Permit Application Forms

Clean Air Branch permit application forms, and the instructions for completing them, are available from this site. These include applications for Agricultural Burning Permits and Air Pollution Control Permits. Permit requirements may be found in Hawaii Administrative Rules, Title 11, Chapter 60.1, Air Pollution Control (June 30, 2014). The documents have been converted into portable document format (pdf) to facilitate their posting on the web. Please review the instructions below on how to view documents in pdf format.

Agricultural Burning Permits

Anyone engaged in an agricultural operation is prohibited from causing or allowing agricultural burning without a permit from the Department of Health. The main requirements for agricultural burning, permits and fees appear in HAR Section 11-60.1-51 to -57, and Section 11-60.1-121.

Click to download the application form and instructions:

Applicants should carefully read the instructions and the application form. If you need further assistance, please contact the Clean Air Branch.

REMEMBER:

  • Submit your filing fee with your permit application.
  • Make checks out to: Clean Air Special Fund – NON
  • Write your phone number on the check.
  • Submit an updated map with each application.

Air Pollution Control Permits (Covered Source Permits and Noncovered Source Permits)

Except as provided in HAR Section 11-60.1-62 or Section 11-60.1-82, an Air Pollution Control Permit is required prior to construction, reconstructing, modifying or operating a stationary air pollution source or air pollution control equipment. Choose from the two categories of Air Pollution Control Permits: Covered Source Permits and Noncovered Source Permits.

Applicants should carefully read the Instructions for Applying for an Air Pollution Control permit and the application forms. If you need further assistance, please contact the Clean Air Branch.

REMEMBER:

  • Submit your filing fee with your permit application. Applicants should use the Fee Schedule in the instructions to determine the amount that must be submitted with your permit application.
  • For a Covered Source Permit:
    • Provide one original and one (1) copy of all application materials.
    • Make checks out to Clean Air Special Fund – COV
  • For a Noncovered Source Permit:
    • Provide one original and one (1) copy of all application materials.
    • Make checks out to: Clean Air Special Fund – NON
  • Write your phone number on your check.

Covered Source Permit Application Forms

Covered sources include those sources that are major sources of air emissions and sources subject to a federal perfomance or control technology standard. For more details, please see the Definitions section of the instructions. The permit applicability requirements for covered sources are specified in HAR Section 11-60.1-82.

Click to download individual Covered Source Permit (CSP) forms separately or download all the forms required for a permit action at once.

Application for an Initial Covered Source Permit

Form S-1 Form S-2 Form C-1 Form C-2 All Forms For an Initial CSP

Application for a Covered Source Permit Renewal

Form S-1 Form S-3 Form C-1 Form C-2 All Forms For a CSP Renewal

Application for a Temporary Covered Source Permit

Form S-1 Form S-4 Form C-1 Form C-2 All Forms For a Temporary CSP

Application for a General Covered Source Permit

Form S-1 Form S-5 Form C-1 Form C-2 All Forms For a General CSP

Application for a Significant Modification to a Covered Source

Form S-1 Form S-6 Form C-1 Form C-2 All Forms For a Significant Modification to a CSP

Application for a Minor Modification to a Covered Source

Form S-1 Form S-7 Form C-1 All Forms For a Minor Modification to a CSP

Application for an Ownership Transfer of a Covered Source Permit

Form S-1

Noncovered Source Permit Application Forms

Noncovered sources include all other stationary sources of air pollution that are not covered sources. For more details, please see the Definitions section of the instructions. The permit applicability requirements for noncovered sources are specified in HAR Section 11-60.1-62.

Click to download individual Noncovered Source Permit (NSP) forms separately or download all the forms required for a permit action at once.

Application for an Initial Noncovered Source Permit

Form S-1 Form S-8 Form C-1 All Forms For an Initial NSP

Application for an Noncovered Source Permit Renewal

Form S-1 Form S-9 Form C-1 All Forms For a NSP Renewall

Application for an Temporary Noncovered Source Permit

Form S-1 Form S-10 Form C-1 All Forms For a Temporary NSP

Application for a General Noncovered Source Permit

Form S-1 Form S-11 Form C-1 All Forms For a General NSP

Application for a Modification to a Noncovered Source

Form S-1 Form S-12 Form C-1 All Forms For a Modification to a NSP

Application for an Ownership Transfer of a Noncovered Source Permit

Form S-1

Contact

If you are unable to download or print the application froms from this website, you may pick them up from the Clean Air Branch office. You may also call to request that forms be mailed or e-mailed to you.

Clean Air Branch
Environmental Management Division
Hawaii State Department of Health
919 Ala Moana Blvd., Suite 203
Honolulu, HI 96814-4920Phone: (808) 586-4200
Fax: (808) 586-4359
E-mail: cab@doh.hawaii.gov