Application For Certificate Of Occupancy Template
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1APPLICATION FOR CERTIFICATE OF OCCUPANCY
Permit No. __________________
Date: __________________
To the Code Enforcement Officer:
Applicant _____________________________________________________
VALIDATION
The undersigned hereby applies for the above permit(s) for the following building or structure, or a
portion of a building or structure, in accordance with the laws of the State of Maine and the Ordinances of the
City of Bangor, plans and specifications herewith, or plans previously submitted in support of a related build-
ing permit application and the following information:
Location: ________________________________ Direction to Structure __________________________
____________________________________________
Application applies to
Entire Structure
Portion of Structure
Description of Interest of Applicant in Site, If not Owner - (i.e. Lease, Option, Purchase and Sale
Contract) ____________________________________________________________________________
Address ____________________________________________ Assessing Map _______ Lot ________
Proposed use of building ____________________________________ Telephone __________________
Last Use ____________________________________________________________________________
Other buildings on same lot ______________________________________________________________
Plans filed as part of application?
Yes _____ No ______
Zone _____________________
Remarks: ____________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
APPLICANT PLEASE READ BEFORE SIGNING:
I hereby certify that I am the owner of record/contract owner/lessee of the subject property, or duly authorized
agent of said person, and that I am fully authorized to make this application. I hereby certify that the information set forth
herein is correct to the best of my knowledge and belief. Further, this will certify that all work completed by me, or my agents,
has been, or will be, completed in accordance with the Land Development Code and construction codes of the City of
Bangor. Further, I understand that no Certificate of Occupancy will be issued until such time as the Building Inspector has
determined that the construction is complete and in compliance with Land Development Code and construction codes of the
City of Bangor. The construction codes are the BOCA Basic Building Code, National Electrical Code, BOCA Basic Property
Code, BOCA Basic Mechanical Code, and Life Safety Code, in current edition as may be adopted with municipal amend-
ments from time to time.
_____________________________________________ or _____________________________________________
Signature of Applicant
Signature of Authorized Agent
APPLICANT DO NOT WRITE BELOW THIS LINE
Approved: ______ /Denied: _____
__________________________________________________
Code Enforcement Officer
Date: ________________
__________________________________________________
Development Coordinator
WHITE - Department Copy
CANARY - Applicant Receipt
GREEN - Assessing Copy
PINK - Fire Department Copy
GOLD - Department Receipt
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