Town of Ontario Building Department

TOWN OF ONTARIO BUILDING DEPARTMENT

Application for Certificate of Occupancy

Date: ______

Application is hereby made for issuance of a Certificate of Occupancy for the structure on premises located at ______Ontario, NY 14519.

Lot Number ______Subdivision ______

Building Permit Number ______

The applicant states that the structure for which certification is requested shall be erected and will be occupied in accordance with the building permit issued therefore and the approved plan and specifications; and in accordance with the applicable codes, ordinances, regulations and building laws.

______Owner or Agent

Certificate of Occupancy

This is to certify that the structure on premises located at ______, Ontario, NY 14519, Tax account Number______has been completed in substantial compliance with the building permit issued and the approved plans and specifications; in accordance with the applicable codes, ordinances, regulations and building law. Such structure or premises may be occupied for the following use: ______. If this certificate does not apply to the entire structure, the portion of the structure to which this certificate applies is limited by any stipulations in the notes below.

This Certificate of occupancy is summarily revocable if any statement contained in the building permits or in the above application is false.

______Building Inspector/Code Enforcement Officer

NOTE: Certificate issued contingent upon the following: