CERTIFICATE OF RE-OCCUPANCY

CERTIFICATE OF RE-OCCUPANCY
Date of Application*

MonthDayYear
Permit #*
Addition to Permit #*
Parcel #*
Date*

MonthDayYear
FEES: $100.00 Commercial, Industrial and Office / $50.00 Residential*
Amount Paid
1. I (we) do hereby request permission to occupy the building or propert listed for purposed indicated. To the best of my (our) knowledge all work will be completed and will confirm with all ordinances of the Village of Somers. Further, it is my (our) understanding that the buildign or property shall not be occupied or used until a Certificate has been certified by your department.
Building Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Present Owner*

First NameLast Name
Present Owner Phone #*

Area CodePhone Number
Present Owner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New Owner*

First NameLast Name
New Owner Phone #*

Area CodePhone Number
New Owner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Present Tenant*

First NameLast Name
Present Tenant Phone #*

Area CodePhone Number
Present Tenant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New Tenant*

First NameLast Name
New Tenant Phone #*

Area CodePhone Number
New Tenant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Corporation Name*
Corporation Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Principal Officer*

First NameLast Name
Principal Officer Phone #*

Area CodePhone Number
Principal Officer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Former Use or Occupancy*
Intended Use of Land and Building(s)*
Please state in detail
Floor Levels*
Stories*
Total Floor Area Sq.*
Hours of Operation*
Maximum Number or Employees*
Maximum Number of Patrons*
Number of Apartments*
2. If certificate of Occupancy will not be issued unless repairs or alerations are performed who will be responsible for work?
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Applicant's Signature*

Clear
Date*

MonthDayYear
Date Signed
Applicant's Phone Number*

Area CodePhone Number
Applicant's Email*
example@example.com
Office Use Only
Change of UseChange of OccupancyMultiple Occupancy
Building Inspector

First NameLast Name
Date

MonthDayYear
Electrical Inspector

First NameLast Name
Date

MonthDayYear
Plumbing Inspector

First NameLast Name
Date

MonthDayYear
Fire Inspector

First NameLast Name
Date

MonthDayYear
Should be Empty: