Application For Temporary Occupancy Permit Page 2
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1
2BOROUGH USE ONLY
ZONING
Zoning District
: _______
Occupancy or Building Permit No.:
Date:
___________
_____________
Temporary Certificate of Occupancy to be issued for:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
for a period of
months or
days.
_____________________
____________________
Conditions for issuance (if any exist):
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
This application is APPROVED FOR ZONING by:
Date:
____________________________________
________________
Homestead Borough Zoning Officer
BUILDING INSPECTION
□
□
Is this a valid request?
Yes
No, explain below:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Are the following inspections required for Final Occupancy Permit approval?
□
□
Electrical
Yes
No
□
□
Mechanical (HVAC)
Yes
No
□
□
Sprinkler
Yes
No
□
□
Fire Alarm
Yes
No
□
□
Plumbing
Yes
No
□
□
Kitchen Exhaust Hood
Yes
No
□
□
Occupancy Placard
Yes
No
□
□
Sign
Yes
No
□
□
Energy
Yes
No
□
□
Accessibility
Yes
No
□
□
Site Plan (parking, landscaping, etc.)
Yes
No
$_____75.00
Permit Number: _________________
Permit Fee:
$
_4.00
Expiration Date:
Scanning Fee:
________
_________________
$
_3.00
Check Number: _________________
Document Storage:
________
$_____82.00
Invoice Number: ________________
Grand Total:
Approved by: _________________________________________________________
Date: ______________________
Building Code Official/
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