Arlington County, Virginia Department of Community Planning, Housing and Development Division CERTIFICATE OF OCCUPANCY APPLICATION (Please read the back of this application before completing this form) Important: Applicant must complete all the non-shaded areas, and mark where applicable. Contact Information Name / Trade Trade/ Legal Name Deliver or mail applications to: Zoning Division, 2100 Clarendon Blvd., Suite 1000 Address to be Number and Street Zip Phone: 703-228-3883; Web: .arlingtonva.us inspected I. TYPE OF BUILDING Do not write here V. CERTIFICATE REQUESTED FOR:  One-Family Dwelling  Two-Family Dwelling VIII. ADDITIONAL INFORMATION:  Town (Rentals)  Master Certificate of Occupancy (MCO) for a new  Use Permit  Variance  Site Plan Approval  Condominiums  Cooperatives or renovated building or conversion to a  Hotel  Building condominium, IX. ZONING: Initials: ______or cooperative.  Commercial/Retail  Industrial Building Zone______Zoning Fees ______ Temporary Structure  Other  Shell & Core (S & C).  *Partial Occupancy of a building. Receipt No.______Date ______II. USE OF BUILDING OR SPACE  Change of ownership of a building.  Change of ownership of a business. X. APPROVED BY Previous Use ______ Change in the use of a building space. Initials Date Proposed Use ______ *Condominium/cooperative unit to be sold. Building ______Nature of Business ______ Condominium/cooperative unit to be rented Electrical ______ Other Maximum Capacity (occupancy) assembly type uses Mechanical ______(ex: restaurants, churches, child care, etc) Plumbing ______E. H. B ______Does the building have an elevator? Elevator ______III. WORK INVOLVED (if any): Yes  No  Fire Prevention ______ New Building  Alteration of an existing building Child Care ______*For , condominiums or cooperatives with Final Survey ______ Neither of the above Building Permit #______elevators, an MCO must be filed and S&C issued prior Bus. Inspection ______to the issuance of these certificates. DES ______IV. AREA TO BE INSPECTED Bus. License ______VI. Does your business involve the storage, Entire Building Yes Zoning Inspection ______ manufacture or processing of Hazardous materials Gross Floor Area _____ sq. ft. Floor ______sq. ft. (radioactive materials requiring approval of the Gross Parking Area ______sq. ft. Nuclear Regulatory Commission, gasoline, paint, etc)? Total # of Parking Spaces_____ Yes  No  XI. Building Official Date ______Total # of Floors in Garage ___ Total # of Units______Number of Floors ______Unit Numbers ______Storage of hazardous waste materials is regulated by the Uniform Statewide and Arlington Fire Amenities Yes  No  / Pool Yes  No  Prevention Code.

Partial Occupancy Yes  VII. Ready for inspection? Garage Floor ______sq. ft. Yes  No  # of Parking Spaces______# of Floors in Garage ___ The premises described under this application are in Total # of Units______Square Footage ______compliance with law, ordinances and regulations, as Revised 8/13 Number of Floors ______Unit Numbers ______determined by the inspections indicated. I, the Applicant, hereby certify that the information supplied on this application is true and correct to the best of my knowledge; and that any construction, alteration or repair has been performed in accordance with the applicable regulations and under a valid permit issued by Arlington County. I acknowledge receipt of the application instructions. Signature Applicant name (Print) Address Phone

On Site Contact Person (if not the applicant) GENERAL INFORMATION

Paragraph §15.3, Arlington County Zoning Ordinance, and Section 117, Virginia Uniform Statewide Building Code (VUSBC), state that no occupancy or change of occupancy, use or change of use of any land or building shall take place until a Certificate of Occupancy has been issued. This Certificate shall state that the building or proposed use of the building or land complies with all provisions of law and all country ordinances and regulations. Therefore all construction work, alterations, remodeling, or repair must be done under permits issued by the Inspection Services Division. All safety regulations, Department of Human Services regulations, and Public Works Department must be complied with.

“NO” OCCUPANCY OR USE IS PERMITTED UNTIL THE CERTIFICATE APPLIED FOR UNDER THIS APPLICATION HAS BEEN ISSUED

I. GENERAL IV. NEW BUILDINGS A. Read instructions carefully, Erroneous information will result in delays in the Applications for and issuance of Certificate of Occupancy for newly issuance of a Certificate of Occupancy. constructed buildings or portions still under construction will adhere in B. Applications must accompanied by a check for the full fee at the time sequence to the following procedures: of application, made payable to Treasurer of Arlington County, and must be hand-delivered or mailed to: Zoning Administrator, Suite 1000, 2100 A. Entire Building: Clarendon Boulevard, Arlington, VA 22201. An application shall be filed for the entire building, including all site C. All new construction and all alterations (other than painting) involving building, improvements, amenities, and appurtenances. If approved by BZA variance electrical, plumbing, heating, ventilation, and air conditioning work require or use permit, County Board use permit or site plan, submission of separate permits and inspections from Inspection Services Division. Note: This is documents identifying such approval must be submitted. separate from the Certificate of Occupancy process. B. Partial or Temporary Occupancy: II. CERTIFICATE OF OCCUPANCY INSPECTIONS A fter the application described in Step A has been filed, additional A. Generally, when applications are submitted before 4:30 p.m. on Thursday, applications for Certificate of Occupancy for a portion of the building, either final inspections will be scheduled for the following Tuesday-Friday. If the premise still under construction or complete, may be filed, accompanied by was not ready for inspection when the application was submitted, please call 703- appropriate fees. Such certificates may be issued if that portion is in 228-3883 to schedule an inspection when the premise is ready. compliance with the following requirements: B. Please be sure you can be reached at the telephone number shown on the 1. It must be complete in all respects, with final inspections completed and application. approved by the Inspection Services Division and other applicable agencies. C. No inspections will be made unless: 2. It must be capable of being occupied safely with all safety and alarm 1. The applicant or his representative (18 years of age or older) are present on systems, mechanical, electrical and plumbing systems properly operating. the premises. 3. All required means of ingress and egress must be completed and at all 2. All equipment has been installed and connected. times are to be kept clean and free of debris and construction material 3. If Zoning inspectors find premises are not in proper condition for inspection, and provide a safe, clean means of exit from the area to be occupied to the no inspection will be made, and upon return, a re-inspection fee will be charged. street in compliance with applicable laws and ordinances. D. Certificate of Occupancy inspections may involve several County agencies. 4. When applicable, a separate elevator for occupants use must be provided. Use of this elevator by construction personnel is prohibited. III. FREQUENTLY FOUND DISCREPANCIES 5. There must be no major interference with or interruption of the The most frequently found discrepancies which result in delaying issuance of a occupant’s normal activities as work on the balance of the building Certificate of Occupancy are as follows: progresses. A. Fire Extinguishers 1. Improperly placed or hung. V. CAPACITIES FOR OUTDOOR/INDOOR SEATING 2. Inspection tags are not current. Please provide 5 copies of all seating layouts. For outdoor, please show the B. Plumbing seating layout in a scaled plat (5 copies). Commercial establishments do not have water closets as required, or backflow prevention. C. Electrical Improper use of extension cords. Use of extension cords is not permitted and they should be removed.