REQUEST FOR CERTIFICATE OF OCCUPANCY
TO: Building Department / Authority Having Jurisdiction
[Building Department Name]
[Address]
[City, State, Zip]
[Phone]
[Email]
DATE: [Date]
1. PROJECT INFORMATION
| Project Name: | [Project Name] |
| Project Address: | [Street Address] |
| City, State, Zip: | [City, State, Zip] |
| Parcel/APN Number: | [Parcel Number] |
| Zoning District: | [Zoning] |
2. PERMIT INFORMATION
| Building Permit Number: | [Permit Number] |
| Permit Issue Date: | [Date] |
| Permit Expiration Date: | [Date] |
| Permit Valuation: | $[Amount] |
Related Permits
| Permit Type | Permit Number | Issue Date |
|---|---|---|
| Electrical | [Number] | [Date] |
| Plumbing | [Number] | [Date] |
| Mechanical | [Number] | [Date] |
| Fire Sprinkler | [Number] | [Date] |
| Fire Alarm | [Number] | [Date] |
| Grading | [Number] | [Date] |
| [Other] | [Number] | [Date] |
3. APPLICANT INFORMATION
Property Owner
| Name: | [Owner Name] |
| Address: | [Address] |
| Phone: | [Phone] |
| Email: | [Email] |
Contractor
| Company Name: | [Contractor Name] |
| Contact Person: | [Name] |
| License Number: | [License #] |
| Address: | [Address] |
| Phone: | [Phone] |
| Email: | [Email] |
Architect/Engineer (if applicable)
| Firm Name: | [A/E Name] |
| Contact Person: | [Name] |
| License Number: | [License #] |
| Phone: | [Phone] |
| Email: | [Email] |
4. PROJECT DESCRIPTION
4.1 Type of Construction
☐ New Construction
☐ Addition
☐ Tenant Improvement
☐ Change of Use/Occupancy
☐ Shell Building
☐ Renovation/Remodel
☐ Other: [___]
4.2 Occupancy Classification
Primary Occupancy: [e.g., R-3 Residential, B Business, A-2 Assembly, etc.]
Secondary Occupancy (if any): [___]
4.3 Construction Type
Construction Type: [e.g., Type V-B, Type II-B, etc.]
4.4 Building Information
| Number of Stories: | [___] |
| Building Area: | [___] square feet |
| Number of Units (if applicable): | [___] |
| Number of Occupants: | [___] |
| Use Description: | [e.g., Single-family dwelling, Office building, Restaurant, etc.] |
4.5 Project Description
[Provide brief description of the project/scope of work completed]
5. TYPE OF CERTIFICATE REQUESTED
☐ Certificate of Occupancy (Final) - All work complete
☐ Temporary Certificate of Occupancy (TCO) - Partial occupancy requested
- Requested duration: [___] days/months
- Areas to be occupied: [Describe]
- Reason for TCO: [Explain why full CO cannot be obtained]
- Remaining work: [Describe incomplete work]
☐ Partial Certificate of Occupancy - For specific portion/phase
- Portion/Phase: [Describe]
- Area: [___] square feet
☐ Change of Use Certificate - Change of occupancy type
- Previous use: [___]
- New use: [___]
6. REQUIRED INSPECTIONS STATUS
Building Inspections
| Inspection | Date | Result | Inspector |
|---|---|---|---|
| Foundation | [Date] | ☐ Passed ☐ N/A | [Name] |
| Framing/Rough | [Date] | ☐ Passed ☐ N/A | [Name] |
| Insulation/Energy | [Date] | ☐ Passed ☐ N/A | [Name] |
| Drywall/Lath | [Date] | ☐ Passed ☐ N/A | [Name] |
| Building Final | [Date] | ☐ Passed ☐ Scheduled | [Name] |
Electrical Inspections
| Inspection | Date | Result | Inspector |
|---|---|---|---|
| Underground/Rough | [Date] | ☐ Passed ☐ N/A | [Name] |
| Electrical Final | [Date] | ☐ Passed ☐ Scheduled | [Name] |
Plumbing Inspections
| Inspection | Date | Result | Inspector |
|---|---|---|---|
| Underground/Rough | [Date] | ☐ Passed ☐ N/A | [Name] |
| Plumbing Final | [Date] | ☐ Passed ☐ Scheduled | [Name] |
Mechanical Inspections
| Inspection | Date | Result | Inspector |
|---|---|---|---|
| Rough | [Date] | ☐ Passed ☐ N/A | [Name] |
| Mechanical Final | [Date] | ☐ Passed ☐ Scheduled | [Name] |
Fire/Life Safety Inspections
| Inspection | Date | Result | Inspector |
|---|---|---|---|
| Fire Sprinkler | [Date] | ☐ Passed ☐ N/A | [Name] |
| Fire Alarm | [Date] | ☐ Passed ☐ N/A | [Name] |
| Fire Marshal Final | [Date] | ☐ Passed ☐ Scheduled | [Name] |
Other Inspections
| Inspection | Date | Result | Inspector |
|---|---|---|---|
| ADA/Accessibility | [Date] | ☐ Passed ☐ N/A | [Name] |
| Health Department | [Date] | ☐ Passed ☐ N/A | [Name] |
| Elevator | [Date] | ☐ Passed ☐ N/A | [Name] |
| [Other] | [Date] | ☐ Passed ☐ N/A | [Name] |
7. REQUIRED DOCUMENTATION
