DATE: ADDRESS:

YES YES BATHROOM NO NO (I1) Has landlord notified tenant? (I2) Has tenant refused access?

INSPECTOR # APT#

KITCHEN

(I3) Toilet not in working order (I4) Bathtub/shower not in good repair (I5) Water pressure not adequate (I6) Drains not functioning properly (I7) 1 Elec. Light fixtures not in good repair (I8) 1 Outlet/Receptacle not in good repair (I9) Ventilation not adequate (I10) Window(s) not in good repair (I11) Screens/storm windows not in good repair (I12) Doors not in good repair (I13) Walls not in good repair (I14) Ceiling not in good repair (I15) Floor not in good repair (I38) No G.F.I. Outlet(s)

(I26) Ceiling not in good repair (I27) Floor not in good repair

(I28) Insects/Rats present LIVINGROOM AND/OR DINING ROOM (I29) Light fixtures not enclosed (I30) 2 Elec. Outlets not in good repair (I31) Or 1/1 Switch/Outlet not in good repair (I32) Window(s) not in good repair (I33) Screens/storms not in good repair (I34) Door(s) not in good repair (I35) Walls not in good repair (I36) Ceiling not in good repair

(I37) Floor not in good repair SLEEPING ROOM (NORTH) (I100) Light fixtures not enclosed (I101) 2 Elec. Wall outlets not in good repair (I102) Or 1/1 Switch/outlet not in good repair (I103) Window(s) not in good repair (I104) Door(s) not in good repair (I105) Walls not in good repair (I106) Ceiling not in good repair

(I16) Sink not in good repair (I17) Drains not functioning properly (I18) Water pressure not adequate (I19) 1 Elec. Light fixtures not in good repair (I20) 1 Wall outlet/counter receptacles not in good repair? (I21) Ventilation not adequate (I22) Windows not in good repair (I23) Screens/storm window(s) not in good repair

(I107) Floor not in good repair

(I108) Illegal use of extension cords present SEE ATTACHED SHEET FOR ADDITIONAL BEDROOMS

(I24) Door(s) not in good repair

(I25) Walls not in good repair SLEEPING ROOM (SOUTH)

SLEEPING ROOM (EAST)

(I200) Light fixtures not enclosed (I201) 2 Elec. Wall outlets not in good repair (I202) Or 1/1 Switch/outlet not in good repair (I203) Window(s) not in good repair (I204) Door(s) not in good repair (I205) Walls not in good repair (I206) Ceiling not in good repair (I207) Floor not in good repair (I208) Illegal use of extension cords present

OTHER:

(I300) Light fixtures not enclosed (I301) 2 Elec. Wall outlets not in good repair (I302) Or 1/1 Switch/outlet not in good repair (I303) Window(s) not in good repair (I304) Door(s) not in good repair (I305) Walls not in good repair (I306) Ceiling not in good repair (I307) Floor not in good repair (I308) Illegal use of extension cords present

SLEEPING ROOM (WEST)

(I400) Light fixtures not enclosed (I401) 2 Elec. Wall outlets not in good repair (I402) Or 1/1 Switch/outlet not in good repair (I403) Window(s) not in good repair (I404) Door(s) not in good repair (I405) Walls not in good repair (I406) Ceiling not in good repair (I407) Floor not in good repair (I408) Illegal use of extension cords present

(I450) Other: (I451) Other: (I452) Vacant unit follow up required. (I453) Door(s) not self-closing (I454) Smoke detectors not operable w/in 10 ft