HomeMy WebLinkAbout05/03/2022 08. First public input meeting on the 2021 Consolidated Annual Performance Evaluation Report (CAPER) • ri\
BUSINESS OF THE CITY COUNCIL
YAKIMA, WASHINGTON
AGENDA STATEMENT
Item No. 8.
For Meeting of: May 3, 2022
ITEM TITLE: First public input meeting on the 2021 Consolidated Annual
Performance Evaluation Report (CAPER)
SUBMITTED BY: Joan Davenport,AI CP, Community Development Director
Archie Matthews, O N D S Manager(509) 575-6101
SUMMARY EXPLANATION:
As part of the process of submitting to the Department of Housing and Urban Development
(HUD)the 2021 Year End Consolidated Annual Performance Evaluation Report (CAPER), the
City must hold two public input meetings to accept comments on the year end report. This is the
first public input meeting on the 2021 Consolidated Annual Performance Evaluation Report. The
full CAPER report for the Year 2021 is available online at:
http://www.yakimawa.gov/services/neighborhood-development-services/
ITEM BUDGETED: NA
STRATEGIC PRIORITY: Neighborhood and Community Building
APPROVED FOR SUBMITTAL BY THE CITY MANAGER
RECOMMENDATION:
ATTACHMENTS:
Description Upload Date Type
D 2021 CAPER Draft 4/21/2022 Backup Material
The City of Yakima DRAFT
Office of Neighborhood Development Services
Consolidated Annual Performance Evaluation Report
For Year 2021
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For further information, contact:
The Office of Neighborhood
Development Services
112 S. Eighth Street
Yakima, WA 98901
509-575-6101
CR-05 - Goals and Outcomes
Progress the jurisdiction has made in carrying out its strategic plan and its action plan. 91.520(a)
This could be an overview that includes major initiatives and highlights that were proposed and executed throughout the program year.
Our 2021 program year was successful, below is a detailed summary of each goal accomplishment for the program year.
The City of Yakima continues to receive both Community Development Block Group (CDBG) funds and HOME Investment funds. Additionally, in
2020 the City received CDBG-CV1 and CDBG-CV3 funds to prepare, prevent, and respond to the Covid 19 Pandemic that was utilized for projects
in 2021.
The City continues to use the bulk of its CDBG funding to address "Single Family Rehabilitation" in the form of a "Senior/Disabled Emergency
Repair Program" that assists qualified low to moderate income Senior and/or Disabled homeowners with emergency type repairs. These repairs
include no heat, no power, no hot water, leaking pipes, leaking roof or other such emergency repairs.The Single Family Rehabilitation program
also includes an Exterior Paint Program and a Wheel Chair Ramp program as funding and demand allow.
CDBG funds also assists three eligible activities in the Public Service category of National Objectives.The first is a funding of public service
programs administered through the Henry Beauchamp Community Center for low to moderate income citizens. The second is a funding of public
service programs administered through the Washington Fruit Community Center for low to moderate income citizens. The second eligible
activity is an emergency heating program that assists low to moderate income Senior/Disabled homeowners with a "Gap" heating assistance
payment that brings them current with their heating bill.
CDBG funds were also used to support eligible activity of Code Compliance in order to enable the Yakima Code Department to further assist low
to moderate income areas with the continued cleanup efforts associated with Code Compliance through assisting the payroll of staff.
The HOME Investment funds continues to support local Community Partners and Community Housing Development Organizations (CHDO) such
as Habitat for Humanity,Yakima Housing Authority,and Catholic Charities Gensis Housing with New Construction of affordable housing.
Constructing either Single Family dwellings or Multi-family dwellings. The Single family dwellings are then sold to qualified low to moderate
income first time homebuyers, while the rental units in the Multi-family residential units are tracked for a set affordability period, inspected
regularly and required to be rented to qualified low to moderate income individuals or families.
CAPER 1
OMB Control No:2506-0117(exp.09/30/2021)
Comparison of the proposed versus actual outcomes for each outcome measure submitted with the consolidated plan and
explain, if applicable, why progress was not made toward meeting goals and objectives. 91.520(g)
Categories, priority levels, funding sources and amounts, outcomes/objectives, goal outcome indicators, units of measure, targets, actual
outcomes/outputs,and percentage completed for each of the grantee's program year goals.
Goal Category Source Indicator Unit of Expected Actual— Percent Expected Actual— Percent
/ Measure — Strategic Complete — Program Complete
Amount Strategic Plan Program Year
Plan Year
Administrative HOME
HOME Investment HOME:
Other Other 1 1
Investment Administrative $ 100.00%
costs costs
Public Facility or
Infrastructure Activities
CDBG-CV CDBG- Persons
CDBG-CV other than 0 1
"Cares Act" CV: $ Assisted
Low/Moderate Income
Housing Benefit
Public service activities
CDBG-CV CDBG- other than Persons
CDBG-CV 0 602
"Cares Act" CV: $ Low/Moderate Income Assisted
Housing Benefit
CDBG-CV CDBG- Businesses
CDBG-CV Businesses assisted 40 53
"Cares Act" CV: $ Assisted 132.50%
Non-Housing Housing Code Household
Code CDBG:
Community Enforcement/Foreclosed Housing 100 361 350 361
Compliance $ 361.00% 103.14%
Development Property Care Unit
CAPER 2
OMB Control No:2506-0117(exp.09/30/2021)
Community
Non-Housing
Development CDBG:
Community Other Other 1 1
Block Grant $ 100.00%
Development
Administration
Community
Household
Housing Affordable HOME: Homeowner Housing
Housing 2 0 2 0
Development Housing $ Added 0.00% 0.00%
Unit
Organization
Economic Economic CDBG: Businesses
Businesses assisted 0 0
Development Development $ Assisted
First Time Household
Affordable HOME: Homeowner Housing
Homeownership Housing 1 0
Housing $ Added 0.00%
Program Unit
First Time Direct Financial
Affordable HOME: Households
Homeownership Assistance to 0 0 2 0
Housing $ Assisted 0.00%
Program Homebuyers
Household
New Affordable HOME:
Rental units constructed Housing 3 41 16 41
Construction Housing $ 1,366.67% 256.25%
Unit
Household
New Affordable HOME: Homeowner Housing
Housing 0 0
Construction Housing $ Added
Unit
Public Facility or
Public Facilities Non-Housing Infrastructure Activities
CDBG: Persons
and Community other than 0 0
$ Assisted
Infrastructure Development Low/Moderate Income
Housing Benefit
CAPER 3
OMB Control No:2506-0117(exp.09/30/2021)
Public service activities
Non-Housing
CDBG: other than Persons
Public Service Community 3500 5091 3522 5693
Development $ Low/Moderate Income Assisted 145.46% 161.64%
Housing Benefit
Single Family Household
Affordable CDBG: Homeowner Housing
Rehabilitation Housing 80 87 85 87
Housing $ Rehabilitated 108.75% 102.35%
Program Unit
Table 1-Accomplishments—Program Year&Strategic Plan to Date
Assess how the jurisdiction's use of funds, particularly CDBG, addresses the priorities and specific objectives identified in the plan,
giving special attention to the highest priority activities identified.
The City of Yakima continues to focus on needs and goals outlined in the 2020-2024 Consolidated Plan. During the 2021 program year the City of
Yakima assisted 87 low to moderate Senior/Disabled homeowners with Emergency Repairs. This program assists elderly and or disabled
homeowners to remain in their home as long as possible by making emergency repairs that might otherwise displace these citizens from their
homes and becoming homeless.
CAPER 4
OMB Control No:2506-0117(exp.09/30/2021)
7
CR-10 - Racial and Ethnic composition of families assisted
Describe the families assisted (including the racial and ethnic status of families assisted).
91.520(a)
CDBG HOME
White 84 4
Black or African American 0 0
Asian 1 0
American Indian or American Native 2 1
Native Hawaiian or Other Pacific Islander 0 0
Total 87 5
Hispanic 22 0
Not Hispanic 65 5
Table 2—Table of assistance to racial and ethnic populations by source of funds
Narrative
The CDBG Single Family Rehabilitation program assisted 87 families with an average of$5,400.73 spent
per household with an average monthly income of$1,655.41 per household.
The HOME program partnered with the Yakima Housing Authority with construction of a 41 unit Multi-
family project 5 of the unit where HOME assisted in 2021.
CAPER 5
OMB Control No:2506-0117(exp.09/30/2021)
8
CR-15 - Resources and Investments 91.520(a)
Identify the resources made available
Source of Funds Source Resources Made Amount Expended
Available During Program Year
CDBG public- federal 1,060,372 1,161,327
HOME public- federal 561,746 878,379
Other public- federal 983,539 595,150
Table 3-Resources Made Available
Narrative
The City of Yakima does not limit either CDBG or HOME Investment funds to any limited target area, but
uses these funds to the best of its ability to assist any and all low to moderate income applicants that
qualify within the programs funded within the entire City Limits of Yakima.
Identify the geographic distribution and location of investments
Target Area Planned Percentage of Actual Percentage of Narrative Description
Allocation Allocation
Table 4—Identify the geographic distribution and location of investments
Narrative
The City of Yakima does not limit either CDBG or HOME Investment funds to any limited target area, but
uses these funds to the best of its ability to assist any and all low to moderate income applicants that
qualify within the programs funded within the entire City Limits of Yakima.
CAPER 6
OMB Control No:2506-0117(exp.09/30/2021)
9
Leveraging
Explain how federal funds leveraged additional resources (private, state and local funds),
including a description of how matching requirements were satisfied, as well as how any
publicly owned land or property located within the jurisdiction that were used to address the
needs identified in the plan.
CDBG funds are leveraged with partnerships with non-profits such as OIC of Washington in the
continued operation of the Henry Beauchamp Center (formerly known as the South East
Community Center)to provide community service programs to low and moderate income
citizens.
HOME Investment funds are used in partnership with local Community Partnerships
and Community Housing Development Organizations (CHDO)to construct affordable housing
units for low to moderate income qualified renters and/or qualified first time homebuyers.
Matching Contribution requires all HOME PJs to contribute throughout the fiscal year to
housing that qualifies as affordable housing under the HOME program. The City of Yakima
Match reduction is zero due to fiscal distress, severe fiscal distress, Presidential disaster
declarations, and reductions requested by HOME Participating Jurisdictions (PJs) due to the
COVID-19 pandemic
This match reduction applies to funds expended by a PJ located in Presidentially declared-
disaster area between October 1, 2020 and September 30, 2021.
Fiscal Year Summary—HOME Match
1. Excess match from prior Federal fiscal year 15,845,116
2. Match contributed during current Federal fiscal year 0
3. Total match available for current Federal fiscal year(Line 1 plus Line 2) 15,845,116
4. Match liability for current Federal fiscal year 0
5. Excess match carried over to next Federal fiscal year (Line 3 minus Line 4) 15,845,116
Table 5—Fiscal Year Summary-HOME Match Report
CAPER 7
OMB Control No:2506-0117(exp.09/30/2021)
Match Contribution for the Federal Fiscal Year
Project No.or Date of Cash Foregone Appraised Required Site Bond Total Match
Other ID Contribution (non-Federal Taxes, Fees, Land/Real Infrastructure Preparation, Financing
sources) Charges Property Construction
Materials,
Donated labor
Table 6—Match Contribution for the Federal Fiscal Year
HOME MBE/WBE report
Program Income—Enter the program amounts for the reporting period
Balance on hand at Amount received during Total amount expended Amount expended for Balance on hand at end
begin-ning of reporting reporting period during reporting period TBRA of reporting period
period $ $ $ $
$
282,645 222,179 147,434 0 357,390
Table 7—Program Income
CAPER 8
OMB Control No:2506-0117(exp.09/30/2021)
11
Minority Business Enterprises and Women Business Enterprises—Indicate the number and dollar
value of contracts for HOME projects completed during the reporting period
Total Minority Business Enterprises White Non-
Alaskan Asian or Black Non- Hispanic Hispanic
Native or Pacific Hispanic
American Islander
Indian
Contracts
Dollar
Amount 407,820 0 0 0 217,731 190,089
Number 54 0 0 0 28 26
Sub-Contracts
Number 0 0 0 0 0 0
Dollar
Amount 0 0 0 0 0 0
Total Women Male
Business
Enterprises
Contracts
Dollar
Amount 407,820 0 407,820
Number 54 0 54
Sub-Contracts
Number 0 0 0
Dollar
Amount 0 0 0
Table 8-Minority Business and Women Business Enterprises
Minority Owners of Rental Property—Indicate the number of HOME assisted rental property owners
and the total amount of HOME funds in these rental properties assisted
Total Minority Property Owners White Non-
Alaskan Asian or Black Non- Hispanic Hispanic
Native or Pacific Hispanic
American Islander
Indian
Number 0 0 0 0 0 0
Dollar
Amount 0 0 0 0 0 0
Table 9—Minority Owners of Rental Property
CAPER 9
OMB Control No:2506-0117(exp.09/30/2021)
12
Relocation and Real Property Acquisition—Indicate the number of persons displaced, the cost of
relocation payments, the number of parcels acquired,and the cost of acquisition
Parcels Acquired 0 0
Businesses Displaced 0 0
Nonprofit Organizations
Displaced 0 0
Households Temporarily
Relocated, not Displaced 0 0
Households Total Minority Property Enterprises White Non-
Displaced Alaskan Asian or Black Non- Hispanic Hispanic
Native or Pacific Hispanic
American Islander
Indian
Number 0 0 0 0 0 0
Cost 0 0 0 0 0 0
Table 10—Relocation and Real Property Acquisition
CAPER 10
OMB Control No:2506-0117(exp.09/30/2021)
13
CR-20 -Affordable Housing 91.520(b)
Evaluation of the jurisdiction's progress in providing affordable housing, including the
number and types of families served, the number of extremely low-income, low-income,
moderate-income, and middle-income persons served.
One-Year Goal Actual
Number of Homeless households to be
provided affordable housing units 41 41
Number of Non-Homeless households to be
provided affordable housing units 103 87
Number of Special-Needs households to be
provided affordable housing units 0 0
Total 144 128
Table 11—Number of Households
One-Year Goal Actual
Number of households supported through
Rental Assistance 0 0
Number of households supported through
The Production of New Units 59 41
Number of households supported through
Rehab of Existing Units 85 87
Number of households supported through
Acquisition of Existing Units 0 0
Total 144 128
Table 12—Number of Households Supported
Discuss the difference between goals and outcomes and problems encountered in meeting
these goals.
The City of Yakima was successful in creating new affordable housing units during program year 2021
working with partners and staff to meet our goals. Problems encountered in meeting goals are the rising
costs of construction and continued barriers caused by the COVID 19 pandemic.
The following activities contributed to the success of meeting,or exceeding one-year goals:
CAPER 11
OMB Control No:2506-0117(exp.09/30/2021)
14
• Single Family Rehab Program-assisted 87 Families
• New Construction-Completion of a 41 Unit Homeless Veteran Housing.
Goals are set with the lack of knowledge by entitlements as to availability of future funding in both the
Five Year Consolidated Plan and individual Annual Action Plans.The City of Yakima continues to try to
meet the goals as stated in the current Five Year Consolidated Plan.
Discuss how these outcomes will impact future annual action plans.
Future plans are set with an estimate amount of entitlement. Every year entitlement amounts dwindle
thus impacting future plans. The surge of homelessness, rising costs,the need of affordable housing,
does not keep allow us to keep up with the need. Additionally, the growing population of
Senior/Disabled homeowners that continue to seek much needed emergency home repairs. Not only is
the need growing for such services but the increasing cost of labor and material continues to outpace
the allocations of both CDBG and HOME funds.
Include the number of extremely low-income, low-income, and moderate-income persons
served by each activity where information on income by family size is required to determine
the eligibility of the activity.
Number of Households Served CDBG Actual HOME Actual
Extremely Low-income 35 5
Low-income 34 0
Moderate-income 18 0
Total 87 5
Table 13—Number of Households Served
Narrative Information
CAPER 12
OMB Control No:2506-0117(exp.09/30/2021)
15
All programs funded through the City of Yakima continue to assist low income citizens that are 80%or
below of the 2021 Federal Median Income guidelines as established by HUD.
CAPER 13
OMB Control No:2506-0117(exp.09/30/2021)
16
CR-25 - Homeless and Other Special Needs 91.220(d, e); 91.320(d, e); 91.520(c)
Evaluate the jurisdiction's progress in meeting its specific objectives for reducing and ending
homelessness through:
Reaching out to homeless persons (especially unsheltered persons) and assessing their
individual needs
The City of Yakima continues to struggle with increasing costs of living,construction and labor costs
while our entitlement funds fail to keep pace. The City continues to us the majority of its limited CDBG
funds in assisting low to moderate income Senior/Disabled homeowners with emergency repairs in
order to keep them in their homes and thus keeping this fragile populace from becoming displaced
adding to the Homeless situation. The City Continues to partner with local organizations to assist with
affordable housing projects to help reduces homelessness. The City of Yakima continues to work with
the local Continuum of Care in assessing the numbers and needs of the unsheltered homeless.
Addressing the emergency shelter and transitional housing needs of homeless persons
The City of Yakima continues to work with the local Continuum of Care, Neighborhood Health and
Transform Yakima in providing temporary emergency shelters to assist the homeless through severe
weather conditions as well as transitional and more permanent housing.
Helping low-income individuals and families avoid becoming homeless, especially extremely
low-income individuals and families and those who are: likely to become homeless after
being discharged from publicly funded institutions and systems of care (such as health care
facilities, mental health facilities, foster care and other youth facilities, and corrections
programs and institutions); and, receiving assistance from public or private agencies that
address housing, health, social services, employment, education, or youth needs
The City continues to work with local community partners to assist in Multi-Family unit projects. Our
local Housing Authority completed construction of a 41 unit Multi-Family project that assists homeless
veterans. The City of Yakima has also partnered in 2021 with Catholic Charities Genesis Housing to
construct a 16 Unit multifamily Farmworker housing project.
Helping homeless persons (especially chronically homeless individuals and families, families
with children, veterans and their families, and unaccompanied youth) make the transition to
permanent housing and independent living, including shortening the period of time that
individuals and families experience homelessness, facilitating access for homeless individuals
and families to affordable housing units, and preventing individuals and families who were
CAPER 14
OMB Control No:2506-0117(exp.09/30/2021)
17
recently homeless from becoming homeless again
The City continues to work our local partners in addressing the need of affordable housing. The City
partnered with the Yakima Housing Authority and completed construction of a 41 unit multifamily
Veteran housing project for homeless veterans. This project was completed in 2021 and is fully occupied
thus assisting 41 homeless persons with affordable housing.
CAPER 15
OMB Control No:2506-0117(exp.09/30/2021)
18
CR-30 - Public Housing 91.220(h); 91.320(j)
Actions taken to address the needs of public housing
The Yakima Housing Authority (YHA) offers affordable housing through a variety of programs. Each
program is designed to meet the need of our community.
• Housing for families;YHA offers two housing programs for low income families. The first is the
family Housing/Low Rent Program which has 150 units at scattered sites across Yakima. Rent is
determined based on family income.
• The Housing Choice Vouchers-Section 8 program; Eligible families will receive rental assistance
and can rent from any landlord that accepts Section 8 vouchers. Unit size and maximum rent
limits apply.
• Housing for the Homeless-YHA subsidizes 75 units located throughout Yakima County
specifically set aside for individuals and families that qualify as homeless. YHA has partnered
with several not-for profit organizations which allow eligible tenants to receive assistance with
health care,substance abuse and job training.
• Housing for Veterans;YHA offers a Section 8 voucher program specifically for Veterans who also
qualify as homeless under the Veterans Affairs Supportive Housing Program (VASH).
• Housing for Farmworkers;YHA owns and manages 172 units throughout Yakima County which
are set aside for Farmworkers and their families. Reduced rents and rental assistance may be
available.
• Housing for the Elderly;YHA owns and manages a 38 unit apartment building in Yakima for the
elderly. In order to qualify for the one bedroom units,the individual and his or her spouse must
be 62 or older.
• Housing for the Disabled;YHA offers a Section 8 Voucher Program specifically for Non-Elderly
Disabled Individuals through the NED Voucher Program.
Actions taken to encourage public housing residents to become more involved in
management and participate in homeownership
The Yakima Housing Authority encourages resident involvement with programs like the Resident
Advisory Board (RAB).The (RAB) provides the YHA and residents with a forum for sharing information
about the Agency's Annual Plan. RAB membership is comprised of individuals who reflect and represent
the residents assisted by the PHA.The role of the RAB is to assist the PHA in developing the PHA Plan
and making any significant amendment or modification to the Plan. In addition,Yakima Housing
Authority is an active participant in crime free rental housing which allows our residents to be a part of
the local block watch inviting residents and local organizations to National Night Out.
The YHA also participates in the Yakima County Asset Building coalition and they are establishing a
partnership with YV-CAN for the Union Gap and Yakima area. YHA also works with AmeriCorps VISTA
CAPER 16
OMB Control No:2506-0117(exp.09/30/2021)
19
Educational Project with the goal of every eligible resident signing up for the college bound scholarship.
YHA also administers the Family Self-Sufficiency (FFS) Program.This program enables families assisted
through the HCV program to increase their earned income and reduce their dependency on welfare
assistance and rental subsidies
Actions taken to provide assistance to troubled PHAs
The Yakima Housing Authority is not designated as "Troubled".
CAPER 17
OMB Control No:2506-0117(exp.09/30/2021)
20
CR-35 - Other Actions 91.220(j)-(k); 91.320(i)-(j)
Actions taken to remove or ameliorate the negative effects of public policies that serve as
barriers to affordable housing such as land use controls, tax policies affecting land, zoning
ordinances, building codes, fees and charges, growth limitations, and policies affecting the
return on residential investment. 91.220 (j); 91.320 (i)
The Yakima City Council is an elected body chosen by the citizens of Yakima and as a governing body is
able to direct the Yakima City Manager as to managing changes, negative or otherwise concerning public
policies that serve as barriers to affordable housing within the cities control concerning land use
controls, tax policies affecting land, zoning ordinances, building codes, fees and charges, growth
limitations and policies affecting the return on residential investment.
Actions taken to address obstacles to meeting underserved needs. 91.220(k); 91.320(j)
Due to the continued limitations of federal entitlements, the ability to take action to address ever
growing obstacles to meet the need of underserved citizens continues to grow.The City of Yakima
assists its citizens to the best of its ability as directed by the Yakima City Council as the elected and
governing body representing the citizens of Yakima through the programs described throughout this
document. The Cities Annual Action Plan and Five Year Consolidated Plan as approved by HUD.
Actions taken to reduce lead-based paint hazards. 91.220(k); 91.320(j)
The Office of Neighborhood Development Services addresses Lead-Based paint hazards as required and
outlined by HUD within its individual programs.
Actions taken to reduce the number of poverty-level families. 91.220(k); 91.320(j)
The City of Yakima was able to assist 53 microenterprise businesses so that they can continue to prosper
during the Covid 19 pandemic, thus having the ability to continue to have employees.The City continues
to strive to increase its Economic Development avenues to increase available local jobs that pay
reasonable living wages.The City continues to seek to establish new businesses as well as commercial
manufacturing and agricultural opportunities to broaden the employment avenues available to its
poverty-level families.
Actions taken to develop institutional structure. 91.220(k); 91.320(j)
Institutional structure is expanded as needed and as funding allows.
Actions taken to enhance coordination between public and private housing and social service
agencies. 91.220(k); 91.320(j)
CAPER 18
OMB Control No:2506-0117(exp.09/30/2021)
21
The City continues to partner with both public and private housing agencies, such as Yakima Valley
Habitat for Humanity,The Yakima Catholic Diocese Housing Services, Next Step Housing and the local
Yakima Housing Authority to address affordable housing issues within the city limits of Yakima. The city
also communicates with a large variety of social service agencies through several committees in which
both a City Council member and/or staff attend.
Identify actions taken to overcome the effects of any impediments identified in the
jurisdictions analysis of impediments to fair housing choice. 91.520(a)
Any impediments identified by the City of Yakima are addressed on an individual basis and then
addressed by either the individual City department with the expertise to do so,or assigned by the
Yakima City Manager as directed by the elected governing body, the Yakima City Council.
CAPER 19
OMB Control No:2506-0117(exp.09/30/2021)
22
CR-40 - Monitoring 91.220 and 91.230
Describe the standards and procedures used to monitor activities carried out in furtherance
of the plan and used to ensure long-term compliance with requirements of the programs
involved, including minority business outreach and the comprehensive planning
requirements
The City of Yakima's Office of Neighborhood Development Services is regularly monitored by both
Region 10 HUD monitors and the Washington State Auditors Office as to program compliance and
comprehensive planning requirements per mandated Federal HUD regulations. Both of these
monitoring reports are available through HUD and the Washington State Auditors office through the
"Public Disclosure Act".
The City of Yakima monitors all Subrecipients and Developers per HUD regulations.
Citizen Participation Plan 91.105(d); 91.115(d)
Describe the efforts to provide citizens with reasonable notice and an opportunity to
comment on performance reports.
As outlined in the City of Yakima's adopted "Citizen Participation Plan",a Fifteen day written comment
period is conducted as advertised in both the Yakima Herald newspaper and the El Sol newspaper,along
with two public meetings.Those meetings are held before the Yakima City Council and held in order to
provide the public the opportunity to comment on the Consolidated Annual Performance Evaluation
Report, as mandated by HUD.The City also posts the CAPER on the city's website so that it can be easily
downloaded and reviewed.
CAPER 20
OMB Control No:2506-0117(exp.09/30/2021)
23
CR-45 - CDBG 91.520(c)
Specify the nature of, and reasons for, any changes in the jurisdiction's program objectives
and indications of how the jurisdiction would change its programs as a result of its
experiences.
There are no program changes in the reporting year of 2021.
Does this Jurisdiction have any open Brownfields Economic Development Initiative (BEDI)
grants?
No
[BEDI grantees] Describe accomplishments and program outcomes during the last year.
CAPER 21
OMB Control No:2506-0117(exp.09/30/2021)
24
CR-50 - HOME 91.520(d)
Include the results of on-site inspections of affordable rental housing assisted under the
program to determine compliance with housing codes and other applicable regulations
Please list those projects that should have been inspected on-site this program year based upon
the schedule in §92.504(d). Indicate which of these were inspected and a summary of issues
that were detected during the inspection. For those that were not inspected, please indicate
the reason and how you will remedy the situation.
Due to the COVID 19 pandemic HUD issued a waiver for HOME onsite inspections for 2020 and was
extended through September 30, 2021.The following HOME onsite inspections where performed during
the 2021 program year.
• Rose of Mary-9 HOME Units
• Triumph Treatment- 1 HOME unit(for 2020)
• YWCA- 2 HOME units(for 2020)
• Next Step Housing- 5 HOME units (for 2020)
• Catholic Charities Karr- 1 HOME unit(for 2020)
• Pioneer Plaza- 10 HOME units
• Mapleleaf- 1 HOME unit
Yakima Housing Authority Chuck Austin Place initial inspection for project completion,41 units
inspected.
Provide an assessment of the jurisdiction's affirmative marketing actions for HOME units.
92.351(b)
ONDS assesses the results of its affirmative Fair Housing Marketing Plan annually with a summary of
"Good Faith Efforts" taken by its Grantees in the CAPER.
ONDS assesses the information compiled in the manner described under Section V and Section VII above
and evaluates the degree to which statutory and policy objectives were met. If the required steps were
taken, the office of Neighborhood Development Services will determine.
Refer to IDIS reports to describe the amount and use of program income for projects,
including the number of projects and owner and tenant characteristics
In the 2021 program year the following program income was utilized for the Yakima Opportunity
Housing Phase 1 project that the City of Yakima contracted with in November of 2021. Program income
CAPER 22
OMB Control No:2506-0117(exp.09/30/2021)
25
in the amount of$128,021.00 was utilized for this ongoing project of a 16 unit multifamily project for
farmworkers.
Describe other actions taken to foster and maintain affordable housing. 91.220(k) (STATES
ONLY: Including the coordination of LIHTC with the development of affordable housing).
91.320(j)
The City continues to work with housing partners to continue to bring more affordable housing to
Yakima. Collectively we continue to work together to understand the need of affordable housing and
how we can work together to assist with the barriers that we come across to be more affective in
creation of affordable housing in Yakima.
CAPER 23
OMB Control No:2506-0117(exp.09/30/2021)
26
CR-58 —Section 3
Identify the number of individuals assisted and the types of assistance provided
Total Labor Hours CDBG HOME ESG HOPWA HTF
Total Number of Activities 0 0 0 0 0
Total Labor Hours
Total Section 3 Worker Hours
Total Targeted Section 3 Worker Hours
Table 14—Total Labor Hours
Qualitative Efforts -Number of Activities by Program CDBG HOME ESG HOPWA HTF
Outreach efforts to generate job applicants who are Public Housing
Targeted Workers
Outreach efforts to generate job applicants who are Other Funding
Targeted Workers.
Direct,on-the job training(including apprenticeships).
Indirect training such as arranging for, contracting for,or paying tuition
for,off-site training.
Technical assistance to help Section 3 workers compete for jobs(e.g.,
resume assistance,coaching).
Outreach efforts to identify and secure bids from Section 3 business
concerns.
Technical assistance to help Section 3 business concerns understand
and bid on contracts.
Division of contracts into smaller jobs to facilitate participation by
Section 3 business concerns.
Provided or connected residents with assistance in seeking employment
including:drafting resumes,preparing for interviews,finding job
opportunities,connecting residents to job placement services.
Held one or more job fairs.
Provided or connected residents with supportive services that can
provide direct services or referrals.
