OFFICIAL USE ONLY REG # _____ FEE ____ CHECK NO. ______ RECEIVED BY _____ DATE PAID __________ SCHEDULED INSPECTION DATE(S) Sales registration fee of $75 includes 1 initial inspection and 1 _________________________ _____________________________ re-inspection. If/When the property fails a re-inspection. Initial RE-INSPECTION A $75 fee must be paid before additional inspections. TOWNSHIP INSPECTION PROPERTY ADDRESS: APT# BLOCK/LOT OWNERS NAME: OWNERS PHONE NUMBER: OWNERS ADDRESS: OCCUPANT: OCCUPANT PHONE NUMBER: (CIRCLE ONE) HOUSE / APARTMENT / TRAILER NUMBER OF BED ROOMS: New Owners Name: INITIAL RE-INSP INITIAL RE-INSP OFFICIAL USE ONLY DATE DATE DATE ITEMS IN THIS COLUMN ARE CONSIDERED DANGEROUS AND _______ ________ ______ _______ MUST BE CORRECTED IMMEDIATELY! WINDOW OPERATION, LOCKS, DETECTORS PRESENT P F P F P F P F GLAZING SMOKE DETECTORS P F P F WATER CERTIFICATION P F P F OPERATING CARBON MONOXIDE PLUMBING P F P F P F P F DETECTORS PRESENT (PIPES & FIXTURES) CARBON MONOXIDE P F P F 10. SEWER CERTIFICATION P F P F DETECTORS OPERATING FIRE EXSTINGUISHER P F P F WATER PRESSURE P F P F APPLIANCE VENTING P F P F INTERIOR SURFACES P F P F (EXHAUST FANS) RELIEF VALVE / P F P F DOORS P F P F FLOOR DSCHARGE INTERIOR PAINT HAND RAILS P F P F P F P F EXTERIOR PAINT EMERGENCY 3RD INFESTATION P F P F P F P F FLOOR EXIT (MICE, RATS, ROACHES) CLEANLINESS,HEALTH ITEMS P P F TRASH/GARBAGE CONTAINER P F P F F HEATING CERTIFICATION P F P F BASEMENT YARD & STORAGE P F P F ELECTRIC P F P F ROOF CHIMNEY P F P F ( WIRING RECEPTICLES) PORCHES, DECKS, STAIRS, ROOF/CHIMEY P F P F P F P F RAILING
OFFICIAL USE ONLY REG # _____ FEE ____ CHECK NO. ______ BY _____ PAID __________ SCHEDULED INSPECTION DATE(S) Sales registration fee of $75 includes 1 initial inspection and 1 _________________________ _____________________________ re-inspection. If/When the property fails a re-inspection. Initial RE-INSPECTION A $75 fee must be paid before additional inspections. INSPECTION PROPERTY ADDRESS: APT# BLOCK/LOT OWNERS NAME: OWNERS PHONE NUMBER: OWNERS ADDRESS: OCCUPANT: OCCUPANT PHONE NUMBER: (CIRCLE ONE) HOUSE / APARTMENT / TRAILER NUMBER OF BED ROOMS: New Owners Name: INITIAL RE-INSP INITIAL RE-INSP OFFICIAL USE ONLY ITEMS IN THIS COLUMN ARE CONSIDERED DANGEROUS AND MUST BE CORRECTED IMMEDIATELY! DATE _______ DATE ________ DATE ______ DATE _______ DETECTORS PRESENT P F P F WINDOW OPERATION, LOCKS, GLAZING P F P F SMOKE DETECTORS OPERATING P F P F WATER CERTIFICATION P F P F CARBON MONOXIDE DETECTORS PRESENT P F P F PLUMBING (PIPES & FIXTURES) P F P F CARBON MONOXIDE DETECTORS OPERATING P F P F 10. SEWER CERTIFICATION P F P F FIRE EXSTINGUISHER P F P F WATER PRESSURE P F P F APPLIANCE VENTING (EXHAUST FANS) P F P F INTERIOR SURFACES P F P F RELIEF VALVE / FLOOR DSCHARGE P F P F DOORS P F P F HAND RAILS P F P F INTERIOR PAINT EXTERIOR PAINT P F P F EMERGENCY 3RD FLOOR EXIT P F P F INFESTATION (MICE, RATS, ROACHES) P F P F CLEANLINESS,HEALTH ITEMS P F P F TRASH/GARBAGE CONTAINER P F P F HEATING CERTIFICATION P F P F BASEMENT YARD & STORAGE P F P F ELECTRIC ( WIRING RECEPTICLES) P F P F ROOF CHIMNEY P F P F ROOF/CHIMEY P F P F PORCHES, DECKS, STAIRS, RAILING P F P F TOWNSHIP RECEIVED
New-Sales-Form.docx