DATE: BUILDING PERMIT #:
For Public Occupancy: Open for Business: Stocking/Training Employees:
Other:
Projected Completion Date:
Signature of General Contractor is required. By signing this application, I agree to the following conditions:
I acknowledge full responsibility in controlling the use and occupancy of the building until all clearances and inspection
requirements are completed and a full Certificate of Occupancy (CO) has been issued. I shall remain responsible for
site safety at all times the project is under the TCO status. If the TCC issued allows partial occupancy of either persons
or property, I will advise those persons, or any other tenants or other occupants that their continued occupancy and/or
use is subject to compliance with the terms of such temporary certificate of compliance.
TELEPHONE NUMBER
DATE
60
90
I, hereby, request a Temporary Certificate of Compliance for the following reasons and utilities for the following
portion of the building which may be safely occupied prior to final completion of the building:
Signature General Contractor
TCC placards (similar to permit placards) shall be posted conspicuously and shall NOT be removed until the CO is
issued. The placard gives notice of the TCC conditions and restrictions and date of expiration. If the placard is missing
when the inspector returns for follow-up inspections, the contractor will be charged a $75.00 fine for failure to post.
I accept the tems of the Brunswick County policy to allow an additional renewals by the Chief Building Inspector.
Extensions beyond the original projected completion date will require the submittal of a completed TCC application form,
payment of TCC fee followed by departmental inspections prior to the issuance of a renewal. If the project has
effectively stalled, the authorization for use and occupancy shall be immediately revoked. The Code Administration staff
will begin the processes necessary to remove all utilities and/or forfeiture of the associated bond if applicable.
Furthermore, I acknowledge that violation of the TCC is a Class 1 Misdemeanor per G.S. 160A-423.
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Phone Number
Phone Number
Project Address
City
Zip
NUMBER OF DAYS REQUESTED:
30
Contact Person
Phone Number
Email
BRUNSWICK COUNTY CODE ADMINISTRATION
75 Courthouse Drive, Building I
Bolivia, NC 28422
910-253-2021
TEMPORARY CERTIFICATE OF COMPLIANCE APPLICATION FORM