �'Zone
55 i 66 ClaqL)
C Apri:' 2,
i J-,
Zonefs" AO use base-flooddepth,
F? _ s tr�-
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P
166,3
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED!
7`7
Co,- gtr,'cw, S- suildin," urcar
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cnmn:t!,
C, E ZDre� Af' A TEFE: VE Vi -,; j SFE AR ARZ,i, 4RAF
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C2
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i J-,
NAVD
F? _ s tr�-
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fcBP"3,rn
c, P:ozecten Ait�a i,,,)rAi- Yes L, No
ChecK he measurement
user
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED!
Co,- gtr,'cw, S- suildin," urcar
C -j Finislied
cnmn:t!,
C, E ZDre� Af' A TEFE: VE Vi -,; j SFE AR ARZ,i, 4RAF
Ar,,AL-1, AF AO.
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11 .1; 0 17, 11
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D Quiir
)alum, ;-cr 6, -lev2tions sa,-ne �rs t;-141 used f 1,1-,,,, EF.---
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ChecK he measurement
user
fee:
mneters
fee:
meters
P:
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2arp0e, ;tor: 7)1., S,a(;,
fee:
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:,,Zw 1; _63.6
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,,se z)-, eo. c --e- Bnd r Ccrrmel.it-,
feet
meters
_t iov, s: f a. -i; Soi,;,:ri J,3,3,-,,
'D feet
meters
SECTION D - SURVEYOR, ENG;%'EER, OR ARCHITECT CERTIFICATION
FF -'.'A FOMIn 1',3,0 3" See 'everze, slo'E, f,�; x,;
6-
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No. 11 859
Replaces all
:,J L,; in'.- 'L
Z 2.
11 .1; 0 17, 11
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a nc A 11Sev:on A
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FF -'.'A FOMIn 1',3,0 3" See 'everze, slo'E, f,�; x,;
6-
LfCeNSFD
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No. 11 859
Replaces all
ELEVATION CERTIFICATE, page 2
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSuRANCE COMPANY USE
Bu, Wg MOW AVress (Mends g Apn Unk, Sw moor By No i of r G Rome and Box No Policy Number
Cis, H53:aceHl ZIP Code 9vw Company NAE Number
SECTION 1) - SURVEYOR, ENTNEER. OR ARCHITECT CERTIFICATION (CONTINUED)
E-c.Lsen sts-a
-;: L
r; CZ -S; This ele atop is te _mom AW7 ning area for we w -Life. The uppe.�flnor I;vng area: i 77.8 feet
qw CId EKwAn lE fir oxen car orf KA 23 square W "closed swinge rovi ash no fund aas,Lgs
Or Qn. Alneo dyer and nawr heawr am wwo an boom tax %-g ana
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (W17ROUT BFE)
FxZMWAOMa A mol out BFj,wwpwe itmoll'-E& K do CCmPlor-SACtio.-is A, 6
C ;. Qws E, , we raws grace.'; We nswj,weilt und In PuE.:',c Kcfily, enterinakr:s
pavae hvmmn wt0w01- 100 00�0 wz Ann Ye mwa es tc shvvy vzow he a%smr to a0we M cVcn the h1nev ajwwrl
are, .t !0':'Vast ad;acenz' grar-e
170* &bxw 50w:T1Udwg base m,T cvw*P7'-e 7' j NO D mWw', ��: nove orMe HAG
c � Tc2� c- ;z;:,-, r �,: rm, tog baseme, � a," a.., once 0,enf,s,,., Dfeet E.rnetzex- '-1abo;eorL] loe�c'.,vtneLAG
F2 =w BL40g Diagrams 6-9 0.0 pe, valew face 1penrgs powsi ri SevmnA 1terrs Paq�-�30 of AWNnUnn Mean Nperfkor
Te bWW9 s feet D rlete!s C1 2X0.2 Gr Ej HAG
E3 KwNec garage imp ofslab) k Wel Onvini Elanoveor []beAvMeHAG.
F" -Cp C4 piv"'orr.) of mww"q a", equy"a" soww& the LOW M 11 to 13 memo Q alow or F7 nelay; We HAG
EE ZweASGry
cranuce? -,yes :, No rl Wwriow
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE, CERTIFICATION
-'- sty cwrer or ,wer S a"Sn" "Pes"Ove Am mmwwn SeT ws A 6 wA E fu Zone A Whoit, a FDIA-rssoea rr comr-kin�1ty.,5sueo BFE;
a Zwe AO mum &OWer, Toe irmternens ii Sams A, s, so L wo ad m oe wE "I, Evowledge.
'�"'Op5ly 3'.ne a, O'.'ne. s �Utrior.zed Na r rev G Jac.-'-sc
ZIP We 91078
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De
ss., 6 20 L 14"wne W01005-
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-
Check here if attachments
SECTION G ~ COMMUNITY INFORMATION (OPTIONAL)
Tw ywc Piet_ SwWonsh, 8 Cxrw sAG
W"Is.wMck"w", w arts,rcynn Zrw
G. ire I. Senor 0::.a5 *Her Qvn cza uonow w -i — naw been s1reo Pic simej by a fw.sw o""on engineer or archism wk�
z au= .,,•,,._! by ow m cam! aln" wkwa" Ow*00 me m.n am UWT 4 Me "OOVw Cal w 1W (Am"ems area below)
G.'_. ')'*,','t',:_;_C,7,-",!eled F Q a by An 0=41 w lain A ! Qw: a FEUXAs,ed or cwnmun4r *Sued BFE) or Zone AD
Ir The T&ONQ is Prov da, f- f PW003es
.7 Dawni
0 ZEE or w ZwP AM d,K
frac� meters (Dtun)
Gil CX, mm y S dwq; 7=0 eavador,
mate's LD:urn
L=n Wows Nwy� -------
&Fwori Date
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RepAces all previous edws.