Fillable Printable Certificate of Occupancy Application - Richmond
Fillable Printable Certificate of Occupancy Application - Richmond
Certificate of Occupancy Application - Richmond
THIS IS AN APPLICATION ONLY. IT IS NOT AUTHORIZATION FOR USE OF PREMISE.
NO USE SHALL START UNTIL A CERTIFICATE IS ISSUED.
OWNER’S INFORMATION
B
JOB/PROPERTY ADDRESS (STREET & NUMBER)
E
PROPERTY OWNER’S ADDRESS/ZIP
D
PROPERTY OWNER’S NAME (PRINT CLEARLY)
C
FLOOR/ROOM NO.
F
PROPERTY OWNER’S DAYTIME TELEPHONE NO.
G
DESCRIBE CURRENT STRUCTURE USE (IN DETAIL) IF CURRENTLY VACANT, INDICATE LAST USE & YEAR IT WAS LAST USED.
H
DESCRIBE PROPOSED STRUCTURE USE (IN DETAIL)
PROPERTY
INFORMATION
1!
SQUARE FOOTAGE TO BE USED
__________ SQUARE FEET
1@
DESIRED OCCUPANT LOAD PER
FLOOR
__________________
1#
ARE FLOOR PLANS ATTACHED?
YES
NO
YES
NO
YES
NO
IS A SITE PLAN ATTACHED?
__________ PARKING SPACES
IF YES, ATTACH LEASE & SITE PLAN
1$
NO. OF ON-SITE PARKING SPACES
__________ PARKING SPACES
1%
ARE PARKING SPACES LEASED
OFF-SITE
J
RESIDENTIAL USES
ONE FAMILY
TWO FAMILY
THREE OR MORE FAMILY
NO. OF UNITS _________________
LODGING HOUSE
NO. OF ROOMS________________
NO. OF PERSONS______________
NURSING HOME
NO. OF BEDS__________________
ADULT CARE RESIDENCE
NO. OF ROOMS________________
NO. OF PERSONS______________
GROUP HOMES
NO. OF PERSONS______________
NO. OF COUNSELORS __________
OTHER (SPECIFY): _______________
_______________________________
_______________________________
RESTAURANT, SIT-DOWN
RESTAURANT, DRIVE-THRU /TAKE-OUT
NIGHT CLUB
RETAIL STORE
GROCERY/CONVENIENCE STORE
FURNITURE STORE
HARDWARE OR APPLIANCE STORE
SHOPPING CENTER
CLINIC (MEDICAL/DENTAL)
BANK
BEAUTY/BARBER SHOP
LAUNDRY /DRY CLEANER/ LAUNDROMAT
REPAIR SHOP
WHAT TYPE ___________________
OFFICE
CHURCH
NO. OF SEATS _________________
DAY NURSERY
NO. OF CHILDREN _____________
NO. OF STAFF _________________
ADULT DAY CARE
SHELTER/SOCIAL SERVICE DELIVERY
NO. OF ROOMS________________
NO. OF PERSONS______________
SCHOOL
SERVICE STATION
MOTOR VEHICLE REPAIR/SALES
MANUFACTURING FACILITY
NO. OF EMPLOYEES ___________
WAREHOUSE/STORAGE FACILITY
NO. OF EMPLOYEES ___________
NO. OF COMPANY VEHICLES ____
OTHER (SPECIFY): _______________
_______________________________
1)
COMMERCIAL/INDUSTRIAL USES
DEPARTMENT OF PLANNING AND DEVELOPMENT REVIEW
BUREAU OF PERMITS AND INSPECTION
ROOM 110 CITY HALL
900 E. BROAD STREET
RICHMOND, VIRGINIA 23219
PHONE (804) 646-4169
FAX (804) 646-1569
DCD02H (Rev. 07/12)
112037-5
PERMIT NO.
H
B
PROJECT NO.
I
OWNERSHIP
CHANGE
TENANT CHANGE
OFFICE
USE ONLY
(CHECK ONE)
PARTIAL C.O.
TEMP C.O. OTHER
CONTACT INFORMATION
1*
APPLICANT’S ADDRESS
1^
APPLICANT’S NAME (PRINT CLEARLY)
1(
APPLICANT’S DAYTIME PHONE NO.
2)
APPLICANT’S FAX NO.
2!
APPLICANT’S EMAIL
2#
CONTACT PERSON (IF DIFFERENT THAN APPLICANT)
2$
CONTACT PERSON DAYTIME PHONE NO.
2@
APPLICANT’S SIGNATURE
1&
BUSINESS AND/OR TRADE NAME
ZIP CODE
2%
CONTACT PERSON ADDRESS
ZIP CODE
OFFICE USE ONLY
ARTS DISTRICT
EXISTING USE GROUP
APPLICATION APPROVED ON DATE
CONDITIONS
APPLICATION DISAPPROVED ON DATE
REASON FOR DENIAL
VIOLATION ON PROPERTY
PROPOSED USE GROUP
VIOLATION NO. CORRESPONDING CO
PERMIT FEE FEE RECEIVED
CHESAPEAKE BAY PROTECTION AREA?
RECEIPT NO.
CHESAPEAKE BAY MANAGEMENT AREA?
CASH CHECK CREDIT CARD
YES
NO
HISTORICAL DISTRICT
YES
NO
YES
NO
YES
NO
YES
NO
2^
DO YOU WANT TO BE CALLED TO
PICK UP PERMIT WHEN ISSUED?
NAME PHONE NO.
YES
NO
DELINQUENT TAXES DUE? AMOUNT OWED $ DATE PAID
YES
NO
CODE ENFORCEMENT ADMINISTRATOR CODE ENFORCEMENT ADMINISTRATOR
CERTIFICATE OF
OCCUPANCY
APPLICATION
TRACK 1 TRACK 2
DCD02H (B) (Rev. 07/12)
112037-5
FOR OFFICE USE ONLY
AGENCY REVIEW
ITEM DESCRIPTION
DISTRICT/SUP/CUP/
MASTERPLAN/
NONCONFORMING
PLAN OF
DEVELOPMENT
HISTORIC APPROVAL/
URBAN DESIGN
ROAD ACCESS
CHESAPEAKE BAY
FIRE MARSHALL
HEALTH
BUILDING/PROPERTY
MAINTENANCE
OTHER
ZONING
LAND USE
COMPREHENSIVE
DPW
P & E S
FIRE
HEALTH
PERMITS &
INSPECTIONS
AGENCY
APPROVAL
NUMBER
ACTION
TAKEN
REVIEWER
& DATE
COMMENTS
Certificate of Occupancy, including Temporary and Partial is $263.00
Reprinting of Certificate of Occupancy is $32.00
RECORD OF ACTUAL FINAL ON-SITE CONDITIONS
FEE SCHEDULE
At the top right hand corner of the application is a capital “H”. In this space your permit number will be hand-written by intake personnel
after you have paid the application fee. There is also a capital B, this is where you will write any building permit number that is associated
with the HCO application.
INSTRUCTIONS ON COMPLETING A CERTIFICATE OF OCCUPANCY (HCO) APPLICATION
Box #1 - Provide the address (number &
street name) for the location of the use or
business.
Box #2 - Provide the space within the
building where the use or business is
going to be located. (NOTE: To be used
on applications where more than a single
tenant/space/apt. exists.)
Box #3 - Provide the name of the owner
of the property. (NOTE: This may require
the submittal of a recorded deed from the
Circuit Court record room for newly
purchased property.)
Box #4 - Provide the property owner’s
address, including zip code.
Box #5 - Provide the property owner’s
daytime telephone number.
Box #6 - Indicate the current/existing
use(s) of the property (i.e. - office, 2-
family, restaurant, single-family, etc.)
Box #7 - Indicate the proposed use(s) of
the property (i.e. - office, 2-family,
restaurant, single-family, etc.)
Box #8 - OFFICE USE ONLY
Box #9-10 - Check the appropriate box
that most closely indicates the use,
including any additional information (i.e. –
no. of units, no. of seats, type, etc.)
requested.
Box #11 - Provide the size of the space
(in square feet) being used/occupied by
the applicant.
Box #12 - Provide the desired occupant
load, if for more then one floor state the
occupant load you want for each floor.
Box #13 - Check the appropriate box
indicating if floor or site plans are
provided, as applicable.
Box #14 - Provide the number of parking
spaces existing ON the site. (NOTE: Do
not
include spaces provided off of the site,
either on-the-street spaces or leased
spaces.)
Box #15 - Check the appropriate box, as
applicable, regarding leased parking
spaces and include a lease and site plan
for the leased spaces
Box #16 - Provide the applicant’s name
requesting the permit.
Box #17 - Provide the business or trade
name, if applicable. (NOTE: This may
require the filing of a trade name approval
with the Circuit Court.)
Box #18 - Provide the address of the
applicant(s) where the permit is to be
mailed.
Box #19 - Provide the applicant’s daytime
phone number in order that they may be
contacted, if necessary.
Box #20 - Provide the applicant’s
facsimile (FAX) number (if exists) in order
that they may be contacted, if necessary.
Box #21 - Provide the applicant’s E-mail
address (if exists) in order that they may
be contacted, if necessary.
Box #22 - Provide the applicant’s, or
applicant’s authorized agents, signature.
Box #23 - Provide the contact person’s
name, if different than the applicant.
Box #24 - Provide the contact person’s
daytime phone number, if different than
the applicant.
Box #25 - Provide the contact person’s
complete address and zip code, if
different than the applicant.
Box #26 - Check the appropriate box
whether or not you would like to be called
to pick up the certificate upon completion.
If you check, “yes”, provide the name and
daytime phone number for the person
wanting to pick-up the certificate.
