CERTIFICATE OF RE-OCCUPANCY

CERTIFICATE OF RE-OCCUPANCY
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Permit #
Addition to Permit #
Parcel #
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
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
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate Signed
Applicant's Phone Number

Area CodePhone Number
Applicant's Email
example@example.com
Office Use Only
Building Inspector

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Electrical Inspector

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Plumbing Inspector

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Fire Inspector

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty: