HomeMy WebLinkAboutForm - Final Inspection ChecklistDEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI‘I
Phone: (808) 961-8218 Fax: (808) 961-8684 E-Mail: cohdlc@hawaiicounty.gov
Hawai‘i County is an Equal Opportunity Provider and Employer
12/4/17
FINAL INSPECTION FOR INSPECTORS’ SIGNATURES
Applicant’s contact:
APPLICANT: DATE:
dba: TMK:
I. Pursuant to and subject to the exceptions in Rule 4-2-L of the Rules and Regulations of the Liquor Commission,
a final inspection is required for:
II. Pursuant to Rule 4-2-L, a final inspection may be waived in circumstances that the department finds no alterations
have occurred which may compromise the safety of patrons. The department may waiver final inspections from
Public Works if no alterations or renovations were done or work did not require a permit from Public Works.
In lieu of Public Works signature(s), applicant certifies: No alterations or renovations were done that required
permits from Public Works.
Signature of Applicant/Date:
III. Contact the agencies that have been marked. Present this form to the inspector. The signature of the
inspector shall signify the agency’s clearance. Upon completion of inspection, please send this form to
Department of Liquor Control at Fax: (808) 961-8684 or email: cohdlc@hawaiicounty.gov.
Public Works (Hilo: 961-8476 / Kona: 323-4720)
Building: Date: ____________________
Occupancy:
Electrical: Date: ____________________
Plumbing: Date: ____________________
Fire Dept. (Hilo: 932-2914 / Kona: 323-4761, 4762, 4763)
___________________________________________ Date: ____________________
State Health Dept. (Hilo: 933-0917 / Kona: 322-1507)
___________________________________________ Date: ____________________
Department of Liquor Control Final Inspection: (Hilo: 961-8218)
*Required prior to final inspection assigned to Liquor Investigator. (Verified by office.)
*Class 5, Category D: Registration of employee(s)/entertainer(s). If applicable. (Rule 5-1-A)
Any changes to floor plan/area, if so submit new floor plan. (Rule 4-2-Q) Yes
Pending receipt of documents:
Liquor Liability Insurance in the amount of $1,000,000) (§281-31-r) Waived (convenience minimarts)
*Liquor License Fee (Rule 3-3-A): $ Effective Date:
*Mailing address, E-mail, and ph#:
Special condition(s) imposed by Commission: Yes No
A checkmark (✓) by the Liquor Investigator indicates compliance.
Premises complies to floor plan/area approved by the Commission (Rule 4-2-Q)
Liquor Storage Area (Rule 5-13-B/Retail Premises)
Rules and Regulations & Chapter 281, HRS (Rule 5-10)
Operating a Vehicle Under the Influence of Intoxicant sign (§281-44) (Provided by Dept.)
Sale to Minor sign (Provided by Dept.)
Human Trafficking sign (Act 245 (SLH, 2013), effective 1/1/14) (HRS §371-20) – Class 5 Dispenser or Class 11 Cabaret (Provided by Dept.)
I.D. Checking Guide (Provided by Dept.)
Collect Liquor License Fee (Rule 3-3-A): $
Applicant to receive notice of confirmation of liquor license prior to order from wholesaler
Licensee/Representative:
Applicant ___________________________ Signature__________________________ Date
Liquor Investigator _____________________________________________________ Date
Originals sent to Hilo office/date