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ADA Certification (Fillable)
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ADA Certification (MUST SUBMIT WITH BLDG PERMIT APP)
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ADA Certification (Fillable)
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10/10/2025 10:20:38 AM
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9/30/2011 1:44:31 PM
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ADA Certification
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\Public Works\Building Division\Forms & Permit Applications\ADA Certification (MUST SUBMIT WITH BLDG PERMIT APP)
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BUILDING DIVISION – DPW <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 />TO: OWNER OR ENGINEER/ARCHITECT <br />FROM: BUILDING DIVISION <br />SUBJECT: BUILDING ACCESSIBILITY FOR PERSONS WITH DISABILITIES <br />BUILDING OWNER/ <br />TENANT: <br />LOCATION: <br />TAX MAP KEY: <br />Buildings or portions of buildings shall be accessible to persons with disabilities in accordance with the following regulations that are applicable to the subject building: <br />1)Federal Fair Housing Amendment Act applicable to multiplefamily projects (4 units or more) <br />2)Federal Architectural Barriers Act applicable to Federal <br />financed projects <br />3)Federal American with Disabilities Act applicable to places ofpublic accommodation <br />4)HRS 103-50 applicable to State or County financed projects <br />Before issuance of the building permit, the owner or the engineer/architect must certify to the foregoing. <br />CERTIFICATION <br />I certify that the subject project shall conform with the applicable accessibility requirements. <br />Owner or Engineer/Architect Telephone No. <br />Signature Date <br />The County of Hawai‘i is an Equal Opportunity Employer and Provider <br />THIS CERTIFICATION MUST BE SUBMITTED WITH THE BUILDING PERMIT APPLICATION
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