Provided or connected residents with supportive services that provide
one or more of the following:work readiness health screenings,
interview clothing,uniforms,test fees,transportation.
Assisted residents with finding child care.
Assisted residents to apply for,or attend community college or a four
year educational institution.
Assisted residents to apply for,or attend vocational/technical training.
Assisted residents to obtain financial literacy training and/or coaching.
Bonding assistance,guaranties,or other efforts to support viable bids
from Section 3 business concerns.
Provided or connected residents with training on computer use or online
technologies.
Promoting the use of a business registry designed to create
opportunities for disadvantaged and small businesses.
Outreach, engagement, or referrals with the state one-stop system,as
designed in Section 121(e)(2)of the Workforce Innovation and
Opportunity Act.
CAPER 24
OMB Control No:2506-0117(exp.09/30/2021)
27
Other.
Table 15—Qualitative Efforts-Number of Activities by Program
Narrative
CAPER 25
OMB Control No:2506-0117(exp.09/30/2021)
28
Attachment
2021 MBE Report
CAPER 26
OMB Control No:2506-0117(exp.09/30/2021)
29
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CAPER 27
OMB Co ntiol No:2506-0117(exp.09f3Q13121)
30
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CAPER 28
OMB Co nttol No:2506-0117(exp.09f3Q13121)
31
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CAPER 29
OMB_m NO:__ _gym
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CAPER 30
OMB Co ntiol No:2506-0117(exp.09f30/2021)
33
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CAPER 31
OMB_m___ _gym
34
2021 HOME Monitoring
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CAPER 32
OMB Co nt611 No:2506-0117(exp.09f3Q13121)
35
T),-, OEPARTMBIT Ct.WIIIN3(Iltt MD ECOXCIO,C,DEVROPXDR
"` 1)., dCceeflkageymFmd 0awl:Met Sates
II'; 1125mltll EV36161nW two:Gal Del'1DW2MI
`!1( r. Yekma,D9 S75ton 9UOl Tan 1:39 P61
Ij, Alone S)56101•Fax(9A)575-51)6 Marmon:Omes4
Pl..).
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
IIOMEBUYER:
Apanweat I:110,113,200,209,211,303,309,310&315(1 Betruol)
PROPERTY ADDRESS:5401 W.Walnut.Roxe of Mon
PROPERTY AGE:_13 Verve
SECTION ONE:
Bln1.MNGExTR010R PASS PAy, COMMENTS
lCcdltiol aff otdrum X
odiilioaofrmW
—
3.CoDd al
ion of Ott,rails,&;cm x
a.Conhlanofexlmar milky' X
Nam s0101.act
5.G[Cdkim ofcxkowy NIA
6.Ccedikm o(FA&
a) oeckinw staling a pars Ca C
b) ligpinc a'Iog Ca a
e1 ulexuactly%load aranM Ox ;
SECTION TWO:
BUILDING SYSTEMS PASS PAD, COMMENTS
titmice cowman X
2.Vamlluka•Cm;ilk "X
3.Y'ater bout) X
e.R00gb;kmmn0 X -
S.Sop X
6.Elearkol mnioe Wbinp X
7.S wke Delman X
SECTION THREE:
LUN NG ROOM f PASS PAD. CUMMENfS
I-Flocecoadilim I X
211irtdoocawgm (x
—
3.0 ,N curcopion 11 X
d_Xexticel fi=1:* A
5(cilme LM,:Iiliuo x _
&WW1omdmq, X _
7.0on1Mon of pant •X
a) ankig),smugga paling 1 6X C
b) lipping a lave: lax C
a) adecuxel,:t)alnd arttlb4l LTC n
SECTION POUR:
EITCIIE`a PASS I FAIL. CORMIDIl5
1 Flow=Awe X
2W�k,law citrrfnoa X
3.Docr aa,diiion X
A.EkCcol flume X
SSi,A coodki0n X
'6.061n1Crmtrma condidom X
7.Celhog canttim X
&W'elI ondii on X _1
J.A) cn11ngakc ,gim: x J
b) llgpbg a Maw at CI_ e) At.quotk IInmkd or coved y u
CAPER 33
OMB Do ntioI No:2506-0117(exp.09f30.13)21)
313
SECTION FIVE:
BATHROOM PASS PAW COMMENTS
I SloeccooSica X
S.Window condition X
2.Iluq'pp BUT. X
d.Cltrnb 6xvmxvuarbpoo X
5.Toike emd cc X
6.Wall butmtsbmalogomdisces X
T.'Ibbxabowx caitcondillon X
1.CORR:eood*kq X
Mall Condition X
9.Cordlicc efiale:
U traria Q.Kali*or Nap. n a
b) chlppiracr Inc
c) Magus.*ampler coma] T o
U q
I
SECTION SIX:
`LAUNDRY ROOWVITLITY ROOM: PARK FAIL I COMMENTS I
I Flow&indium X
2Window make X
3.Oxr m'odidon X
4Slceeol fitga.''Yalubliot X
s.rsJ coadiceq X
•
6.Wmcondxix X
ICmdiCen of peon y
a) caking soiling.or wiles cx n
n) J.yagot Now cx o
el ndw2mtt,wood xxnamd gee
SECTIONSEVEN:
BOOM NO I:Iaeellon PASS FAIL i COMMINDS
I.floxcxdliwn X
2.Wmdow a:aya X—
3.Doorco dkiot X
5Nn0i0ll&wes X
S.CailinFcand'nion 'X
twill onldltim X
7.coNIXion od paint x
a> tnckbe.Salim,er paclia; ax
b) dtipplacx loose ay c
c) admctwly Moved or antral qg c
SECTION EMIT:
BEDROOM NO2:IooWaq N/A I PASS FAIL COMMENTS
IFbxoondition
2Wbdpw mMikm
3.Docr condition
a.tclit a)?bon.disc
S.CNIiccnatdidea '
6 Will exclaim
7.Ondidon Bryant
a) troekirt.aaalina.a-pcalicc n o
b) tbgpag x loose a
c) adectukB tread hwrtm2 D I
SECTION NINE:
BEDROOM NO3;bets :WA —PASS I PAIL COMMENTS
decor cccama
2.Window coM3in
3.Dnx indite. —
a.CIeeNL-a:alarm
S.Citaocr ditko_
9.W'n cm:14m
7.Cbndiym croak' .
a) tMkiem aralog.x peeling a u
b) &ixfins ex bn.= a
a
c) ado4akiymmtl xooaad a a 0
SECTION TEN:
DINING ROOM OR DINING AREA PASS FAIL I COIMMINIS
I. co axmtidnn IX I i
CAPER 34
OMB Co nttoI No:2506-0117(exp.09f3Qr2021)
37
T.Wine econdaat IX
3.Daorccobiuon _X
o m
d.EkkA Iam X
S.CeR'uq to/idiom X
6.WIHca:.flkc X
7.Ca:dilion reps. x
a) kediis ttalll:L or pallns ux n
0) `*pi Iwloose nx ,_•
cl edeTadv mood at aamnd or to
SC(.TION ELEVEN:
OTHER ROtnl:lolwun A:A PASS FALL COMMENTS
I.Noorcardkko
2.BSndor condition
iLooreoaal:a
4IlmtimlExtra
S Off Sing comliiox
!.Wan ccndid./:
'.Conlon ofpam: —
a) aackit.falil%cc pathig u o
0) cbippina tA.ace o a
-) admuaely muted./towed a o
—
SECTION TWELVE:
ENTRIES HALL/VA/SON S'TAIRCAFFR: PASS PAID COMMENTS
IDloor wndlcen X
e.Las medium X
3.Elmtital axiom X
4.Ceiliaxcccdtrka X i
d.Wancandilion XO.
6. +iox:olpeim: x
i) crocking.salt.or cycling a
b) chlpp'y„cc kat zx u
`c) adeaumeh•natal ix covered rx o
SECTION THIRTEEN:
I U`OLABI'1'ABLE ROOMY N/A I PASS FALL OIMME.NSS
1.1ilcirkalcoStllom
=Pcounlvty h:andocs awn 1 —
3.CandkioaofMai:
al amki-g rmli/La perch% a o
0) chipping a loon 1 o c
H aeleeuralrlrateice nwnd t C
—
SECTION FOURTEEN:
r SUMMARY OF INSPECTION
VISUAL ASSESSMENT OF DETERIORATED PAINT: I PAS I PAIL
WHEWVknal Assessment of Deteriorated Paint sec Section 15 on nett page) X
/� 10/621)21
INSPECTOR SIGNATURE DATE
SECTIONFIF EEN::
Fldled Visual AssamxM of Deteriorated Paint
Failed Irnpcction Sermon utanba: L _II
Brat:ation Results:
Recommended Refrain Using Seib Work Pradias:
CAPER a
OMB Co ntioI No:2506-0117(exp.09f30.13)21]
38
Failed Visual Assessment of D.A.i..onJ Paint
Failcd Inspection Sccdon number:
Svaluation Results;
Recommended Repairs Using Safe Wock Practices:
LFailed Visual Assesroem ofDeteriastad Paint
Failed Invasion Section number:
EvIkalao Rcculu
Roxmmmcnded Repairs Using Safe Woe(Pea:tiaee
CAPER 36
OMB Co ntml No:2506-0117[exp.09f30/2021]
39
�.s Y� 06'MME1R OP 0OMXLNr11'MD E0OMMIC Oraltat8Ef
•t l'` u of RlbhbaSopp OrcioP^'MR Scrum ]
'i 2 Spite Eyhlh SAS¢t Impe¢Ia3Due:I Irr41
'�: YAWPR.'Walle3tan 9Wt1 lOGOAAI.
Phase(R%)$Isdl0l.Fda('Co)s 561M Rcaln .l-bW.lw
Funn c 952.1T33
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMEBUYER: h'1 c small Crlvlceca
Apartment N: Niel Rouse
PROPERTY ADDRESSSr13 Su j neiiof L -
PROPERTY AGE:_20 Yema
SECTTON ONR:
BOLLOLYO EXIUIOR - PASS I PAIL COMMERIC
IA:mayimofrouadasim X
2.Cmdkka of roof X
3.Candinon orsut.Iaill.&porch; X
4.Cadkw ermerx.Atoms X
Eoi.$e.sat co)
S.CorokLt Mchincey WA
OCcadnion apt:
a) aOkior,maim pkallS a 1 n
b) °Limns micas* at n
OS adooORA}wined or aan d I ex n
SECTION TWO:
IBmtOIXC SPRTDYS PASS !AIL COMMENTS
I I ika1MMarui2urs X
t.VmtlRbmTmkra -X
3.Waa hcimr X
a.Ronie plw.iB X
S.Saws X
6.9.Axoiaslsnc'i:U rtrira X
?�4<ko Dmemols X
SECTION THREE:
COMMON ARBAF LATNC ROOM PASS I PAIL I COMMgYTS
I Flow condition X 11
1Wlndow conflict X
3.Domcondition X
4.13konAul 6261170o X -
Sialint ccadida. X
6 WalaoAtlka X
t.Cwdifko ofpnnt X -
a) rlx ks to*.reptant cx u
b) dims or loose cx n
c1 aAxPddyeesadmpaxxdf ox o
SECTION POOR:
f PASS PALLCOMMENTS
I.P
lltHRK
loorccatan x
2.Win&pe condition X
S.Ilooeca4 a X
d.Ekarxal Rxalros X
S.9nQlrkx1tian X
6rabioeortoaump owdirom X
TCilinscon9lion X
SW'oll ox aldit X
9.ro,icon of mint X
I) Cfl t milks AI mils T C
b) dripping a Lome
0mantah'mama or m C
wxrcd CO O
SECTION PNR:
CAPER 37
OMB CO nttoI No:2506-0117(exp.09f3Qf2021)
410
BATHROOM PASS I FAIL COMMENTS
ISInmasipou X
1.Windpacnaikloa X
3.Duc cccdkkon _X
4.Kltc kn16xh mVegiblic@ "X
S.TO'llaaw c X
6.W Maas b a .t4bclawy omdaona X
7_Mb Qr Mout unb ocadldoa X
7.Ceara amnion X
[Willac€um X
'9.0:ndlbcn°foa"
a) crocking mBmpa peeling u 0
D) cbgpolgmlcolc a a
') tommIalyb..xdorantral a a
SECTION SIX:
LAUNDRY ROOMiLTILITF ROOM: PASS PAIL GONDAEDTd
a.Fkee condition X
8NVbetw condom X
3.Doa nuidon X
4E cal I.ct ll,w%Vtaaa.Ioa - X
S.CtlikB mndicca X
6.WSIcmdakm X
i.Cmdjym apex. x
a) emtAing =a.ea;tang a
b) ckippkc ur ive, c u
e1 a egmlclyaxwed nr.nwnd ox u
SECTION SEVEN:
BEDROOM NO I:Walton PASS I FAIL COMMENTS
IMooraed[ion X
3 Widowcoadilion X
gnoanadrim X
4.Olmukal ralula X
SClilkgam@Im X
tW6ll QMdidun X
7.Co dbinn of paint
a) nrckia:.Baliasap:aliq na o
b) ellippinca loox I i u
O admuatly mums ora:2 roc
a
SECTION RIGHT:
BEDROOM Rote*mike WA PASS I PAIL (OMMENTS
17lccrcntmuoo
).Window pmdidnn
Silas,ccmdiicc
4Elaalmlr wra
501ilinecma*loa
O.Wtll ccndiIi n
7.Con±:im,mpikl:
I) a2c lm6ep.apeale0 a a
b) chipping or loose a a
p) adaQucely mused a covad a a
SECTION NINIQ
BRIIPOOM NO3:Wanks NIA PASS PAIL!COMMENTS
I.Fkaandkko
2.Window agodikon
3.1kn.cmddcc —
44Elanlml Wawa
(Lilkc<oadalm,
&mall mndilioa
'tundnlon of gat
a) mckks,wain or probe b) chipping a 0loou u I o
a) adyuaalr Inured et mind u 0
SECTION TEN:
DINING ROOM OR DINING AREA PASS FAIL COMMENTS
I.FlourooMulpd X
2.WIodo.mlWNnn X
)Dear or,e&aka X
CAPER 38
OMB W MioI No:2506-0117(exp.09f3Qp2D21)
41
4.EkadealMaas _ X
- bdubdtirn X
iwweo:u-`"kc X
T.Nodilian ntp att 'x
a) eskiLLbolas mpaluls ut o
b) n*Vpb¢m Iwo at a
C) adwmink aaad m oo.emd nu c ,
SECTION ELEVEN:
OTHKR ROOM:beaus FUA I PASS FAIL I COMM'
I.Fbarmadbt.a
LWiadoaeapRke:
3.giconotdnn
<.ukmtod finals
e. ak;aradiss
Small eoediim
7.Caoddoa tint
a) anekintwtlmp,m peeltas n o
b) abkpkg 714006. a a
c) e4C lIS''aeane6 at cowed o a
SECTION TWELVE:
MMTBIIS.HALLWAYS OR ATA@CASG9: PARS FAIL I coenNIB
1 Sur wadidan X
2.Doer rondtliun X
3.F.LW,1 fiaat8 X
teethe.madRta X
S.B_xacandtbn X
6Cceditka ataxia:
t) <radars&mitt onetime se o
b) chipping at bow ax u
e) adegmab•stool or emend re u
SECTION THIRTEEN:
VNNABITABLnnOOMS:K/A PAPS FAIL I(OMMINTS
IEIe kale aii:iota Ir
2.Mea ixea ho,ads a t.taea
).Candnion of Set
a) aokina,sWlnp-ce Kali* i n
b) Mropins*clonte C
e) alunaby:rest!cc coorot o a
SECTION FOURTEEN:
SUMMARY OF INSPECTION
[VISUAL ASSESSMENT OF DETERIORATED PAINT: I PX I FAIL
o at failed Yawl Assetxmwnt of Deteriorated Paint we Section 15 ea nest page)
-r
INSPECTOR SIGNATURE 11di21
DATE
SECTION FIFTEEN:
Failed Visual Assetimeat ofDededontod Paint:
Failed Iasixalon Section numben r
b:v.laadon Results'
Recommroied Repairs Using Safe We*Practice.:
CAPER 39
OMB Co Ito I No:2506-0117(exp.09/3Q12021)
42
Failed Visual Assessment of Detceianled Point;
Failed Inspection Section mythic
EValautioo Results:
Rttvmmea ted Repairs Using Safe Work Prudes":-
Failed Vista!Aateaamen[of Ibletiolaled paint
Failed Inspection Section numbos: C —
Evaluation Results.
Rwammended Repairs Ileing Sate Work?radices
CAPER 40
OMB Co mill No:2506-0117(exp.09f3Q13121)
43
OFPARTMEYT OF COMPANY MD NOSOMX:DE' &OPMENT
,.I l,l 0lfte of lkgh9t �dsoed OrnWno-t Santo I
IIZ SCA01 Oath WW1 Ingn4Ea pIa 11221
7j /'. Y9Gv,Uashiston 980Ot TInM:IO AM.
`Vu` Xtom(SCCOPS6un.Faxcsm)SI mom Canna!coon Ouvn
%nm:
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
IIIOMEBUYER
Apartment*7&13(I BR)
PROPERTY ADDRESS:SIB W Yakima 3sve
PROPERTY AGE: 10 Veera
SECTION ONE:
B7'E.WNG EXTERIOR PASS FAIT. COMMENTS —
I.Cmdllim offmndaloa X
tCcodldtn orroof X
3.Os,dihcn ofsiais,rails,at Dames x
aCodidon of cum*Drama X
(dd[A tall%,4w)
S.CnMIiom tfclt:nut WA
6Cmdxlst ofpaht:
a) tro:AinL=Sale.at pvlinx as a
b) thirplm:or tome a a
c) heAgWIty toed a.ants tax n
SECTION TWO:
at.ILDING SYSTEMS PA65 FAIT. COMMENTS
IRmdnC andpma,: X
2Vwaimen'Cuulim X
"Wait Ismer X
X
S.SrnM %
bk]ewiml servInsWiii,a - X I
7Sm:belr¢nnces X I
SECTION TRREP<
USING ROOM PASS I PAO, COMMIS
IFIcarcemdtim MMX
2.M ¢vdieou "X
S.IMm,aodiebn X
4Elmnk*l Eulmm X
3.Ctilinecond<lon X
t.Woll¢`A,dilion X 1
1.Cm.3iiw of paint X
o) nentneaudios a pair as a
h) chipping c.loose Ea a
e) ad=auely amledcccoveted ar n
SECTION FOUR:
I--rom PASS F66E.I COMMENTS
1 11xc ca,diliun X
2.Wedow<texllm X
3.Oem<endilion X
d.00eadorl 1 one X
S.Sinkcmnrloc X
6.Cabiontai enop(anfnlnrx X
Ceilint condition X
Laann'sadism X
r
.a) cre aroriwodpoinl: X
tin¢.mate,mpmlmC cm c
b) chin:inv.lame cala
0adedwaNtramal or gemmed u
CAPER 41
OMB Co MIDI No:2506-0017(exp.09/30/20211
44
SECUtON FIVE:
1 BATIOWOM I PASS PALL I COMMENTS
TFbccconditun X
ZWk4cw coratioa X
151xx anainn X
4SJceruJ flunailitnebilon X
S.Toikt ooc&oo X
6,Watt basinlAbonwry con:Moto X
r 7.Tub N flamer ask conikium IX
7.Canino coraicc X
&Wall andirondd,c. X
9.Cnalkionol palm
a} thpin stoney,cc moll% n
b) atrippita Rome o C
0) adorvmely tNWd awned o u
SECTION SIX:
LAUNDRY ROOM/Will/TY ROOM: PASS PAIL CO
l.Fkor condition WA2.WwduwaMitico WA
3.Rnrc0Meia WA
Uikcalal A'wroNcnuimbn WA
S.cbillecmMMoo WA '
•b Wall ordicm WA
7.Ccadiiun of pent
▪ Ok%a.al:g,cepeclile
b) °a91�^gorkoa
• odoqa•lnaed or crowed
0 u
n u n o
SECTION SEVEN:
BEDROOM NO 1:Mtyin I1��%
ZW'b P��ASS PAW XDMMFNTS
con I I Flow dbeft I doacerdkkx•. X I
].Dec oxditun X
a.EIe kc fixiu, 'X
S.001iMac4incn X
6.WDRcurdiurc X
7.Ccedlw ofgirc: g
a) eadico xaiee,eroding re:- a
b5 ebipph,or was nA n
e) adeauoelVaorkd oremxrd ,on D
SECTION EIGHT:
BEDROOM NO 2:location WA PASS FAIL, COMMENTS
I Fbr°AMI - WA
Z WIT.&acundiinn WA
7.0xecca011ion WA
AF.Iytrbal fixmnp WA '
d_Collttsurtt w WA
6.Wkf condi:Ion WA
7<Sl-dilico arpoln:
fl cnclungamiiy or wane a a
lot cblppkk or bttc J n
e) aatnic naiad et cowrod . o
SECTION NINE:
BEDROOM NO 3:location WA PASS:FAIL COMMENTS
1.Fbroxdkax' WA
1WlAlow•coodiko WA
].Dec cc.WWcn WA
1.Ckacea foams WA
S.Ccalnlandlncn WA
6.well erdaw WA
7 QVMita nrpcMr
A) cracking.*'nag,or reeling n
t) clpprg at Imo
v) adeaoaWy waled a umwred L n
a a
SEC77ON TEN:
I DIMSc:ROOM OE OWING ARRA 1 Ifloecoodioon �PAS9I FAILIODMM[NIS 1
X M
CAPER 42
OMB Co MIDI NO:2506-0117(exp.0Bf3Qp3)21]
46
2.)Endoe b.odi:ion X ^
333an occ4 z n x -
I a.Elaniml natures .-X
S.CeiliwCeerdriaa X
Mall mldbicn X
7.CmdtiN:of mint: n
a) mmaep.rralir6 a Pat&.c In c
b) d.ippi:aa base ra o
c) ndolmalrcmmta covets _ Ca o
SECTION ELEVEN:
OTHER ROOM: mlion N:4 PASS j PAD. COMMENTS
liloar OTHER OOM PA I
2.Wob.»oadimoa WA
3Doa am6tke N/A
4 Rabic&fatu,e, WA _
&CeilingceMiliem WA I
&Wall attaoff WA
7.a) tnoa of pant
a) axklog amlins a paellas o c.
b) 4sautcyINgeVina•vieem o c
O adwimelYsaxalamvet o l is
SECTION TWELVE:
ENTRIES,HALLWAYS OR STAIRCASES: PASS PAIL I COMMENTS
I.Fm condition X
T.Dos coMltian X
3.Bkamoa Sawa. X
a CatTcs rat :art X
S.WlaemBkc X
faCaIOWn vivacity: x
a) mating.acta.arra:ling Op o
b) Mippr prime at o
a) adeammly casd or cowed ea o
SECTION THIRTEEN:
LNHABrrABa.F.ROOMS:N/A PASS Pan. COMMENTS
IElwwlral=JEN m N/A
2Pvmdalklminaka&atns WA
3.Candnlon of plat -I
a) tracking scalinsa peeling c n
b) tenon or hose C O
4adaPatdviremed meowed O I o
SECTION FOURTEEN:
SUMMARY OF INSPECTION
VISUAL ASSESSMENT OF DETERIORATED PAINT: EAII
U I FAIL
(If filled Visual Assessment of Deteriorated Paint tee Section IS on nest page)
//
4a s I V3f2027
INSPECTOR SIGNATURE DATE
SECTION FIFTEEN:
Failed Visual Assessment of Dektiasted Perot:
Failed Inspection Section number: I
Evaluation.ResWI:
RweaMmnded Repairs Using Salk Work Ptcliees•
CAPER 43
OMB CO ntloI NO:2506-0117(exp.09f30.f3121)
46
Failed Visual Assessment of Deteriorated Paint:
Failed Insparoon Section number. '
EValuseon Addis:
R000m.-nended Repairs Using Safe Work Praedcw.:
Failed Viaml Assessment of Dcac j.t[ed Paint:
Failed inspection Section manta:
Rxahunnn Revolts:_
Recommandal Repairs Using Sak Work Practices:
CAPER 44
OMB Co ntmI No:2506-0117(exp.09f3Q12021)
47
et L( DEPATI ROr C014KUV:TYAI0EWIKAMIC DC.t10,11RR
i DSK9a Se6'klx+ta)CDxccbpSMMSenmS 111 noS r c
Inspection DW:IQz 119011
Moe:10.C9AUri6ne,YMcio.yn SSppl phovlSD9)4)s5141•fare(29)52561:U kale.:
1140) pout
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
IIOMRRUYER:
Apartment P:206(2 Bedroom/I Beth)_
PROPERTY ADDRESS:Pear Tree 291MI Powerwoaxc Rd
PROPERTY AGE!_14 Year,
i
SECTION ONE:
_T/Romat emit ems
I.CobItimn offom411on .1 X J
2.Coedkm eCnof X
LCccdi6ca ofemin ra&pomes x
' A:ranmute.,e,Xc note. X
(Odin soft ex)
d.Contlun of mummy ;NIA
d.C) cn. dpaim:
a) cbirphg•s:oocm.IX mbar or C
b) Mippilge bow oc O
e1 adeumeWomml or covered ea C
SECTION TWO:
S0IEDNC SYSTEMS PASS PAR. COMMENTS
I.Ifantimag mnl X
2.VexibtkaY.'enMe X
3,Wgcr boor X
4 RoushahnMnc X
S,Senm X
6.EkmnkN n:meAVkkn X
7.S make Dower X
SECTION THREE:
LIVING ROOM I PASS PAW COMMENTS
I.Fk condtm X
2.wndMvu e�Dian I X -
3.IX ccoMidnn X
e,Ckcolmi Futons X
d CwiIs, merrierX _
.&Wall eacd ica X
3.0.ndiden&Pp.ep
a) weck4 sailing.cc prang nx t
b) *pine(cleans ml o
ei bated cc oobaoj nx
—
SECTION FOLR:
KITCHEN PASSJ�AAIL C(TIMEMIS
Iktow gonad= X
2.NSMxn mndilion X —
1Aon ocndsno X
4.Dleenkal fixlwm X
d.c'nk oxidises X —
d.CManmComu3npeadaYnn X
7.CrlaA condition X
RWAI c¢aizI. X
9.Cmditlon ofpsAu
n) ccah,.cnlbyet pnaiteg m n
b) chppnc toicc.n ex n
c) adaumely created cc moo, in 1 n
CAPER 45
OMB Matto!No:2506-0117(exp.09f30•/3121)
48
SECTION FIVE:
BATHROOM PASS I FAIL _COMMITS
I.11pxcnr4idoa X
2.Wmduw c adimn X
3Daorcmxkko X
♦kkctdml Mouu•V<nlilrim N
S.Toilcl condition X
6 Wash MI/IAb'satmcomhlmt X
7.Taber Swan out otM¢kn X
-
I.Caere orlilim X .
S.WallccWiliun X
9.Caml:dm apt:
a) aadeng.static,at NAIR a u
h) (lamina Ixaa a o
__O adwucely moat ur cowed y< O
SECTION SIX:
IADNDRY ROOMAIfILITY ROOM: PASS PAIL COMMENTS
I_L•foa abli:ion X
2.Windor coaditiun X
31Ia0iccm ckc X
a.tleatkal 4Wum•Ventloloa X
c Ccilmg condition X
&Wallcoadidpn X
7.Condlliva of pas
a) amainp.;ling.0 pwRnp tx o
b) dp(+ecc Sm.. Cs o
c) oo' Ih„'arxd*waved a a
SECTION SEVEN:
BRORGOMNO It landau PASS FAIL COMMENTS
IFhc cccditam X
2.Whidowcmdkiaa X
3 DecaacNtan X
_txlaukd Stores X
.CeiliAt cooStiaa X` ,
6.Wall condition X
7.C(nd 1oz d)eim: -
n1 <cackigscaI
6) chipping a locac a o
01 adcqugdv owedacoah l a o
sECI'ION EIGHT:
BEDROOM NO 2:Iv-Atha PASS PAIL. COMM1N3S
I.Flont emti<icn X
2.Windo._maiden X
3Douroondikg X
ntlaninl Mum X
s.Coif=coMmnn X
AW011 condition[7.CanX
Slnn of paint
a) [rectify..%calms.a wantox a
b) ahixonx a Imo0 W a 3
equmnY Doted ac+ool a
SECTION NINE:
BEDROOM NO3:Imam I PASS FAIL CIMIMENT3
I.t'xn amalgam
2Yfmdec eaclnm
;Loco con$lmn
q.Exaolnl Swots
SW=caminon
Wall apdikm
LMiliun of pun.
towkinA man*•or pealigp o 0
cirri Rap loose R n
_ caWa•x:Th eW eando•oa o n
SECTION TEN:
LDINDIC ROOM OR DIMINGAREA PASS VAIL ODMMEMS
Irlxr conditionX
CAPER 46
OMB COMIoI NO:2506-0117(exp.09f30.12021)
49
2.R aduu ondir as X
tenet conMoan X
4.Eleertiu1 loran X
—
s.CeRfaaccudiRon X
6 Wall aed:nr: X
7Amdinon of puce
a) =caking,salmi ca peeling ex o
bl cbtc+pbgarko.e Ox a
0) aiegeeIsteexd moo.tw5 ex
SECTION ELEVEN:
OTHER ROOM:WNW,_WA PASS FAIL OOfMV TS
Illom marina
2.Wlndds condi n
7 Dom anlitim
IFlechi:al flxIuree --
d CYilinxconielon
QWnll&'odium
7.Cbadiflcn of puny
e) erkiny:c:ling.cc mans e o
b) *pingcckese :e o
0) M1Tmle4 ceded nr context u
SECTION TWELVE:ENTRIES.HALLWAYS OR STAIRCASES: —
PASS FAIL COMMENTS
1 arum.dieal X
1.Dam oxdllla X
1 bbxkk I Eames X
4.Celling:audition X
5.WAl medium X
Madigan of malt
a) t ckir.senhlp-u peeling ex o
b) c_ppmg or!cost ex a
a) novas oared nr amend ex n
SECTION THIRTEEN:
CRNABITAHLE ROOMS:ha PASS FAIL COMMENTS
LHN dti.I oondiSns
21catamIH Mint*Inures
1 gndifim of pets
3) cracklepaeRpp,or peeling o n
e) chippkge kart o 0
c) akummN nets or comxred c O
SECTION FOURTEEN:
SUMMARY OF INSPECTION
PASS FAIL
VISUAL ASSVSSMENT OF DETERIORATED PAINT: X
G�(I�f failed Visual
Agpmelt of Deteriorated Paint we Sestina IS on next pane)
"' 10/21/2021
INS ACTOR SIGNATURE DATE
SEC1f1ON FIFTEEN:
Failed Visual Assossment orA+teeiaakd Paint
Failed Inspection Section numbs::
EVsluadcm Results'
Re nmendod Repairs Using Safe Woik Pounces;
CAPER 47
OMB CO In Io l No:2506-0117(e xp.09/3Q13D21)
50
wed YiStml ACtSSaimlt of Lit/visaged Paine
Failed Impaction Sadism punka:
Evaluation Results'
Rcwmmanda1 Repairs Using Safe Pork Pumices__
Failed Vissal hats.-ant of lk-cr:crr.Vnire
Failed lnapaclion Section number, I
EuxJosNnn Raculia:
Ravauna.ded Repairs Laing Sale Work PreNioes:
CAPER 48
OMB Coat iol No:2506-0117(exp.09f30/2021)
51
/ '-4, 0DWM1XEMDFCOMIMlrfAhp[COMIC DtvtIcFFE1fT
' �"is.., ate*c(Negheals300 Dereban K STicc
I12 SSW.Bra Shea !
