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r<� <br /> ;... '.. . :;'.. BUILDI 10 DIVISION - DPW <br /> COUNTY Olt HAWAII _ <br /> .Ia�'. ' � 101 Pauahi'Street, Suite <br /> 'r 1ii(u, HnwoLii 96720 <br /> Ph Hilo OfWee(808)961-8331 Kona Office(608)323-4720 DECLAIM IUN>T ACCEPTANCE DATE <br /> •,ti <br /> IOECIAAATIQN OF COMPLIANCE <br /> HAS SECTION 46.89 REIATING TO AL.IUCULT URAL STILI.CTuRCS <br /> PROJECT/PROPERTY INFORMATION I <br /> • <br /> PRoJ[Cra1AAt[ tti _ <br /> rtyevsc <br /> b.IAItLAM)Wt.DLSIGNAUOM �• ' cilia liot, Alt Land the Dcs(gnadon,canlactlh Depattmeretor?(anningat(808}961.8288. <br /> !/-1T s V <br /> -14-lo 3 14-Qwai ®e.t-I- �o( .l_ uta - kDha i °LP1 41) <br /> 11 AAA GEr Db a -O I FROC1RI]LA1llA facies) <br /> STRUCTURE INFORMATION C�7 <br /> MEMSTRUCTURt 1\1\8 (ca)OIA 1 �f. C <br /> Lt1LAMPTION:40(teehHou(Oa""Stheets T 2._(-'4A1.-43 <br /> 6t LUItAAIi 5r 1QR[kF Iruous:7612ONan} {k}tmusibrIva than]Sft) <br /> DISTANCE RGMNEM(STSTRUCTURE (ft)tom...1sa) lo1ALi HOWL AREA OD 4,41.10.) <br /> DIMENSIONS OESIRUCIURL lenstll 5-D IA)aL: ' I (ft) [• ,. <br /> AGGREGATE Fl OCRMLA OF.HL tXCMPHOSTRUCTURkS1.1UMt111R+ICILR(6kS46.03 6,00 Al(l.) <br /> ProvrdeIron,mum/1nAli ihepIStliarnitipr umesphorng( n aperIt� rLrunur�eat toa�gs acsdmt.iuonlofnrutwa.and�nyid+ak!ereaenttnfarmoon. <br /> Attach estusheets.dmeets eq. t nfA1` if Ch <br /> 1 lT i' <br /> COMMENTS(rot deparlmerr use care)• gA j /n? L <br /> LAW <br /> (Obuin approval eignanne.pint to,vb.n.t,ii'iiff Deelatitice to ruble Wats) <br /> ENGINLE RING DIVISION APPROVAL <br /> l� <br /> 111ineuejChVKlsn Clan <br /> OWNERS CERTIFICATJoistme LARATION <br /> 1 declare this project la be etvmpt horn Applicable bu'(dl..r,per rn:r/code roll!'cmwli under the pruvltiorls of HRS Sec than 4649.1 how.cad and fuller understand HAS 46.68 and coolly <br /> that the Fora(an is in compliance. <br /> 1. I understand that this exemption only aphis."to caftan.budding pet ocilktmle itspdteineAll.ishallobtainillotherreguiredpernsmandappravnhandshalconplywithall <br /> applicable cedes and Laws aswtlated with!bit dtvelop.naa.which may Include and not he lImieed 10 Specht Management Arta,Flood 1•latardt elecuicat plumbing,Eradlne, <br /> dnveway,ww4 in Ceunty/Ssale right al w eys.flie.,vaitetvdttr and Dap rtntent of Health reTalmo;tntt <br /> 2. 1 vrtdeutand that the issuance of a derlar,titin number by ehr Colony'hook/.101 sr teltcn to mean khat cvnlpllance with HAS 46 88 lies been confirmed.and that it is my sale <br /> responsibllity to conhm mmQliatate.The State os County sisal net tee Garda tar any claims irisins Fran ronsuuction of buildings.su uclwes.a appurtenances dtereto exempt <br /> from the building cads and peard it pr xeis as dasenbed Irt 1IRS 46.89. <br /> Pwpatiy Owner: 0 �l <br /> Adtllt:ts: ' (j-�}I D ij tko1,w&[ (altd r �ILI UAQ-kOho , F-H. 9b1 i4-D <br /> Phone No: "./1 'q ✓ ti-si{I EnsaiF (o FYI[as j tl rh e e,3 1 .Qf7` <br /> Signature: i �° <br /> Printed Name ) Grote, 4 jJ)d a <br /> roST CONSTRUCTnON A'INAL&'• IT IF TION FORM must submit Led upon completion of cansrucnun.Failure to wbmli the form mil cause dl <br /> II!<Qu1REMlMS+ DECLARATION 0'COMPLIANCE lu be declared INVALID and thanVOID the budding pennh miller code taerood oILA single Final As-Quilt <br /> Netifcafron Feint n1uu he whinnied in compliance with both ci due Iolluwing deadlines. <br /> f Submit form within T year of Declaration of Compliance acceptance date. <br /> 2 Submit Ilif,rrn within 30 days of completion,occupancy.or use of immure <br /> Hawal'i County is an Equal Opportunity Provider and Employer Rev.3/22 <br /> Orril <br /> ROA DOCUMENT 1 PAGE 010 <br />