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Home My WebLink About2-2-045:183U.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 KAI V TORNGREN, III & LAURIE ANN V CARIAGA-TORNGREN Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No. Company NAIC Number: 61 HOONANI PLACE City HILO State HI ZIP Code 96720 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) (3) 2-2-045-183; LOT 12-A, HILO HOONANI SUBDIVISION A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 19-40-59.62 N Long. 155-03-47.43 W 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 5 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 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 COUNTY - 155166 B2. County Name HAWAII COUNTY [33AAw HA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone na Q feet ❑ meters Revised Date ❑x feet A0, use base flood depth) 890 C APR 02, 2004 AE 117.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: ® FIS Profile ❑ 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 ❑x No Designation Date: / / ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ❑x 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/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: USGS 1957 5YY Vertical Datum: NGVD 1929 Indicate elevation daturn 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. h k h d 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 115.4 Z feet ❑ meters 117.9 ❑x feet ❑ meters 117.2 Z 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 x❑ Check here if attachments. licensed land surveyor? M Yes ❑ No Certifier's Name License Number LAN Z INABA 5626 LPLS Title Com any Name INA6A ENGINEERING, INC City State AVE HILO HI Date Teleph 04/06/2015 808-9 FEMA Form(Q96-0-33 (7/12) See reverse side for continuation. -3727 PSN Z rNA�9 LICENSED PROFESI40NAL 'LAND SUAVE" Nm 56'26 ygrVAll, v 5�' Replaces all previous editions. C ec t e rneasurement use . 119 4 ❑x feet ❑ meters 120.0 Z feet ❑ meters na Q feet ❑ meters na ❑x feet ❑ meters 118. 7 x❑ feet ❑ meters 115.4 Z feet ❑ meters 117.9 ❑x feet ❑ meters 117.2 Z 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 x❑ Check here if attachments. licensed land surveyor? M Yes ❑ No Certifier's Name License Number LAN Z INABA 5626 LPLS Title Com any Name INA6A ENGINEERING, INC City State AVE HILO HI Date Teleph 04/06/2015 808-9 FEMA Form(Q96-0-33 (7/12) See reverse side for continuation. -3727 PSN Z rNA�9 LICENSED PROFESI40NAL 'LAND SUAVE" Nm 56'26 ygrVAll, v 5�' 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, andjor Bldg. No.) or P0. Route and Box No. Policy Number: 61 HOONANI PLACE City State ZIP Code Company NAIC 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 `LOMC CASE NUMBER(S) APPLY: 14-09-2534P. MULTIPLE PANELS APPLY: C2.e) Lowest elevation of equipment servicing the building is a washing machine and a dryer located in utility room (see photo). Signat� .vL Date U4/06/2015 SECTtQIY,.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, 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 beiow the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor !including basement, crawlspace, or enclosure) is ❑feet n meters ❑ above or below the H .AG. bi Top of bottom floor (including basement, crawlspace, or enclosure') is E 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 7 meters ❑above or below the HAG. E3. Attached garage (top of slab) is [I feet ❑ meters ❑ above or ❑ beiow 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 '_IP C -de 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 I G5. Date Permit issued G6. Date Certificate Of Compliance/Occupancy Issued j G7. This permit has been issued for: ❑ New Construction, El Substantial Improvement (38. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or lin Zone AO) depth of flooding at the building site: . '_ feet J meters Datum _ G10.Community's design flood elevation: feet nneters Datum, Local Official's Name Titre Communitv Name Teiep+ one �� S ign at.. ------- Da. 1 e -'— -- --- — Comments — -- C eck here if attachments. FEMA Form _ _-.1-, 3�' (7/12) fill f-+rYlacac all r,rcvini,c nriir�n,-,n