ID'2h1p21
1: Pt Wa u'9BFJ: Tuna I0:011 A.M.
�Z" Mrs
(
R59)Sp5d101•Fax(503)5]561J6 Recker
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMEBUYER:
Apartment D;113&III)(3 Bedroom)
PROPERTY ADDRESS:Pear Trey.Poet 2900 Pmwtrbouse Rd
PROPERTY ACE:_14 Years
SECTION ONE:
BUILDING EXTERIOR PASS PAILCOMMENTSI_Cmxtake ofmwdabp X
2.Cced6v erase( _ X
3Rptd0Eoo ofsml.K nSr-R pomle. X
a.dMaJ14v11 V[OSencc,u VOa X
fiMint scat ale)
S.Candhlnn ofdlimnry WA —J
6.Conjtioo oipinl;
b) clllpiryvrr,bm arpw4ot ma
a c
a) adyuuelvammla<uwred at e
SECTION TWO:
BUIEBCNG SYSTEMS PASS FAIL COMMBR'IS
I.Ilouigqulpnnu X
2.VJaibdw.Ceapne X
3.1euefhaller X
4 Ramapmnhine X
5.Snua X
6.EloaricaloereobWiing X
]Snake Osmium I X (
SECTION THREE:
1.1VRIG ROfMl PASS FALL ODMMPN[S
IilavoAMie*, X
2Wipdov main. X
3Acsramdi[m X
.1.ClcaMeal:bailees X
s.Celisamna dil -X
6.Wa leanSsim X
TCavdiboo ol'papc: X
a) ?akin9.main,or pedal a D
N.), hipp}ger late re u
ei adeauuely pvaxd or covered la u
SECTION FOUR:
KITCHEN I PASS FAIL CQMMTNES
1.btt wndiliun X
2nndwn vmmsv, X
3.LVa O Mhian X
a.gxeall Sums X _
S.SMkvord'dgv X
i.Cahln.-a.Caunlmnp mptim au X
70eilineeanIiiio X
!.Nall madam X
9.Caadiimeepda: X
4 eling.scamp,or ping a a
h) ct cine or loofa PI o
4adq rw netted y.nd as c
CAPER 49
OMB Matto!No:2506-0117(exp.06f3Q13121)
52
SECTION FIVE:X2
BATHROOM f PASS PAIL COMMENTS
I.FICor<adDm 1 X
2.Window audition X
3.1loommdkim X
AElalrial 6xwueavupeihololl X
3.Tnlln coth L, X
6.Ware hnvleborulnyoculkoau X
7.Tlb or thaxweunn modilon X
7.OLilinn<oalilim X
SWolla+od4, X
9.Cgbilirm Hpsit
a) cb ppim,solmga Prof ox
b) dd pyiraly tr p ux e
adNUYnIV YCiMldfroVp[d M Io
SECTION SIX:
LAUNDRY ROOMNTILRY ROOM: PASS PAIL COMMENTS
I.FIcorcordki.< X
%Window'mulilion X
3.MorooMmo X
41Ial E:mrnvm:iluaioa X
fan'u.Cbdianemdikn X.
&wall mldinm X
?.Cmsslm.dpoint X
a) D.v14t,sail*.of pee&g ox a
h) d4ppin6.t imic ax U
r) admoucl YWG4 emuccrtN Sa U
—
SECTION SEVEN:
BEDROOM NO I:bnlba PASS PAIL COMMENTS
I.Fboroc4aloa X
IOU*.coalition X
3.1b2r mulilioo X
4Elatrkol nxm.er X
&Cellists aiy —X
6.Wa1I coalition X
7.Coo t a Mine X —
o) motsup.utdieu,outdate, aw o
h) 4hippizcrbwt ax u
I c) akgousNumbsi or<over.V [a o
SECTION EIGHT:
1 BEDROOM NO2:boumn I PASS In COMMENTS —
• I.pbxpvdilioo X
2Wvdowoumke X
1.I)oo.rylldnion X
4.Ekarb al forms X
ScAdIsoxdidon X
6114E moxke N
rndidon&punx X
=kite,soling of pudila ox u ducpinx o7Imseox o olOrmaT mmdh wood co
SECTION NIN
M k4aliam r PASS PAIL CGBiMBNTS
IBED otcoROOM louoo condition X
jllll X
Minimnd
3.foorcdxkts X -
m
4Ele:6ical f wuot X
S.Okilbpmtdkko X
&wan uxldlaen N ,
7.Cerdkiaocepaml: X
I) <uud¢g'a600a pot* ox
h) chippirg.r I,x< me o
<) edepuuxly oxsuc on:owed tcm a
SECTION TEN:
DI I GR .,OR DINT ARRA E2I7E FAIL CANMINTS
1.IUxecni lion X
CAPER 50
OMB CO MIDI NO:2506-0117(exp.O9f3Qf3)21)
53
B' mdoa condition X
3Do:om>3bc X
a37aalal Snnves X
S.Ctiliii coixIkic X
6.PlWII tadilion X
T.Cwdaloa apt.* X
e) caMic..%amorotc}S 0a 1 u
h) e hipping a bow as o
c) adeouclf'emote or cownd ex o
SECTION ELEVEN:
QTIIER noon,Wooden WA PASS:FAD, COMMENTS
I Plow and:tia
Dunotndn.:n
3.C.11no.:. (ai
6.WaIIcoo;ttua I
6.WcdItho Eta
kl cooking,sato,or Feting 2 n
b) 01i2Pkt0 bat o 0
: c) Montag'',metal or enwnl e o
SECTION TWELVE:
RATIOS.HALLWAYS OR STAIRCASES: PASS FAIL. COMMENTS
IJ'ba mediate X
2.axe couldim X
3.ERnYtl Raton X
d.Calhgre.aaitn X
5.Wallcondainn X
6.0:xasko of coin:: x
o) crating.^soti-q urpedet8 at o
b) chipprag.t kow a u
i c) ndegmtls ccobl N cewad a o
SECTION THIRTEEN:
INHABITABLE ROOMS:Na PASS PAIL WM6IRYI$
I.Th vital ta:diuuw
2loI1nhplly%wacdom tatu,q
2.Condi&m of pate.
a) oackhg.mexog.cc mhos c o
n) IL'ppnsnrloust I c a
e) Wrautylttved et Cnatd 0 a
SECTIONFOURTEEN:
SUMMARY OF INSPECTION
VISUAL ASSESSMENT OF DETERIORATED PAINT: I PAss FAIL
/ Wailed Visual Assessment of Deteriorated PRIM me Satlon IS on neat Fuze)
I Ot21:202I
INSPECTOR SIGNATURE DATE.
SECTION FW ItLN:
Failed Vldl®I Assessment ofDeR,;an,M Pain: _Failed taspxlion Salina number: L 1
Evaluolion Results:
—
Roaommcnd.d Repoits Using Sale Work Ptaeliou
CAPER 51
OMB Coln to No:2506-0117(exp.09f3Qt3D21)
54
Failed Visual Ames meat of Dateritcaed Paint
Paned inspection Section number: L
Evaluation Result:
Recommended Repairs Using Safe Wosk Practices:
Filed Visual AsatssmemafOderiatlad Paint;
Failed InspaMion Seation number L
Evaluation Itmults:
Reoommended Repairs Using Safe Work Praccoes'
CAPER 52
OMB Co ram No:2506-0117(exp.09f3013121)
55
�- ,. DtlMTKOIT OF CCMKOVT'MO ECOOXIC OINHOPMOST
OBa ce MkRbo&om Omkpment SWIM
."3 %:)'_ 111 South MOP Slice Imp
Mclft.]1M21
t> S'�' ValPmar WmhnEmn 9M01 Tin:IONA.M.
.��� h._; Plene OOM915756101.Fu(509)S71J175 ftwkv.
i:. Pas:
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMEBUVER:
Apammeot#:III&201(1 Bedroom)
PROPERTY ADDRESS:Pear Tree Place 2900 Poo erhome Rd
PROPERTY AGE:_I4 Yen:
SECTION ONE:
RCTLDINT:FlT®BOR PAm FAIL COMMENTS
lecadldnn((Comdata X
7.Condhionorwr X ,
:Leon:blon of nos.mllk A pcStcs X
a.CnnAIMocexlnur ammo. X
(Ad$.MIBI.d4
S.Cw&eln nrehhxan' MA
6 Cmditn MIR: ..
a) mxkb%scaling orpwling cR o
b) arming a bow Lx o
c) mommeaveeeM or cowed cx n 1
SECTION TWO:
[ur13.DaNVi SYSTEMS PASS FAIL COMMFNTS
1 Bodine equiRwat X
2Vndmtipn'Copgm X
3.Waln raver X
e.Ro111keiumbhg X —
'Seine X
6.12ecotl 3evk.AWktre. X
*Smoke Demean X
SECTIr9N THREE:
UVMG ROOM PASS FAR _COMMENTS
I.6looreonEtioe X
3 Wilda*cndniml x
1 nuucacdtka X
4.Eleenknl Sono X
I.
5.CamcorBtko X
d.Woll conditionX - ,
7.Canakc oipoln X
.) codas xrdigU orpesilg oa e
b)
chipplrg or lox. m a
c) adnuaxly motet a coved cm n
SICCTION POUR:
1 KITCI EN TARS FAIL COMMENTS
friarmndiliuo I X
7.WMdnu'oc 4sn X —
3.Dxr:ondiliun X
d.RIxkial taraaa X
5Sinl:cad3ix: x
&(1Nlwttcamnropcondrkw X
7.0eillMeopdiiax I X
&Wall cooMinn X
9.Comakoorplim: X
al crecenlp.aTm me ling as o
b) dupping a tomeIlt C
) adesmink'vaned ar covered og o
CAPER 53
OMB Co M to I No:2506-0117(exp.09/3Q1302H
56
SECTION FIVE:
BATHROOM PASS:FAIL COMMENTS
LEW.ccoako X
2.WIndxn condition X
3Dnmooadi6o.i X
4.BIONkkl rixlureCVacihdea X
S.Toileconaioc X
R.Wei NACII c:oreloryamNlinu X
7.1t b at dower unll mMiko X
7.Celing(cedhian X
Mall gxiditcn X
9Cdadltoa orpkine
a) cocklti naliug.or polies C n
b) c41: gmloas a a
e) ad14/11v traced orumead o a
SRCTION SIX:
LAUNDRY ROOM/UTILITY ROOM PASS I FAR.I COMM[wrd
].Mote celanna X 111
WSduw common X
4•.Uw:ondition X
.Otttol:lv:naNtaebdan X
S.dkl:ha tcaditon X
6.W211amdiioc X
?Ccad dm oratsg xn
a) mainsecuiim.cc poling
b) atpng main. ;x n
C) aSaEGIc rn30ed or a(nlep ca n
d .J
SECTION SEVEN:
BII RDI OOM NO I:Indite PASS FAIL COMMENTS
I Tboondilion X
7 Wcdow onAMicaF X
3.@le condition
4.Kkericl foams X
S.Catisst ndieccl.w X
6.R' rdibx
7.Cccdiccn orkahe X
R
a) cocking•war*m pmlulp ca o
M cMp.tgor km* cx n
c) nkpwtoly ma.V or.roared i cx a l
SECTIONE(GHT:
i BEDROOM NO2:location NIA I PASS FAIL I COMMENTS
1.7'ca condition
7.Wndow=Mica
3.Ccarcorahlon
4.Oecmml Dimes -
S.Oillogmndilion —
6.Wall tcctjdoo
7.0alaklaaorp, c
a) oakick some.ceptolhE n a
b) (hrpping ce loon o a
cl adqunelr malodor cove o c
SECTION NINE:
BEDROOM NO 3:Imam WA PASS FAIL OgMMBns
IstomcaaRiaa
3.N'indon condition
i.nom coodrko
4.Tdecnkol Exams
i.CtIling comi:Ioc
&Wall condition
7.CcN iam oescinl:
a) aadm6.wittily.mpedall o a
b) ehippkq to k.os
C) adcgmml)'Celled orcmen6 o n
c rn
SECTION TIiN:
DINIMi ROOM OR DMING AREA PASS I PAR.I COWITIDITS
IFluaomdti-a X
CAPER 54
OMB CO nttoI No:2506-0117(exp.06f30.12021)
57
2.Wlndowucndidm X
3.LWr emaitim X
02m:ea Gunn X
S.Csiinp ccodiliun X
6 Wall oadv ti —X
7.0.ndidon afps it
a) atkins emling,r paling CX a
b) &Epings lame mo c
v) tdaq:Onz:road ao»Wo3 az I a
SECTION ELEVEN:
OTHER ROOM locaRun WA 4 PASS pall.'COMMENTS
I.Fleercondman
2.Wwdow:mdieco
I.D crcoAtitiaa
al2eantal Gum
Weal Ovedidon
6.Wal corlckn
n.mdieco drpoia-
e) cldoing,»aliy,orpmlln8 e 0
b) OARME0/kneeu e n
a! SSCQurMN mond or cowed e n I
SECTION TWELVE:
r RNTRIER HALLWAYS OR STAIRCASES: PASS FAIL COMMENTS
1 TEE.=loon X
x DO W mnadm X
3.EkenknlSores X
4.Cali:Kcc Sko X
S.Wall condition X
6.Cm.4lnorraim:
a nkiv.&EOMmpedey rn
to ebippinSer Rene ON C
e) admuuoly Teru.3cccovered m C
SECTION THIRTEEN:
UbRABITABLE ROOMS:RYA 1 PASS RAIL COMMENTS
I.F.be-v¢a;batzde
2.Ponceolty bvanaas fmwes
3.t31Cikc nf-polm:
e) andunp,xerI&m eeda8 n e
M Cl:ippbg or laze u c
el 4dammll'nd11al ix covered c n
SECTION FOURTEEN:
SI:MDIARV OF INSPECTION
JVISUALAcFSSTIENT OF DETERIORATED PAINT: PASS FAILI
y�/��Of faked Vunal Maresca of Delmioratd page)
Paint see Section IS on neat pa
10R1/2021
INSPECTOR SIGNATURE DATE
SECTION FIFTEEN:
Vai3ed Visual A$apsmmtotnactiolud Paint:
Paled Irnpedion Section mmlbec I I
Euoltmlian Results:
Reconnnended Rcpailx Urine Safa Work Prwicee:
CAPER 55
OMB Co mlol No:2506-0117(exp.0Sf3Qf3021)
58
I Failed Visual Assessment ofDctethmtcd Paint
Failed Inspection Section numbs?:
Evaluation Results:_
Itecommetxlud Rcpaus Using Safe Weak Pmctiecs:
Failed Visual Assessment of Deteriorated Paint:
Failed Inspection Section number: r J
Ewlusting Results:
Recommended Rcpaics Using Side Work Praedccs:
CAPER 56
OMB Co at to No:2506-0117[exp.09f3012021]
59
'r r 1.. COMMENT Cr Q tlWCY MC EONCMICGfiRCPEEIN
Q'ekeof Neah3Mlad Or,&g nare S,nka
, Ll2SattSfl Sereee 7mpeakppme:IlOYd1
jr r !. YaDml.'AbMlgm 569Y Tma 10:00 P.M.
