Application for Hot Work Permit - Hawaii

This "Application for Hot Work Permit" is a part of the paperwork released by the Hawaii Department of Land & Natural Resources specifically for Hawaii residents.

The latest fillable version of the document was released on June 1, 2011 and can be downloaded through the link below or found through the department's forms library.

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APPLICATION FOR
HOT WORK PERMIT
Division of Boating and Ocean Recreation
Department of Land and Natural Resources, State of Hawaii
1. PERMIT INFORMATION
OFFICE USE ONLY
Start Date:
Start Time:
End Time:
/
/
:
:
Date Received:
Island(
) :
q
Hawaii
q
Kauai
q
Lanai
q
Maui
q
Molokai
q
Oahu
one
4
Received By:
Location:
A welding or burning operation shall be performed by (name):
q
Check to acknowledge the person performing work is responsible for abiding by all existing regulations concerning
hot work.
Description of Hot Work:
2. APPLICANT INFORMATION
Name (Last):
(First):
(M.I.):
Suffix:
q
q
Date of Birth:
Gender:
Female
Male
/
/
Phone (business):
(home):
Email:
Mailing Address:
Apt #:
Address Line 2:
Country:
City:
State:
Zip:
3. VESSEL INFORMATION
Vessel Name:
Port of Registry:
q
Registration
q
Coast Guard Documentation
q
None
Documentation Type:
Registration or Doc.#:
Expiration Date:
/
/
Hull Manufacturer:
Hull ID#:
Year Built:
Number of Hulls:
Hull Color:
Cabin Color:
Top Deck Color:
Trim Color:
4. AGREEMENT & SIGNATURE
I agree to comply with the provisions of the Hawaii
Administrative Rules as promulgated by the Division of
/
/
Boating and Ocean Recreation applicable to this permit.
Signature of Applicant
Date
Hot Work Permit, Revised: 06/2011
Page 1 of 1
APPLICATION FOR
HOT WORK PERMIT
Division of Boating and Ocean Recreation
Department of Land and Natural Resources, State of Hawaii
1. PERMIT INFORMATION
OFFICE USE ONLY
Start Date:
Start Time:
End Time:
/
/
:
:
Date Received:
Island(
) :
q
Hawaii
q
Kauai
q
Lanai
q
Maui
q
Molokai
q
Oahu
one
4
Received By:
Location:
A welding or burning operation shall be performed by (name):
q
Check to acknowledge the person performing work is responsible for abiding by all existing regulations concerning
hot work.
Description of Hot Work:
2. APPLICANT INFORMATION
Name (Last):
(First):
(M.I.):
Suffix:
q
q
Date of Birth:
Gender:
Female
Male
/
/
Phone (business):
(home):
Email:
Mailing Address:
Apt #:
Address Line 2:
Country:
City:
State:
Zip:
3. VESSEL INFORMATION
Vessel Name:
Port of Registry:
q
Registration
q
Coast Guard Documentation
q
None
Documentation Type:
Registration or Doc.#:
Expiration Date:
/
/
Hull Manufacturer:
Hull ID#:
Year Built:
Number of Hulls:
Hull Color:
Cabin Color:
Top Deck Color:
Trim Color:
4. AGREEMENT & SIGNATURE
I agree to comply with the provisions of the Hawaii
Administrative Rules as promulgated by the Division of
/
/
Boating and Ocean Recreation applicable to this permit.
Signature of Applicant
Date
Hot Work Permit, Revised: 06/2011
Page 1 of 1

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