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COUNTY OF HAWAI`I DEPARTMENT OF PUBLIC WORKS – BUILDING DIVISION BUILDING PERMIT WORKSHEET FOR CHAPTER 5, PERTAINING TO BUILDING NOTE: THIS WORKSHEET SHALL ACCOMPANY CONSTRUCTION DRAWINGS. APPLICANT IS RESPONSIBLE TO APPLY IN PERSON. WE DO NOT ACCEPT WORKSHEET / PLANS ELECTRONICALLY OR BY MAIL Section 5-22. Expiration. (a) Every permit issued by the building official under the provisions of this code shall expire by limitation and become null and void (i) three (3) years after the date of issuance, or (ii) 180 days from the date of issuance if the building or work authorized by the permit is not commenced by such date. A permit shall expire if the building or work authorized by the permit is suspended or abandoned for a period of 180 days or more at any time after the work has commenced. In the event of strikes or other causes beyond the control of the builder, the building official may extend the aforementioned three (3) year or 180-day periods. The extension of time granted shall be a reasonable length of time but in no case exceed six (6) months. Requests for an extension must be made in writing to the building official. No exceptions will be allowed for building permits issued prior to the adoption of this code. (b) Upon expiration of a permit, all work shall cease and shall not be recommenced until a new permit is obtained. The building official may waive the requirements for submittal of plans and specifications in connection with a permit renewal if the work previously permitted remains the same, no amendments have been made to the building code affecting the work, and previously approved plans are still on file. When the building official determines that plans need not be submitted, the original plans, stamped and approved by the building official, shall be the renewed permit plans. (c) An owner-builder permit shall expire by limitation and become null and void five (5) years after the date of issuance. If the building or work authorized by the permit is suspended or abandoned any time after the work has commenced, the building official, upon request, may suspend the permit expiration until such a time that the owner-builder is ready to re-commence building or work authorized by approved permit. (Section 5-22) 3) refunds for permits shall be made in accordance with section 2-12 of the Hawai‘i county code. (Section 5-32); 4) separate permits are required for electrical, plumbing, gas, signs, driveways, and grading; 5) data provided herein is public information. Thismust be completed before processing by building division commences APPLICANT TO FILL IN AREA BELOW - PLEASE PRINT WITH BLACK BALLPOINT OR TYPE Legal Owner: Mailing Address: Lessee, Tenant: Mailing Address: Plans by: Qualification: AR SE ME CE OTHER Builder: Mailing Address: Scope of Work: New Alteration Move Reconstruction Electrical Addition Package Home Repair Demolition Emergency Plumbing For New Residential Applications: Is this dwelling located in a wind borne debris region? Yes. Protection provided by: Protective glazing Plywood or shutters Residential safe room No. Description of Work: Estimated Valuation For All Work To Be Performed: $ Project Address: Flood Zone: Engineering (initial): Date: DECLARATION (SEC 444 - HRS) CHECK (X) ONE CONTRACTOR DECLARATION I declare that I am licensed under the provisions of Chapter 444, HRS, of the Department of Commerce & Consumer Affairs, State of Hawai‘i. My license no. is in full force and in effect. NOTE: RME (Responsible Managing Employee) only to sign. Notarized authorization from RME required for designated agents. OWNER-BUILDER DECLARATION I declare an exemption under Sec. 444-2(7) for the following reasons: 1) this exemption allows me, as the owner or lessee of the property, to act as my own general contractor without possessing a license; 2) to supervise the construction myself; 3) to hire licensed subcontractors; 4) the building is for my personal use and not for the use or occupancy by the general public; 5) building will not be built for sale or lease within one (1) year after construction is complete. Section 5-4 Definition “Owner-builder” means owners or lessees of property who build or improve structures on their property for their own use, or for use by their immediate family. This definition shall not preempt owner-builder by exemption as defined by section 444-2.5, Hawai‘i Revised Statues. OWNER’S PHONE NO. TAX MAP KEY NUMBER EMAIL: Z S PL PAR LOT CONTRACTOR’S PHONE NO. (3) EMAIL: Hawai‘i County is an Equal Opportunity Provider and Employer