HomeMy WebLinkAbout2023-02-10 Ex. 04 - Declaration #BX2022-00014 Ag Shed BUILDING DIVISION - DPW
. COUNTY OF HAWAVI
101 Paunhi Street, Suite 7
a:l l•�la Hilo,Hawaii 96720
Ph: Hilo Office (8081961-8331 Kona Office(808)323-4720 DECLARATION 6 ACCEPTANCE DATE
�`'►i►" a(27022000 R ZI ZZ
R;uarsO
DECLARATION OF COMPLIANCE 1/ D
HRS SECTION 46-RR RELATING ILIAGRICUs IURAE SIRUC IURES I�
PROJECT/PROPERTY INFORMATION
1+1401f[1 NAW 0 `ow-
SIAIE EANU%JS(DESIGNAFION of Suir Land Vote Designation,conma the DepArtntcnl of I+ianning as(WH)9h 1 8:88.
Trs L
ADDb, Y'U� �1
s }
TAXMAPMV MOPERTY AREA
111)0M 0 I 6141PAcre51
STRUCTURE INFORMATION
`1 /1 `''�1{w�'tpp•� 4 'T1�
EtFX1Pnl]hNls(ue4nnuhsllnusuRshreu .l¢[ f,� S`RU'TURAtSPAN;r OA EXEMPTIONS7&1.10NEYl (h)'.n-unbelrssrhen25ft►
I1tSIAtvrf lRltMNE ARF5171NSIi TURk 17� �vv') F[llrrvn •51[S l0l Atftt1nRAREA 1-1 lr#
JAM[NM NN?s)1 STROr1HNf iragrh
M1L11IGAEI(UIURANIA[lf All I\IASPTEDSTRI-CTIJRESCtAJM(1tt1NDIRt1RS46.RR isq h)
prnnJrmrnrmumBt^.-sit utrplanshowmgappru iArinratusrsnfsu wrepreprnylrnes.athrrmrsfnwrs.usbacisrnrnher+uunurrs,drmm.mmulstiuU[nr.andauynthrtpnunrnrmormaunrs
Artachrxua shrers_rf rxY r:sarr y4+�� - ��j�(�.s� � � +
COMMENTS(for drpamm�u use smlyi
(obtain approval t Fgrlararn prior to stolon tial of Dirclaristlnn W Public WwW
kNGINk(RING D111S10N APPROVAL
rnrrrrn;[s+vr Isar �.
OWNERS CERTIFICATION/DECLARATION
I detWelilts Forulrtt to be exempt from applicable pudding prrmrt/;ode requirements under the prawsrons of HRS Simian 46-118:have fired Aid fullF undr+ssanrl HRS 46.8111 and certify
that the project n err eomplunce
I i understand that this exemission ooh-Apphn m mtun bu+ldmg permiticodr reNUormrnts I shall obarn all other requited prnnrss and approvals and stiall comply wnh all
applicable codts and laws associated with this development,which nay include and not he lmuted to Special Management AmA,l lood 11aeard,electrical.plumb-%grading.
driveway,work n+CounlylState right of ways,fire.wasiewatrr.and Department of Health requtremems
I understand[hal the isstranre of a declaration number by the County should 0101 be taken to mraas that compliance with HRS 46.RR has been confirmed.and that it is my sole
rrsponsihrlity so confnm complurice [he State m County shale Ions be(rabic for any rlatms arising from construction of isrrildings st-ucsures,ar appurtenances thereto exempt
from site building code and permnLng proress as descr bed err HRS 46.86
Isropefty Owner y
Address: 11
Phone No ` Email: r' 1
Signature PrrrurdName ` T
POST CONSTILlI1MON A FINAAS-BUt N I TION FORM must w itis upon camp Eon construct----Fat are to w mit a m w[ cause this
filiQUTAE&4Emm. DECLAFLA71ON OF COMPLIANCE to be dedared INVALID Wood shall VOID the bsdlding permit and/or code exemption,A tingle Final As-eWh
NoWkgtlon Form must be wbmined in compliance with both of the fallowing deadllrtn
I Submit fonts within t year of Declaration of Cls"liance acceptance dao.
2. Submit Form within 30 days of completion,occupanry,or use of smrcturs.
Hawa1'I County is an Equal Opportunity Provider and Employer Rev.3/22
EXHIBIT 4
q �
pri
ma
X10
ni
73
rRf "'i C' -ice 2 3:
4 10
4A -e = a Kr
14
rM
•5i 4` �` t,.
v
� l
,��+ art' � ' y..4•
rc.rKan . d. PA"t'ipl A,
NICHOLE ROSELAN1 KIYOKO KANOA MUR.AR H wy .•
y 11' .
#JAK .31#38iY01 50600 ENWIRINO
L
DECLARATION#
BUILDING DIVISION - DPW
COUNTY OF HAWAII g,(202Z- 000 IL�
'• •.•. 101 Pauahi Street, Suite 7
,' oRilR�rx Hilo, Hawaii 96720
Ph: Hilo Office (808) 961-8331 Kona Office (808) 323-4720
FINAL AS-BUILT NOTIFICATION
HRS SECTION 46-88 RELATING TO AGRICULTURAL STRUCTURES
***THIS FORM MUST BE SUBMITTED UPON COMPLETION OF CONSTRUCTION.
***FAILURE TO SUBMIT THE FORM WILL CAUSE THE HRS 46-88 DECLARATION OF COMPLIANCE TO BE DECLARED INVALID AND SHALL VOID THE BUILDING PERMIT AND/OR
BUILDING CODE EXEMPTION. ASINGLE AS-BUILT NOTIFICATION FORM MUST BE SUBMITTED IN COMPLIANCE WITH BOTH OF THE FOLLOWING DEADLINES:
1. SUBMIT FORM WITHIN 1 YEAR OF DECLARATION OF COMPLIANCE ACCEPTANCE DATE.
2. SUBMIT FORM WITHIN 30 DAYS OF COMPLETION,OCCUPANCY,OR USE OF STRUCTURE.
PROJECT/PROPERTY INFORMATION
PROJECT NAME S 1cj -� � C+ �(� � _l
,151
ADDRESS 3 p3 Hol w I's ��1�
TAX MAP KEY
AS-BUILT CONDITIONS OFSTRUCTURE
USE OF STRUCTURE 6 rned
DISTANCE FROM NEAREST STR TURE (fr,}(mJin.15 f(t.)) VI TOTAL FLOOR AREA (sq.ft.)
DIMENSIONS OF STRUCTURE I Lengih a i✓ (ft.)x Width CR (ft.)
AGGREGATE FLOOR AREA OF ALL EXEMPTED STRUCTURES CLAIMED UNDER HRS 46-88 D (sq.ft.)
OWNERS CERTIFICATION/DECLARATION
• 1 certify that the as-built conditions of the structure are in full compliance with the requirements and provisions of HRS Section 46-88.
CHECK THE APPLICABLE BOX BELOW:
F�1 The as-built location of the structure is as shown in the original site plan.
The as-built location of the structure has changed from what is shown in the original site plan. if this box is checked,you must do the following:
• Provide minimum 8-1/2"x11"site plan showing the as-built location of structure,property lines,other structures,setbacks to other structures,dimensions of
structure,and any other pertinent information.Attach extra sheets,if necessary.
Property Owner:
Address:
Phone Na U -- �jml I- Email:
Signature: N Ws,�
Pri Pied Name:
The project is not required to comply with county,state,and federaf floodplain management development standards,ordinances,codes,statutes,rules,and regulations pursuant to the
National Flood Insurance Program requirements.
Hawairi County is an Equal Opportunity Provider and Employer Rev.3/22