The following documents are attached or have been submitted:
☐ Approved Building Plans (stamped set on site)
☐ Final Inspection Approvals
☐ Fire Department Approval/Sign-off
☐ Health Department Approval (if applicable)
☐ Elevator Certificate (if applicable)
☐ Backflow Prevention Test Report
☐ Special Inspection Reports (if required)
☐ Structural Observation Report (if required)
☐ Energy Compliance Documentation
☐ Address Posted and Visible
☐ Building Numbers/Suite Numbers Posted
☐ ADA Compliance Verification
☐ Smoke/CO Detector Verification
☐ [Other required documents]
8. SPECIAL SYSTEMS AND CERTIFICATIONS
8.1 Fire Protection
| System | Installed | Tested | Certification |
|---|---|---|---|
| Fire Sprinkler System | ☐ Yes ☐ No ☐ N/A | ☐ Yes | ☐ Attached |
| Fire Alarm System | ☐ Yes ☐ No ☐ N/A | ☐ Yes | ☐ Attached |
| Standpipe System | ☐ Yes ☐ No ☐ N/A | ☐ Yes | ☐ Attached |
| Fire Extinguishers | ☐ Yes ☐ No ☐ N/A | ☐ Yes | ☐ Attached |
| Emergency Lighting | ☐ Yes ☐ No ☐ N/A | ☐ Yes | |
| Exit Signs | ☐ Yes ☐ No ☐ N/A | ☐ Yes | |
| Knox Box | ☐ Yes ☐ No ☐ N/A |
8.2 Other Systems
| System | Installed | Tested | Certification |
|---|---|---|---|
| Elevator(s) | ☐ Yes ☐ No ☐ N/A | ☐ Yes | ☐ Attached |
| HVAC System | ☐ Yes ☐ No ☐ N/A | ☐ Yes | |
| Generator/Emergency Power | ☐ Yes ☐ No ☐ N/A | ☐ Yes | |
| Solar/PV System | ☐ Yes ☐ No ☐ N/A | ☐ Yes | |
| Security System | ☐ Yes ☐ No ☐ N/A | ☐ Yes |
9. UTILITY CONNECTIONS
| Utility | Account Established | Service Active |
|---|---|---|
| Electric | ☐ Yes | ☐ Yes |
| Gas | ☐ Yes ☐ N/A | ☐ Yes ☐ N/A |
| Water | ☐ Yes | ☐ Yes |
| Sewer | ☐ Yes | ☐ Yes |
| Telephone/Data | ☐ Yes | ☐ Yes |
10. TCO CONDITIONS (If Requesting Temporary Certificate)
10.1 Remaining Work Items
| Item | Description | Expected Completion |
|---|---|---|
| 1 | [Description] | [Date] |
| 2 | [Description] | [Date] |
| 3 | [Description] | [Date] |
10.2 Justification for TCO
[Explain why occupancy is needed before all work is complete and how the building is safe for occupancy]
10.3 Areas/Uses Requested for Occupancy
[Describe specific areas or portions to be occupied]
10.4 Life Safety Confirmation
The following life safety systems are complete and operational:
☐ Fire sprinkler system (in areas to be occupied)
☐ Fire alarm system
☐ Emergency egress paths clear and illuminated
☐ Exit signs installed and operational
☐ Smoke/CO detectors installed and operational
☐ Fire extinguishers installed
11. APPLICANT CERTIFICATION
I hereby certify that:
- All work has been completed in accordance with the approved plans and applicable codes
- All required inspections have been completed and passed (or are scheduled)
- The building is ready for occupancy and safe for its intended use
- All attached documentation is accurate and complete
- I am authorized to submit this request on behalf of the property owner/contractor
| Signature: | _________________________________ |
| Printed Name: | [Name] |
| Title: | [Title] |
| Company: | [Company] |
| Date: | _________________________________ |
| Phone: | [Phone] |
| Email: | [Email] |
FOR OFFICE USE ONLY
| Date Received: | _________________ |
| Received By: | _________________ |
| Application Complete: | ☐ Yes ☐ No - Deficiencies: _________________ |
| Final Inspection Scheduled: | _________________ |
| CO Issued: | ☐ Yes ☐ No |
| CO Number: | _________________ |
| CO Issue Date: | _________________ |
| TCO Issued: | ☐ Yes ☐ No |
| TCO Expiration: | _________________ |
| Conditions: | _________________ |
ATTACHMENTS
☐ Copy of Building Permit
☐ Final Inspection Reports
☐ Fire Department Sign-off
☐ Health Department Approval
☐ Elevator Certificate
☐ Special Inspection Reports
☐ Floor Plan (for posting)
☐ [Other attachments]
[// GUIDANCE:
1. Requirements vary significantly by jurisdiction - verify local requirements
2. Many jurisdictions have their own CO application forms that must be used
3. Ensure all final inspections are passed before requesting CO
4. Fire Department approval is typically required
5. Health Department approval required for food service, healthcare, etc.
6. TCO conditions and durations vary by jurisdiction]
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