Application for Certificate of Compliance with Zoning
                                               (Referenced as Certificate of Occupancy in 320.6 Mendon Zoning By-laws)

Refers to Zoning Permit Number _________________________     Application Date ________________________ 

Applicant s Name: _____________________________________________________________________________
(Applicant must be an owner of record, as shown in Mendon Land Records)
Mailing Address: ______________________________________________________________________________

Home Telephone:_____________________________  Work Telephone: __________________________________

                                                                Description of Property

The following information may be obtained at the Mendon Town Clerk s Office

Deed to this parcel is recorded in Book ______ Page ______ of the Town of Mendon Land Records.

Names of all Owners of Record: ________________________________________________________________________

Location of Property (Road Name and Number) ____________________________________________________________

Property Tax Map Description: Map _______ Block ________ Parcel _________

Applicant understands that this Certificate of Compliance is being issued in compliance with 320.6 of the Mendon Zoning By-laws, and the only use hereof shall be to show compliance therewith. This Certificate is issued for the benefit of the applicant only and for the benefit of no other person or entity, and may not be relied upon by any other such person or entity and any liability to any such person or entity is expressly disclaimed.

___________________________________________
Signature of Applicant (At least one owner of record, as shown in the Mendon Land Records, must sign application)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
For Town use only
This permit certifies that the building or use at the above location conforms to the approved plans heretofore filed with the Administrative Officer and with all applicable provision of the Mendon Zoning By-laws and any permits or approvals issued hereunder. No construction may be commenced or change of use made in any building or on any premise which is inconsistent with this permit.

Certificate of Compliance Application Number ________________

Date Received ________________ Zoning Permit Fee_______________ Recording Fee ____________________

Received By ___________________________________________   Date of Inspection of Site ________________

Notes:



APPLICATION FOR CERTIFICATE OF COMPLIANCE: APPROVED _____ DENIED _____


ADMINISTRATIVE OFFICER_______________________________________ Date __________________

For Commercial Applications - A Department of Labor & Industry Inspection is required.