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Home My WebLink AboutInspection Checklist - 10/7/1997 ~,' "~irispection 'Checklist · SeCtion 8 Tenant-Based Assistance Rental Certificate Program Rental Voucher Program OMS Approval No. 2Sn-0169 (Exp 8/31/98 Public Reporting Burden for 1his collection of information isestimat8d to average 0.50 hours per response, including 1hetime for reviewing instructIonS, searc:tllng eXls\ln! data sources, gathering and maintaining 1he data needed, and completing and reviewing the collection of information. Send comments regarding this burden esllma\l or any other aspect of 1his collection of information, including suggestions for reducing !his burden, to the Repor1s Management Officer, Office of Informallon PohCl~ and Systems, U.S. Deparlmentof Housing and Urban Development, Washington. D.C. 20410-3600 and to1heOffice of Management and Budget. Paperwork ReducllOI Project (2sn~169). Washington, D.C. 20503. Do not send !his completed form to either of1he above addressees. Name 0' FamJly=-f" tM:> _ ~cf2f/ ~ I TenantlO No; 1Je-e //38 I I N8I\1htlOO1ood1Census Tract; . -#cO I . I I Date?, U.s. Department of Housing and Urban Development Office of Public and Indian Housing Inspeelor: 12. '~ch)kt7- ~ ?peelion: LlJAtlrtial 0 Special o Reinspection A. Generallntormatlon Inspected Unit ~ /JG('~~ v.., Constructed ~/JfQ 70 Dale 01 Request: /Gl.-/-97 Dale 01 InspectiOn: /{) ,-' 7-9/ HA: i City: I Housing Type: (check as appropriate) o Single Family Detached o Duplex or Two Family o Row House or Town House ~ Rise: 3,4 Stories. Including . Garden Apartment o High Rise; 5 or M0f8 Stories ~ o Manufactured Home o Congregale o Cooperative o Independent Group Residence 10 10 o Other: -.. - Street Address: /34 ;.f-t -p-J- ~ (tp'r#- U {)&'JI k (j s:~ Stale: tJ:Z. Number of Chiklren in Family WIth Elevated BlOod Lead Level I Phone No: I :lB3--J/9~- ? 0'1 8&K;:2~5- {]~fI tV:r 6~9o~- Jt)bS- B. Summa Decision On Unit 0 be com Ieted after form has been filled out o Pa~ . ! Number of Bedrooms for I Number Of. Sleeping Roorns __ at! ! Purposes of the FMR or Payment I .::::::z _ Inconclusive : Standard . : ~ &W"~ ~ living Room Present 1.2 ElectriCIty 1.3 Electrical Hazards 6f Security a9i 1.6 ! Window Condition Ceiling Condition 1.7 Wall Condition 1.8 Floor Condition gf Lead Paint Previous editions are obsolete Single Room Occupancy Shared Housing 3.2 Electricity 3.3 Electrical Hazards Security Window Condition Ceiling Condition 3.7 WaD Condition Floor Condition 4.2 Bectricityllllumination 4.3 Electrical Hazards Security Window Condition 4.6 Ceiling Condition 4.7 WaI Condition 4.8 Floor Condition 4.9 Lead Paint 4.10 I Smoke Detectors . Room Codes: 1 - Bedroom or Any Other Room IJs8d for Sleeping (regardless of type of room); 2. Dnng Room or Dining Area; 3 _ Second Living Roorn, Family Room. Den. Playroom, TV Room: 4 - Entrance Halls, Corridors. Halls. Staircases; 5 - Additional Balhroom; 6. Other Previous editions are obsolete Page 2 Of~ ~~= 7~~~J . 'I i'.' Sec:lricitynnumination Electrical Hazards Security Window Condition Ceiling Condition WaI Condition Floor Condition Lead Paint 4.10 I Smoke Detectors Smoke Detectors 4.1 i Room Code. and I Room Location Electricityllllumination Electrical Hazards Security Window Condition 4.6 Ceiling Condillon 4.7 Wan Condition 48 Floor Condillon 4. Lead Paint 4.10 ! Smoke Det9(,10rS 41 Room Code. and ~ Room Loca1Jon 42 Electricity/Illumination 4.3 Electrical Hazards 44 Security 5 Window Condition 46 Ceiling Condillon 4.7 Wall Condi1Jon Floor Condi1Jon Load Paint 4.10 : Smoke Detectors 4.1 Room Code. and Room Location 4.2 Electricitynllumination Electrical Hazards Security Window Condition Ceiling Condition Waft Condition 4.8 Floor Condition Lead Paint v " ~ . Room Codes: 1 - Bedroom or Any Other Room Used fer Sleeping (regardless of type of room); 2 - Dining Room or Dining At8a; 3 _ Second Uving Room, Family Room, Den, Playroom. TV Room: 4 - Entrance Halls. Corridors, Halls. Staitcases; 5 - Additional Balhroom; 6 -Other form HUD-52580 (9195) ref Handbook 7420.3 Previous editions are obsolete Page 3 016 Room Code' and [fj Room Location 4.2 Electri city/III umination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Lead Paint 4.10 I Smoke Detectors 4.1 Room Code' and D Room Location 4.2 Electri city /lIIu mination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4.9 Lead Paint 4.10 Smoke Detectors 4.1 Room Code' and D Room Location 4.2 Electricity/Illumination 4.3 Electrical Hazards 4.4 Security 4.5 Window Condition 4.6 Ceiling Condition 4.7 Wall Condition 4.8 Floor Condition 4,9 Load Paint 4.10 Smoke Detectors (Circle One) RighVCenter/Left (Circle One) FronVCenter/Rear Roar Level (Circle One) RighvCenter/Left (Circle One) FronVCenter/Rear Floor Level , Room Codes: 1 - Bedroom or Any Other Room Used for Sleeping (regardless of type of room); 2- Dining Room or Dining Area; 3 = Second Uving Room, Family Room, Den, Playroom, TV Room; 4 = Entrance Halls, Corridors, Halls, Staircases; 5 = Additional Bathroom; 6 _ Other . A ;,J, form HUD-52580 (9/95) Previous editions are obsolete Page 3 o"r ref Handbook 7420.3 ~-~~ sad Paint: Exterior Sur1aces I Manufactured Home; I TI9 Downs I <!J2 7.2 7.3 Ventilation/Cooling 7.4 Water Heater 7.5 Approvable Water Supply: 7.6 Plumbing 7.7 Sewer Connection 81 Access to Unit 82 Fire EXits 8 4 Garbage and Debns 85 Retuse DISposal 8 6 Intenor Staus and Commom Halls - ~--<;r 87 Oltl9r Intenor Hazards :.:..~~:.. 88 Elevalors 8 9 Inlenor AJr Quality 8 Slle and N9ighbortlood Condlllons ._--- . 8 tl Lead Pamt: Owner's Certification 8.11 Lead Paint: Owner's Certification little owner IS required to treat any in.nor or exterior surfaces, the HA must obtam certllication that the work has been done In a~rdance with such reqUIrements prior to the execution or renewal of any HAP contract: No relnspeC1lon is necessary if certification is obtained. Suggested wording of this certification is as follows: "The undersigned hereby certifies thatthe property located at (give full address) Previous editions are obsolete has had applicable surfaces treated as required." Owner's SignalLlre Type or print name Page 4 Of1/(" Date form HUo.52580 (9195) ref Handbook 7420.3