Application for Occupancy – Thirty (30) day Waiver

This ORIGINAL application must be notarized and returned along WITH the Application for Certificate of Occupancy

I, (initials) ______do hereby accept the responsibility of assuming ALL violations and agree to make the necessary corrections to attain safe, code compliant, habitable living conditions for the property located at: (print address): ______

This work will be required to have proper permits in place, ongoing inspections and MUST be completed with-in the timeframe stated on the Certificate of Occupancy. Residential Applicants understand that no person(s) shall take residence until ALL work is competed and inspections have been passed and Commercial Applicants understand that no person(s) shall occupy the property and no business shall be conducted until ALL work is completed and inspections have been passed. (An extension of time may be granted at the Building Commissioner’s discretion.)

The City of Brook Park and its employees are released from any claim(s) and demand(s) the undersigned may have in the event that repairs are more than anticipated.

PRINT NAME: ______

PHONE: ______CIRCLE: Home Work Cell

SIGNATURE: ______Date: ______

Sworn before me this ______day of ______20 ______

Notary Public Signature ______

(Seal)

APPLICATION FOR CERTIFICATE OF OCCUPANCY

A Certificate of Occupancy (CO) can only be issued if the property has been inspected, and must be violation free to receive an approved CO

IF THERE ARE VIOLATIONS: The current owner must correct violations and call for re-inspection when completed - - - OR - - -

Buyer must submit Thirty (30) day Waiver Application to assume violations and call for re-inspection when completed (by the waiver date)

Complete & return CO Application to Building Dept. - CO will be forwarded to the Title Company & original’s mailed to you

Title Company: ______Contact Person: ______

Phone #: ______Closing Date: ______

How should we forward the Occupancy Certificate:  Fax: ______

or  Email: ______

RESIDENTIAL
APPLICANTS / Property Address: ______
Is this a rental property?  YES  NO # of Occupants: Adults: ______/ Children: ______
Name(s): ______Buyer/Owner Tenant
Current Address: ______
(STREET ADDRESS) (CITY) (ZIP CODE)
Phone: ______ Home  Cell  Work Alt: ______ Home  Cell  Work
Email Address: ______
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COMMERCIAL
APPLICANTS / Property Address: ______
DBA Name: ______
Type of Business: ______Square Footage: ______# of Employees: ______
Property Owner Name(s): ______
Phone: ______ Home  Cell  Work Alt: ______ Home  Cell  Work
Email Address: ______
Contact Person: ______Tenant Agent
Phone: ______ Home  Cell  Work Alt: ______ Home  Cell  Work
Email Address: ______