1;' - j'.. Nat(%)535LL01.Fax(SM)d754I3s Comb:Ymeu
tRime.
.
ROUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
FROMEBUYER:
PROPERTY ADDRESS;1423 Karr Ave
PROPERTY ACE:_5 Years
SECTION ONE:
BUILDING EXTERIOR PASS PAIL COMMCNES
I.CcedNbn efknad»w X
2 CoadiSan ntroM X
3Andilion*not,rails.R pvrctd) X
aCaonduion of maim at6roa X
(xidaa.soMl,rac) _
S.CaMtlot ufchineey NIA
A.a)uca ;
a) crancking,in5,aatsg,mpaWg at a
IS chIppko urtone ax a
e) ademambAraned or movrvd ax a
SECTION TWO:
BUILDING SYSTEMS PASS PAIL COMMEXIB
I.Rulinn ua3�pnam X
2.V CLIDamEnnllas X
3.Wabn hevhe X
dRwxhPl,lnhine X
SSwm X
d.Ekarkaa tavaeWMn6 X
].Smoke Daman X
SECTION THREE:
MIND ROOM PASS PAIL I fnMMPNfg
I.Yhve andidm X r
2.wadaw coeflia 3
3.Dearcndhlon X
4Y:swi al faros X
S.Cciaoaldilian X
twin oadD.i= X
7.Coadikm apace X
a) amklos,maiiS.wpmling es a
b) cb4:04 Lekan ex a
Sent*kwod mwnmod Oh a
SECTION POUR:
ITCHEN 'PASS PAIL COMMENTS'Elam condeim X
2.Windm.madame X
3Cwwcma[ys X -
a9rcaiel fauns 'X
5 Smicamdlt a X
ac*blxRtmaxnop caxka X
1Ceinnisc{t.:[iae X
a.Wall:undnian X
9.C:t4uz otaim: X
a) =long.folk&m wane In n
i) chipping alone at a
1 c) AM:Palek.owed urormed at Y
CAPER 57
OMB CO MmI No:2506-0117(exp.05f3Q13)21)
80
SECTION FIVE:X2
'IMTIIROQt1 I PASS FAIL COMMINTS
I Flow conditca X
1 Wiad xcmikim I X
3.Dafe omdition X
d.Eltevkk SxavavaNbata X
S.ToilnccceMoa X
A Web burvtabanawy ccaMEMp X
T.'Nb nr Sumac urdtcnMllioa X
T.C<Mag cndilioa X —
(eW'MleattCon Ix —
9.Cvndiden ofpdnl:
a) amkhn waling,cc manic XR a
b) dyyink wluose Xa a
c) reegmlev Exited most d XT. 0
SECTION SIX:
LAUNDRY ROUPLUTII,1TY ROOM: I PARS FAIL COMMENTS
1 Flaxceedillon I X
2.Winduwcwkkke X
3.D3X condition X
i6lsvkYRstumWovlLEm X
5.cenigeocatm X
6.Wall conliliva X I -
:.CmdirinOTfeiO::
a) axeturk,*-Iocc Pxi-c xc a
C) bippblea ka xn
e) adequately scam]at cowed Xa Ia
SECTION SEVEN:
9E0ROOM NO I:(walks SW PASS FAIL I COMMENTS
[Thar aeration X
T.N•wdovecpbldoa X
3AtOrcwd$io X .
AXIcalleal Rums X
s Ckilinv coMbiou X
T WMI omdbCce X
CondMa:kM or pint X
a) abls.snlinia-polio% ex v
b) dlppin$a-Innse OS a
O ndwlulet}'vemdorwlentl nx a
SECTION EIGHT:
BEDROOM NoR Nodes NW PASS FAIL I COMMENTS
1.71oacoodmnn X
2.Waldnwacdilioa X ,
3.IX`Crconlbm X
c.Ekrrmwl Smartt X
S.Cciisa c.'diliun X
.6Wdi wcduun X
l.Candiliun of pnli
a) crackb.smanta paling Xei D
b) tbAccaMa:Ooto 'Co J
cl tleraldy haulm comma Xa o
SP.CTIONNINE:
DRDROQM NO3:lataripn NE PASS FAIL I CUDIMEFTS
I.blONcondMnn X
2.Wlndow wMitm X
3.Umreomthiop X
d—Tbximl Mons X —
3.CClltnt cundblon X
d.Wail corm is X
t.Cnndlllonofpsnt
a) w1ckiD.mans,or peolln6 Xn a
b) aim*a lows X7 a
C Mbar,*VClrcda wand Xa C
CAPER 58
OMB Co ono No:2506-0117(exp.05f30.12021)
61
b'EC ION TEN:
l DINING ROOM OR D)NING ARIA I PASS I FAIL COMMRNIP
1.1.1normalticca 1 x
2.WIImm.moans. X
)Docamedaka X
AFluenieal Samna .X
S.Cefllmcoodiioe X
6.Waall calbmon X
Cm2imadmk6: X —
a) enacia,scalp,ar pta.c Xc I n
b) chIppinc etloxe Xu n
I t) mmaNely mated m aimed Ma n
SECTION ELEVEN:
WIDER ROOM:location I+mlly Room PASS I PAIL commits
ISlarep aiipec X
2.Wixywcerdman X
)Domomddia X ' —
.1 Elmnial Mona X
tecilinsoaadkkm X
6.WaII cmMiliun X
'..1 mlmddm:
b) ain,scene&a.ma* Xe n
b) shipping cc Fes Xc n
e) admumely amid et covered Xa n
SRC7ION TWELVE:
ENTRIES-HALLWAYS OR STAIRCASES: PASS'FAIL COMrCNTS
IFlaeoladuxn X
2.Dom a.?ndiI co- X
3.Elueni:al flames X
d.CleiEnecoedey: X
!.Wall ctoditiun X
6.Cun4lon of mini:
a) mai&feaim,mpev Xo a
b) chipping a.Imm Xn a
e) adrNaey muted mcmen d Xo 0
SECTION THIRTEEN:
JINRABITABI.R ROOMS:WA PASS FAIT. OOMXINNIS
I_Slemlml mediane r1e
2Polmdaly tu.xduca*anew NrA
aebuditen Oran
a) craleins.sm.y ea Feeling n u
b) cnigipm lame r n
e} admenoy lnna6 oronomd o a
SECTION FOURTEEN:
SUMMARY OF INSPECTION
pat FAIL
VISUAL ASSESSMENT OF DETERIORATED PAINT: I = I
at failed Visual Aeaodsmenl of Deterion.ted Paint me Section 15 on Btxt page)
6/ I 1n6n021
INSPECTOR SIGNATURE DATE
SECTION FIFTEEN:
Failed Visual Asecmmenl ofDeterianted Paint:
Failed Ins➢eeioo Section mimben r
CAPER 59
OMB Matto!No:2506-0117(exp.09/3Q12021)
62
Evaluation Results;
Recommended Repair.;Using Safe Work Itanicar
Falb Visual AasemmentofDetabra od Palm:
Failed 4npeceon So lion number:
Evaluation Results;
Recommended Repairs Using Safe Work Practices;_
Failed Visual Asseumam ofDaterxuted Prim;
Failed Inspection Sanion number: -I
Evalumion Results:
Reoommendal Repairs Using Safe Work Preeticcs
CAPER 60
OMB Co nttoI No:2506-0117(exp.09f3Qt3121)
63
CT"... CEPARIMMT OS CONMIMTY PI4D KalONX DEEiSPNEMT
i4,. Cl6re of N atit.dtod Dembpmax Sims
IaaM EYfDl9
YNr6Ta,lWfhytn 9PP01 IMVXMicn Dalt WOO Tint:ISO pm
Wpm MO5756101e Fax(S39)S?5617o TleahW.%YuIm:NA
y Tfiml:
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMEIft INSPECTION CHECKLIST
ROMEBUYRR:Renal
SELLER:YCRA
PROPERTY ADDRESS:I I0S Willow
PROPERTY AGE: 39 Years
SECTION ONE:
BUILDING RXTRRIOR 'PASS PAIL CDILMRAIS
I.Cersdhleo offamisdon X
2.Coofsko Geste X
3.0am4bn ofoolo.na.&rink, X
+Q,ulita.ufuuale sunl(wf X
@idi^in to
S.Cundllion of olshilmmy WA
6.CooStim*Splint -
l) a...Mip.EAR=or xNlso X a
b) chipphga No: X o
i a) adequuoW monad orcmaed X 1 a
SECTION TWO:
BVILDIPIG 515TRMS PASS I PAIL COMMRNTS (
I.Nalint qulpsanl X
2Vmetlioatooling X
3.Walmhmto X
ARougbp'umblax X
Meow X
6.grtial saviooWirilly X
?stocky Demon X
SECTION THREE:
USING ROOM PASS I FAIL COMMRSTS
!Moor caadokm X
2.Winda.cmdidon X
!Mom^ImkOon
_Elaei:ol Sxhues X
S.Ceilirs waibP X
o.Willcolsdhlo0 X
os
JIA wmP.at mAiop X n) NISSMGrimm X n
c edequoslyaresoJ wanted X o
SECTION MLR:
XRTHEN P
SSAL CMMMSceeoikbo X
.Wi X
3.Daur=aka
X
0.Rlmlrb l dllion X
S.SmkxandSan X
6_L'SMnwCou emo WndMaD X
?Coln asnd'alon X
/Wall=Sisrn X _
S..Condhlon of puny. —
0 cuteeng.calk.yrpfrllg X a
b) aiming atom X o
a) Smugly vector covered X n.
—
CAPER 61
OMB Co MIDI NO:2506-C117(exp.09f3Qf2021)
84
SECTION FIVE:
I BATHROOM XJ I PASS PAIL CO)IMENTS
1.Floa condition X
].Wiidaa weak" X
)Worcadika X
4Fbarical faaa4Nealicka X
SThIIOYcoMitim X 6.Wan to intabora ary acclaims X
7.Tabor slower unit mealier! X
7.Cd:ik condMnn X
8 War aca.Hioe X
9.Cinditian ofpaiq
a) =ciao sating.¢ocean X a
b) ecgcvno cc loan X a
aIwxf?A+YaaaeJ¢eaaWW X 4
SECTION SIX:
LAUNDRY Inca ROOMNTIJIY ROOM: 'PASS FAIL COMMBBTS J
lan X i
].W'Oban weaken WA .
"Dacaleal user X -
4J aceIcaIraoec'cHbIa,ice X
ll ne condition X -
6AVa
b.WAll aodital X
?.Candpionofptne
a) awkiraL n) tldppIngora cc peeling X c
X
el adaoeallr I:OWamrt dml
X C c
SECTION SEVEN:
REDROOM NO I:lathes Master PASS I FAN.I COMMENTS I
IJ-lmr catX
2.W'indan eadidea X '
3Dwocaan:n X
4.Ela:lrkallia al X
l.CcBingcwdiim X
6.WelIandltion X
7CopEdx again::
I) cntq,aexlia or?Mkt X c
b) cbippllga'lore X a
C) aJanaq':Melee orcaoncd X a
SECTION EIGIR:
BEDROOM NO 2:lentlen mid Xi PASS.PAIL CQJ*MLVIS
:flax aadiiicn X it
2.Wcdaw eaMicia X
3.Ibdr¢aiiban X
i.k]olaiaa axorxa X .
