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ADA Certification (MUST SUBMIT WITH BLDG PERMIT APP)
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ADA Certification
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1/10/2012 3:11:47 PM
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1/10/2012 2:16:16 PM
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ADA Certification (Fillable)
(ADA Compliant Text Version)
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\Public Works\Building Division\Forms & Permit Applications\ADA Certification (MUST SUBMIT WITH BLDG PERMIT APP)
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<br />BUILDING DIVISION – DPW <br /> <br /> <br /> <br /> <br />COUNTY OF HAWAI'I – 101 Pauahi Street, Suite 7 – Hilo, Hawai‘i 96720 <br /> Hilo Office (808) 961-8331 Fax (808) 961-8410 Kona Office (808) 323-4720 Fax (808) 327-3509 <br /> <br /> <br /> <br />THIS CERTIFICATION MUST BE <br />TO: OWNER OR ENGINEER/ARCHITECT <br />SUBMITTED WITH THE BUILDING <br /> <br />PERMIT APPLICATION <br />FROM: BUILDING DIVISION <br /> <br />SUBJECT: BUILDING ACCESSIBILITY FOR PERSONS WITH DISABILITIES <br /> <br /> BUILDING OWNER/ <br /> TENANT:____________________________________________ <br /> <br /> LOCATION:__________________________________________ <br /> <br /> TAX MAP KEY:_______________________________________ <br /> <br /> Buildings or portions of buildings shall be accessible to persons with <br /> disabilities in accordance with the following regulations that are applicable <br /> to the subject building: <br /> <br />1) Federal Fair Housing Amendment Act applicable to multiple <br />family projects (4 units or more) <br /> <br />2) Federal Architectural Barriers Act applicable to Federal <br />financed projects <br /> <br />3) Federal American with Disabilities Act applicable to places of <br />public accommodation <br /> <br />4) HRS 103-50 applicable to State or County financed projects <br /> <br />Before issuance of the building permit, the owner or the engineer/architect <br />must certify to the foregoing. <br /> <br />CERTIFICATION <br /> <br />I certify that the subject project shall conform with the applicable <br />accessibility requirements. <br /> <br /> <br />_________________________________ _______________ <br />Owner or Engineer/Architect Telephone No. <br /> <br /> <br />_________________________________ _______________ <br />Signature Date <br />The County of Hawai‘i is an Equal Opportunity Employer and Provider <br />
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