HomeMy WebLinkAboutRequest for transfer - rev 12-03-2015 - Form Fillable* $25.00 TRANSFER FEE PER PERMIT
* CASH OR CHECK ONLY
* SUBMIT BEFORE 3:30 PM
Hawai`i County is an Equal Opportunity Provider and Employer
Rev 12/3/15 nce coh33/building/forms/
BUILDING PERMIT REQUEST FOR TRANSFER
DATE: ________________________________
TO: County of Hawaii – DPW – Building Division
RE: Building Permit No(s) ________________________________
TMK: ____________________________
Owner/builder transfers are allowed only if the request is made prior to final inspection. Transfers between contractors are allowed for all
active permits. Originally approved job site plans should be available at the time of inspection or new plans may be required by the
Building Inspector. Additional permit(s) may be required if construction is not per the approved plans.
LEGAL OWNER:
Name: ___________________________________________(print)
Mailing address: ____________________________________
_____________________________________
E-mail address: _____________________________________
Telephone no: ______________________________________
Signature/Date: ___________________________________________
BUILDER:
OWNER/BUILDER: ___________________________________________(print)
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 contracting 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. I hereby acknowledge that the information I have provided is true and correct. I agree to comply with all County and State laws regulating building construction. I fully understand that if I violate
any of the provisions of Sec. 444-HRS, I may be subject to civil action; administrative action, including fines; and/or administrative penalties per Sec. 444-22, 23, 35, &
36 HRS.
Signature/Date: ___________________________________________
OR
CONTRACTOR: ___________________________________________(print)
License no: ________________________________________
Mailing address: ____________________________________
_____________________________________
E-mail address: _____________________________________
Telephone no: ______________________________________
RME Signature/Date: _______________________________________ (see Hawai`i Revised Statutes Chapter 444)
DESIGN PROFESSIONAL:
I acknowledge the transfer of ownership as designated above and accept continued responsibility of the above stated
project.
Signature/Date: ___________________________________________
_________________________________________________(print name/license number)
Approved: ________________________________ DATE: ___________
Building Division, Department of Public Works
For Office Use Only
Transfer Fee Received/Verified by
_________________________
Date: ____________________
Check# _______________
Amount: $_____________
Ownership Contractor
Transfer Completed on __________
By____________________________