S.Gitat(»m k° X
&Walloeedaka X
7.f.1CMiliea afloat
a) ttakl0b'alinS.a Pal* X D
b) tbieanga-lease X a
C) stouts*ironed cc nomad X a
SECTION NINE:
BEDROOM NO3: PASS PAIL CJMMEN7S
I Plaaocad be X -
1.WiMrA¢ndilion X
•]A)a:noocdican X
I.elafiatkN fiat X
III
1(5.Cal'vAa 42ic X
d.Wa1coMklnn X
cook n of part
a) aatho.atlte.or paling X a
o) cloaks:a)me X D
C) toxpalblytntad wonted I X
SECTION ITN:
DINING ROOat OR DCIMO ARIA IPA' PAIL romans
I.Icoorc,MMoa
CAPER 62
OMB Co IR lD I No:2506-0117(e xp.09)3Q13021)
85
2.wiadm.caution X
)Soot wc411600 X
i.@amKal fixates X
_S.Ceillntctnaim X
d.WNlwnd'miml X
7Com not cesaim:
a) cnaang.ma.*,nrpeiin¢ X n
b) ckippirg orlout X o
c) okemnlp mtalal or cal !X
SECTION ELEVEN:
I WHIR ROOM:lxorba I PASS FAIL COMMENTS
15IOamallece
2.1Vinenve con:Waa
3Saoc cmdllion
d.ELatc J lxvtl
S.C22242 o Mlonn
6.W211eoodika _
CCcclidcn ofpaka:
a) crotkins.4nW,at palling n o
b) aalto*mbce< o
c) okgwwb eemta or covered o n
SECTION TWELVE:
@d79tlltl,NALLWAVS OR STAIRCASES: PASS PAIL JOMMENSS
1.F1Ae wndidon X
2.Dan wndIIan X
3.B:onto:at cocoa X
4.Co964 mMieon X
SAVO conimen X
S&Cotdilial apt:
a) ealtkinp ccIte,urpeeIu, X
b) chipping erma.t X a
c) admmmb oaBdcr coated X a
SECTION THIRTEEN:
[INHABITABLE ROOMS: PASS FAIL COMMEXTS
1Flaaindconditinm
ITABLE RYA
11Pooatialbnaoambs dtaoo NIA
3.candilicaafpaiot
cratke,ewlins.ae petting In o
0 sb:ppintaWun c o
c) 2216.21.1213 fraud ntrn l B p
SECTION FOURTEEN:
SC61.NARV OF INSPECTION I PASS I FAIL
x
Of failed Vocal Assessment so Section IS on next page)
12f1621
INSPECTOR SIGNATURE DATE
r SECTION FIFTEEN:
1 Failed Visa Asscssmenl;
Tailed Insyra-[ion Section number. I
Evaluation Results:
IReealumendpd Rquirs Using Sefe Wolk Pmcdces:
CAPER 63
OMB Motto!No:2506-0117(exp.06f3Q13)21]
66
Failed Visual Auetemnt:
Failed Inspection Section manta: L
Evaluation Results:
Recommended Repairs Using Safe WorkPra:Gees:_
L_. Failed Visual Asuasmeat
Failed imp:dion Section number: L 1
Evaluation Results:
Recommended Repairs Using Sate Work Practices:
CAPER 64
OMB Cmn ttoI No:2506-0117(exp.09f3Q12021)
87
^
DE➢A21Nort esOr COMMUNITY Al ECONOMIC pealg(O: r
.-' ,- ODD CC?myNEPT nO nftN 0W CCODaa Se
j", 112 Seth EOM Steed Inspedot Dxr.1Y1621
3�i, )T: Talked, �YlIrcjP,?By]I tow Hapn
j(( 1 Mort(979)57581oI.Pea(30)snllR Wdm1A..w.vam
Plate
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
IDOOIEBUYER.Rectal
SELLER:YCHA
PROPERTY ADDRESS:1410 Willow
PROPERTY AGE:all=
SECTION ONE:
BURDD(G FxTBRION PASSFAIL =D17MFNTS
i.Cc dlaon orfcandapon - X
2.Cwldifl000rroof X
3eedi.Co :iml Mawin.:alls.@ perdue X
.C.:.+ex:..:,:ce.. of senors X
(Siding.sokgelc)
S.CbndiGea of theme"' WA
QRwditca orpamt
e) creeTioa%mlios.ei peslilg X O
b) dllpptnpalomM X o i
c) adequnelr towed a covered X a
SECTION TWO:
BUILDING SYSTEMS PASS FAIL I COMMENTS
c&ec pinmi X I -
I.MOR2.Vemll.ciccK'wlme X
3.W'a cr bear X
ARoup :bi ll plmnp -x
&Sour X
6.ELtten!son100/Vine X
7.Sra*Cancan X I.
SECTION IMPEL:
LIVING ROOM PASS PAIL J COMMENTS
!Moor cardiSel. X r
2.Windor et/Widen X
3Dom oenheiee
X
4. lerkalMaine. X
a.CeilIMoomMxo
G.Wull condNon
7.Cblea of mire:analog,AAllr&orrate. XX
X o
b) chIppba cr Wm X a
O g4rqumey imam!or c vor.d X o
SECTION POUR:
IKIKRBN PASS PALL I C IMEWIS
I.ryoarcoMeom X
2.Wlndoo mediae., X
3DwaoaoEke X
FWrkal flaws
dSA mndilice
6.CebinecGaneace,mldiaces
CilieC aondtinn 'XXXX
_
—
SAVall Nadian
X —
SA:Audition of peat ,
e) aaac.2be,vedas.or(.p}� X a
b) a wnp mime a
e) admaamly Nisei«covered X a
—
CAPER 65
OMB CO MB)I No:2506-0117(exp.09f3Q13)21)
68
SECTION FIVE:
•BATHROOM X2 PAS$ PAIL COMMENTS
I.Psac.Maim X
2.Wmdm mndlXm X
3.DmraoMHm X
&PJcnlcal frum<NemlIRkm X
'STAIR mnditioo X
6 Kash basing shrmnycordklo<o X
7.Tub a<bonarant euwi«.. -X
7.Ceiling oocdition X
8.WMI<oo iun X
9a'Mdym ofpokn
a) 4nitntacbor;scaE X o
b) ahlppkgl bast X o
C) odcoumoly CRolokr covered X o
SECTION SIX:
LAUNDRYROOMARILRY ROOM: PASS PAW COMME IS
IFlem croaky X
1Window cmjMnn NM '
313oore<<Wilta X
'I.Elatrkal Pmmn.Namiloko X _
S.Ce&IInt maim
6.Wall mndifwn X
7.Condaion of paint
a) =MIw login.ap--elInt le n
b) &ppino road palaow X a
H tdw eIyredaommpd X o
SECTION SEVEN:
BEDROOM NO It Imo MMmr PASS Pwll. OD61ME&T6
I.PlotteonJilion ;X
2.Woduw mva lai X
3.Doa Condition X
a.61<miml Swat X
SOS/kg tmdiem X
6W'W mWsia. X
7Cmdiem apart-
a) amkkp,a<kt&cowling X a
b) Chyp&M mkam X a
C) oeoRmia'eced ofdowni X a
SECTION EIGHT:
IIEUROOM K02:location aid XS I PASS JAIL COMMENTS
I.FSacondMon X
3.W.ndow emalr:M X
3.Dcorcondkicn X
CI'umlcal ratans X t
—
Salilhm<nnaeion X
60/all mMidm X
7.Cunditinnefprkk
—
N omteg emlinp.a wok; X o
b) diFpla ce loose X a
in Wait hated at cowed X n
SECTION NINE:
XEfROOM NOR Rooks PASS PAF I COMM a:
I.Manrcmdam
2.'Rlnam emdliscaHE
3Domommko Fa—
a.EI4'llkalRymrt< X _
5.0silimoonim X
d.W.11(ondmon X .
7.Car$kn odpoim:
C) <raCkreaztligC or pears X 0
b) chipping or kmo X a
0 MMus*tooted or cowed X
SECTION TEN:
LIMING ROOM OR TIEING AREA P PAIL COMMER7g
I.Floura>ndzka X
CAPER 66
OMB CO ono No:2506-0117(exp.09f3Q12021)
69
2WiWn.eadein Ix
3.Ooaf modlton lx
AEkcUkel axiom) X
Stallion matte x
6.WWl coalition X
7C n..ton ens:
a) enticing.eceley wpedap X n
b) ebippte5 nrkcw x u
e) adequacy maned or centred x o
SECTION ELEVEN;
OTHER ROOM:laeadaa - WS PAW COMMENTS
Max amazon
7.1)ehdewe rain
3.1)ece condition
adnm en'rumen
5.Ceatgeriditan
Mance:4ki t '
iegivilince Onto
a) Oaklny maw,wattling O e
b) cl P.e es loose o o
c) eStanmh'toned oreonrd o n
SECTION TWELVE:
INTROS,NALLWAYS OR STAIRCASES: PA89 PAW DOMMENTS
I.Mor eaklilion X
yDive mnAMnn x
3.eket<Y Mains x
&Cal mwadix e X
S.Wn6 action X I - _
feCcedlfe apt
a) oxides.xaxq,orleelinp X n
b) CFippig or Yeas X n
0) u*gto aunt or covered X u
SECTION THIRTEEN:
LNMABffAR1 X ROOMS: I PASS PAIL COMMENTS
I Ito:hive,coodidnn WA
1..AxemieihhexWrs koceu WA
SCondition of puuu:
o) cockle&amling.ce mane 1 c o
b) &aping cc loose L -i
el adimaindy tenet au..aed u
SECTIONFOURTEEN:
SL-M%IARY OF INSPECTION I PASS I PAIL
I x
(1t(Biikd Visual Assessment see Section IS on eon page)
/ 12/16/21
INSPEC R SIGNATURE DATE
SECTION FIFTEEN:
Failed Visual Aaveto:cm: I
p Failed lns :don Section number. f J
Evaluation Results:
_
Retwartended Repairs Using Safe WorkPmetices:_
CAPER 67
OMB CO M to I No:2506-0117(e xp.09/3Q12023)
70
Failed visual AxsesSMrnt:
Failed Inspection Section number.
Evaluation Rcaulu:
Recommended Repairs I(sing Salt Work',retaken
Failed Visual Aauaaoti:
Failed Iaspecdoo Sonion number: f
Ewduatioa u�ulm`
R000aunended Repairs IT Rog Safe Work FIai kes:_
CAPER 68
OMB Co miol No:2506-0117(exp.09f3Q12021)
71
DEPARTMENT OF OONCIIrrr MO ECMC CCEVELCPNEIR
\'}`: Wand RB6n0akod lWwloTMm.Sntsr
I IMTenLn Cate:1711671
rfz son eymn SUM
,�i.`"t. roll rmE Ito pm
• 1 '<f )ns'd:Ol•Fm(�911]56r1e Rn•IIor:At•..I•vnu
I:�. , F RE
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMEDUYER:Rectal
SELLER:YCHA
PROPERTY ADDRESS:1412 Willow
'PROPERTY AGE: 39 Yen
SECTION ONE:
BUILDING EXTERIOR PASS PAIL COMMENTS
I.Condten NPouab:ion X
2.Cankon armor X I
—
SAwlilimoPmim fa&Fucks x
Minim se:EL ex)
l.Cendidon of Micany WA
&CalmEen or pint
n) twAbg,soling.a pelim 1 X e
IO Wippint a bate X 0
01 LInwmcry raced b*nixed X a
SECTION TWO:
BUDDING SYSTEMS PASS PAR. COMMENTS
1.11emimegaiveu X
lV.wiWionto xrs
1.W'ma lean X
4.RomE plumhUz X
5.Senr X
6Meomml%avid Wirim X
_are.Nae OPxcros X I
SECTION THREE:
LIVING ROOM 1 PASS j FAIL COAIMErrf3
LHDacendiliea X
2.9Fodow oAvAi l X
3Dmeootidm X
4S IIfi,eo Asann X
61,41I dick.en X
7.Waliiionnin X
].a) .t.lenNls l
o) •aXk'v�g.smlelg.apaling X n
b) e4pingorrInau X O
n) biequnH)wand aoaeron X 0
SECTION POLR:
KITCHEN PASS FAIL I COMMENTS I
I Fx econ,IIIae X
2.W:ndewcccdi&n X
3.Occrcerdtial X
A.Ney Am(al ued ' X
SSmk onr&aim X
6.Cabia reminalop cantinas X
T.CeilimwMYna X —
a_Wollcondidon X
9.Condtiro of;aim:
u) crocking,ec:. ,a,F,:ling X o
L) rasing a loan X c
e) ado metvn aW or covered X n
CAPER 69
OMB Co nt to I No:2506-0117(exp.09/3QT30211
72
SECTION FIVE:
_BATHROOM 'PASS PAIL CObRIBNTB
I.rYurcaMalgs X
2.Win6on'ttadilion X -
3Dnoracdcku X
4 Na6bn1 f:xwetNUNilaebn X
STOUR p=ios X
6.With bc.:Arba toryeadii e:s I XX
7.T aI or ebanv unit a ndiuon
7.Ceilintwniilip6
LAWNI mWiIA o r X
9.CnMaion of pi flu
A) <ntkt4,(caliot,e.pnelirg X e
b) <Nipping or loose X a
e) Stoutly wood of awedx o
SECTION SIX:
LAUNDRY ROOM4.TD3'rY ROOM: PASS FAIL :'OMMFNIN Libor condition X
3.WWdow amnion WA
3.Doaanimon X
4.Ekmiml;iuueeryenr�liw X _
S.Ctiiingcmalaon X
GWAU omdEtke X
7.Ceodilioo of pant
a) ttxbin,azaling.ce radix 1 X a
b) t4ipplotwlaos X c
o) eenluraly regale.cone X a
SECTION SEVEN:
StDR0031NOLBeatles Mama _� PASS I PAIL COMM
I flow aadsa; &
2.W`nlowenocRioa X
X
3.D>or
4.BBca*S o*ktl rxntes X
S.Callnaccr.Naal X
X
6.Willennikic
I T.ebu6ital m'pNy
) catingc'ngm palin
leLTPlot a) MRGcm
Ia omega X X I n
n
X a
SECTION EIGHTY
BEDROOMIoutlon C31N X2 031.61CRS
tis.=akin 2.lvtdow
3 on
X
4.Gkmlgl atom X —�
S.Ceilig maAiliun X
&Wall andisen X
7.Corclklon of palm
4 caapI9.Rallru.er polleeX
6) chino.;or!me X n
L e) **ottaRlr vexed a covered X a
SECTIONNINj::
BEDROOM NO3:louden I PASS FAIL ODMMFNFS
e.Fl crco.WWun 1 X
2.0tendox madmen X
3.D^u canard*
4 Eecoleal 6xout. -X
S.elilintenrdkicc X
6.Wall ctMfian X
Med:ri*:*[Wave
A) =lam.xaBie,W mmHg X a
b) admits ataaa X u
c) rda aik6S i actor coved X a
SECTION TEN:
DINING ROOM OR DINING ARDA I PASS I PAD. COMMENTSIltooreo*dtio. X
CAPER 70
OMB Co It to l No:2506-0117(exp.0913Qt3)21)
73
2.wmdoaa,:dWcn X
3Norcmgtla) _ X
A.Flaial taste, X
SCAllh@ aadidmi X
6Wallanditoo X
7.Coodition of pilot
N0 cncblay*alias.m pcellRI X c
b) r[Wsing or loose X c
d rdcvvdv Raamlx unwed X c
SECTION ELEVEN:
OTHER ROOM:becbm PASS PAIL COMMENTS
I..go co:ien
2A6odew dcvundiden
3loccaraion
a.Rourial DIN.
n SWX111nd cJ&Id.aa
&Wall omdiea
7.0)MM:qu ine
a) umeiv&aalios.o Folk% u o
10 ddppingm loose 0 c
t)
c) adto:ecly tcmalm wand o c
SECTION TWELVE:
FM'Ras.HALLWAYS OR SIAJRCASFS: PASS FAQ. COMMENTS
17lpmemdiice X
a.now weak" X
S.Flaolal Roues X
a.CailiaaeonRioe X
s.Wall ccedlna: X
•Qnndilien tune
M1oel soling,m siding X u
a) �
ippinsmaow X c
el claquesl7 Weirdmcgwn X e
SECTION THIRTEEN:
UNHABITABLR ROOMS: PASS FAIL COMMENTS
I.Rkajml bmirdat
2.pm elltocv2oadaa repose WA
3.Cbndleal orpei;e -
a) nm inw.rcdag.or reeling a o
b) oaypingco bow c o
c) adeoemenruced osaramd p o
1fSECTION FOURTEEN;
I SUMMARY OF INSPECTION I edits FxnJ
(IflSilcd Visual Agaeaaaemg see Section IS on Bcsl page)
INSPECTOR SIGNATURE 12/16/21
DATE.
