State of Hawaii
Department of Labor & Industrial Relations
Hawaii Occupational Safety & Health Division
Boiler & Elevator Inspection Branch

REQUEST FOR PERMIT RENEWAL INSPECTION1

ELEVATORS & KINDRED EQUIPMENT
Date: 11/23/2014
Thank you for using this inspection request form. It helps us to keep track of requests so that we can provide better customer service and assure public safety in the use of elevators, escalators, etc. Questions/concerns may be directed at 808-586-9141 (please have your HAW# available).
Bldg Name:

Bldg Address:

City:   Zip:   Island2:

Last Name of Inspection Requestor:  First Name:

Company:

Phone (Include area code):   Email Address:
Has building name, owner, or billing address changed since last inspection?

Number of OBJECTS to be inspected:

Please ensure that all fields are entered correctly as you may not make changes once you click "Continue"

1A "Permit Renewal Inspection" is necessary in order to obtain a valid, current Permit to Operate. Elevators, escalators, etc. cannot be legally operated in the state without a valid, current Permit to Operate.
2Inspections on neighbor islands will be scheduled for the next available inspection date. Please put in requests at least two months in advance of the desired date to enable us to reasonably meet the request.