SECTION FIFTEEN:
failed Visual AMLwmem:
Failed Inspection Sectionnumber: [----1_
LvaluaGon Reguhg:
Recor stet. p.i Repairs Using Safe Work Praaioe;__
CAPER 71
OMB Co MIoI No:2506-0117(exp.09f3Qf3)21]
74
Failed Visual Asseawmt:
Failed Inspection Seciion number P
Deduction Results:_
Recommended Repairs tlsingSafe Work Practices:.
Failed Visual Aa9e mar:
Failed Inspection Section number. I
Diahrn&m Rnndra
Recommended Repairs Using Safe Work practices:_
CAPER 72
OMB Control No:2506-0117(exp.09f3Qt3121)
75
I ,7s,)-fie I DEPARIWWT OFCOMNWSTY MID BStloxtc 0.i4DX6EXT
/. 1:. Wax at NU�btbooa Oe.ttameRSBvt:s Inspntiaa DPXa ILI621
i 112S0WI D5hm Stitt
` ! Y hm v/p9.ln}an 96901 Tta:l Ap pm
AMC(S:595755101.FX<ISCO)5756175 Eakin kinaio/a6t
I Now
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOAIEBDYER:Recital
,SELLER:YCRA
PROPERTY ADDRESS:507 N 6a Ave
PROPERTY AGE: 39 Yam
I
SECTION ONE:
BUILDING EXTERIOR PASS FAILaNTS
1.Cmdieon o('.wndndx X
2C'a.diiicn otrcot X
).Caadmoo ass".milt,k pcalw X
a ro..yli.o or.w..ior wm[y X
Batt saoh.ac)
,SCordiloa atchhdnan NIA
&Canaan°fat.
a) axkh&salitt rpaella: X a
ID dipping.IOW X n
c) adw9axv mmecicco tad X n
SECTION TWO:
RIIRDIN I SYSTEDIS I PASS ma I COMMENTS
Madreygmror
I X
].Yemlbdcatxdina X
?.Wake hear X
daamb putting X
SSewr X
6.Ekaak-GxncerWiina X
?Smoke newton X I
I
SECTION THREE:
LWIbti ROOM PASS FAIL COMMENTS
I.Pmacmy1:iaa X _
2.W"mdowceudilioo X
]Door ardiren X
ATIscni:W 6xlurds X
5.Cainicare,A, X
6.W.E coaaikm X
7.Covdgxa epic.
a) tladcap•s<oa'ng•or paella': X e
b) ghpp*R W c.n. X a
c) a'vaMbY INNS or comma IX a I
—
SECTION FOUR:
KITCHEN
I-Floor octco LPG FAIL l-Ohn5EN7y
2Winclasaalilion X
X
1Daeccaidiiion
a.Clearid Siam X
SSinkcoaakion X _
6.C:ubinmt:aanmmp<milliam X
X
7.0illag.unditopl
11.WSll roolllicn X
X
9.Groditial*(pain
a) aakinc.scat*ly or wan X e
b) <bippin5a Om X a
a) a3Vmmk amid or omercd X .a
CAPER 73
OMB Co nt to No:2506-0117(exp.00f30.13)21)
76
SEC77ON FIST:
BATHROOM I PASS FAIL OOMM)NIS
IS1oam*4iticn X
2.&i63rucadbia X
3.Daxnxsiiion X
dEka>•ittrnuwvlantdal X .
S.Tok.calk X
6.`A•ub lu.in&sboneoiy undlnan �X
:Tub m'lino u:vasiblon X
p.(lilinecnedpto X
&Wall omdidcn X
.CondXnm or prim:
L9.„.
6) auk kg,Kalin3-ap$N X a
b) cblypinga lam X a
c) adwua:Ay ow cnavas X D
SECTION SIX:
AINDRY ROOMIDIILOY ROOM: PASS I PAIL COMMITS
I Moorcoatida 'X 11
3.Nlndoe mndilen WA
3d)nnraurson X
iPlxulml4VurceVerellRioo X
S.CoiliA condign I X
6.Wall oondidon X
7.Condlion of pint I
n) mckop.rmdeya Prell% X o
b) ailuphou Imo: X u
p) adoauraly Teemed cc coveted X a
SECTION SEVE.N:
BEDROOM NO I:banks Maas PASS I PAIL I CObIMRN S
I.Mooreaodi is X
2.Wlndn.Redman X
3.DOorccadikva X
4Ilaalmlluures _ X
5°AIWA cond;lun X
Wall wndieon X
legation Mpabrt -
a) maim,soling.apetig X D
b) chirpin6 cc loin X o
:) adwuaely timed or cavred X o
SECTION EIGHT:
BM:MOON NO 2:Iomtal Gild PASS PAil.I COMM&`OS
I.-Tkw<ookfan X IL
1-WtAwcooailo X
3.DocrcaldjIial X -
d.Rletiics1 ion X
S.4i i ondiliun X
.6.Wa11 eootltion X -
7.COndilicrederi ni:
o) aakke.main&a pcelinj X a
b) dipping cc loon X
O Wwva:A•.tun-.lud a acra ui X u
SECTION NINE:
BEDROOM NO3:Ioaoaa PASS RAIL COM,MBMN
I.FlourcadxIa. WA
2.Wirdo•.condition WA
l Nun cccai ka WA -
4._1t nkd fixture. WA
S.CalkB aedtica WA
6.14Icondelue WA
7x edkkn atpnke: NIA
ba) cca9dnS.e.tig or!Adios p
) 4A:faller:case
Ai awed arwxtal o
0
—
SECTION TEN:
DINING t.. 1 OR DLNING REA rin I.yba cundilmi I PAIL MMP.NT
X - _
CAPER 74
OMB Coat IoI No:2506-0117(exp.09f30.12021)
77
2.Wuubs condition I X
1Deora reds o x
4.21e:nkal Balurca :x
g.Ceilkeimcclion x
—
4.W'L'Ico dbloo X
t.C.o4IS,c nth:
a) cre:kmo.aanp mpfing X 0
b) chipping or loose X o
') a ogWm{v laced os w.atwl X n
SECTION ELEVEN:
OTHER ROOM:teearne I FARS PAIL COMMBATs
I.Pk eesetu n
2.Watdow Nediece --
S.OcorsonXiiun
a.F.lmiral thrum
Stkilinn owdldon
6Wall omdsza
?.CondiUan orpats
a) taking swans cc means a o
b) etictng w Ice, a o
o) Wcax dvueuedae covered n o
SECTION
SNMRB'S.HALLWAYS OR aTAJRCASXS: PASS I PAIL COMMENTS
1 Floor weak* X
z.non=cav e X
]PI>teiod 6xwraa x _
aCtmnptaedeioa X
}.Wen omdew X
&Codbto)ofpd II
a) anti*nate or peens X o
b) ebirPhISNwnw: X o
e) adeauaely wand N awned X n
SECTION THIRTEEN:
VSNABRABLBR0061S: PASS I PAR. COMMENTS
Megaton wndimns
2PMmlallvMnnlow fawn AYA
2.Ceadldnn of putt
a) >wkigr.sealing.cc pealing e o
b) Tipping cc lame o 0
e) deputny oenwd orwvovd 0
J
SECTION FOURTEEN:
SUMMARY OF INSPECTION 'PASS I FAIL I
_ x
(Waged Visual Assessment see Sanwa i5 on next page)
d , I2116/2i
INSPECTOR SIGNATURE DATE
SECTION FIFTEEN:
Failed Visual Assessment I
Failed Insyeceion Steno)number. 1 I 1
16v:el ation Results:
Recouweaded Repairs Using Safe Work Ptanicer
CAPER 75
OMB go nt to I No:2506-0117(exp.0913Qt3121)
78
Failed Visual Aaf4Ylrefm:
Felled Inspeainn Section number. I
E\alagion Retells`
Reconunsodcd Repairs Using Sart Work Practices:
Failed Visual AttNISOtarl:
Failed Inspection Section mmber. f �_
Evaluation Results:_
Recommended Repairs Using Safe Nock Pracriva:_
CAPER 76
OMB Co nttoI No:2506-0117(exp.09f3012021)
79
-Y'-. DEPARTMTIT OF WNMl1UTY MD ECONCN)COEYBDPRENT
j;- Mee arlkl9rawlmd OaUsenes Snkes I
IQ SeeM WO Sees
WPCtInI Dab:1276TI
. 7`; ran,OSNtgpvl 99901 Time:I:99 Pm
' Rxao(SIB)d35-61(11•Tax(53o)57SS1k Rallm Nau:YtEA
Pleas
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMEBUYIER:Ratal
SELLER:YCHA
PROPERTY ADDRESS:509 N 6i5 Ave
PROPERTY AGE: 39 Yeas
SECTION ONE:
BUILDING ISCTERIOR PASS FAIL WMMINTS
JCaldlkon ofkaldp'vl X
SO:ma im ofm,f X
3.Cnsiioo ofnye%ails.&paam X
d.Coalkloa o(cxerlorwrnere X
INdi e.sofUSSO
S.Crcdhke OCcb'mney WA
6.0tndiGm Atpokc
a) weekbys xalio5,eepaNg X a
b) (lipping cc loon X n
0) demra INalada covered X
SECTION TWO:
BUILDING SYSTEMS PASS FAIL WMMENTS
I.It 1IIN aldomas X
?.VanllmimCo 1 X
3.Waa bar X
d.Rmyl plloobbg X
S.9ek_v X
6F1oceial nrvka'Wbtg X
I Xenia Demon X
SECTION THREE:
LIVIYG RO0d1 PASS PAIL GOMMBN76
I Flom coamske X IIF
2 Wmdmn condtion X
3.Docrnediton X
AP.Wmical RaY,ma X
5.Calloi avd16on — X
6.Win conibba X •
7.Ctneaicn oFealit
a) racking,s ante.o0 paling X e
b) cbpp&go,auw X a
C) o/wmm7 na6.cd or canted X a
—
SECTION POUR:
KITCHEN MS FAIL POSS ENTS
1.9oet condition X
3R"udovmid0ion X
lDoarcopdkion X
S.Elahial Ikans X
lark omdika X
6.Cnb=wcowww rt amazes —X
7.CS(IRS=Atte X _
S.W,Ucandaioa X I
Psa:diem orpaix:
a) aakire,sal:f9,A-palinR X 1 e
I) 019,cpnr X.sc X n
e) WoeOp.Ny Pond cc mud X 0 ,
CAPER 77
OMB Co Miol No:2506-0117(exp.O9f3Q13)21)
80
SECTION FIVE:
�MTNROP)1 PASS FAIL COMMENTS
IIIemanditicc X
2WIMaacoMhbn X -
3.De¢mMidm X -
telmubeafix meNaelean X
S.Tolketcort im X
6.Wash buin•Lahncac y cal:Mow X
7.Tuba.Ihonm ens conMho X
-
7.CoilinRc:oda:al X
6.Wall*odium, X -
9.CaoGdn:W Baia::
O cr/Mag.aca±*or pmbas X o
b) chippit cr h.c X o
c) MeaudeW canal or cowed X o
—
SECTION SIX:
LAI IKDRY ROO.WlTILI7Y ROOM: I PASS f PAIL 'DOMMFNIS
EnosacediSon IIX IIIt
x.Wmdtmr coffieba WA
" x•3.D mndilim
-
9.Bkaiml9x[smNmripliun X -
S.CaOa-grmdl4on X
63VaD wa'iian X
7.Ccndbou of pelt
a) cv:kb%zalina•oc pashas X a
I) d ce Inou X a
c]. Measly mead cc covered X o
-
SECTION SEVEN:
JaDROOM NO I:buUoa Mader PASS I PAIL CYM MENDS
IMcercondmm X 11
Mbar"wndieca X
:.Doorcmt.;kc X
s.Elwuial Exmrca X
S.Ctlllne condi:im X
6.9411¢ndhiuu X
7.CoMtim ofpoim:
e) craNxp,satin or mat X o
b) cblppbm orbc:a X c
c) Ayoub*Banal or covered X p
SECTION EIGHT:
BEDROOM NO i Manna CAM XS PAM FAIL I COMMENTS
LTIc rccndllien X
3.1/lndoac rsSeion X
3.Ibm rn.*loa X
AAleroial from* X
E' Mbion X
etn X -
o:pelat
m.s:olla cr pe.n X O
m or Ioc X n
dely awed erceWml X a
SECTION NINE:
BEDROOM NO3:Imais, I PASS FAIL COMMENES —
1)'botmndikcl X
2Wiadoa eyRLv X
S.Wercundititn -I XX -
a.OeccmL Gums
S.Ccilinc omdldon X
&Wallm+dieion X
7.COMSim of paint —
e) (Tvtip,smarts or prelim I X 3
b) chippir6.r loose X e
t) admuutly mamd or covered X O
—
SECTION TEN:
I DINING ROOM Oft BIKING ARRA PASS FAIL COMMENTS
i L.FIo¢cmldiliol X
CAPER 78
OMB CO nt io l No:2506-0117(exp.09/30/2021)
81
._
2. domwio X
Ot & c X
4.Ebwnounsknl nouns X -
d.CellbacaodEko X
1.11.01n candbldn X
T.Cudgka&pabe
a) eraddas.aealirg,Imputing X a
b) dlipake or doom X a
e) a1`IWbh'timed at covered X o
SECTION ELEVEN:
OTHERROOM:iota e I PASS PA)L I COMMENTS -
I-Floor mndilion
fW'mlpwcanakc
3.Wxcold'nion
470eeeial Moro
SC4/c'it middies
6.Wall emadx:
7.Codlton ofalIt
a) bSckigrotmp.crmikes a n
b) CLP%vpolnnm: o a
el Iduy:auiyneoul tc wool n o
1
SECTION TWELVE:
ENTRIES.HALLWAYS OR STAIRCASES PASS PAIL I COMMSNT,
I!lour cot X
a.IhVrctal and 'X
3.Elocaiol Sauna X
4.C'dllnecondtlen X
S.W'1ll cndidm X
6.Cendiiion of paint
A) aukire aolinp.crpdu ; X a
b) caippingoloou X 'a
o) Woulxwly muted m vowed X i0
SECTION THIRTEEN:
IIUNHABITAULE ROOMS: PASS PAIL'COJDOINTR
I.E1redml etudno. WA
2Polmdolly bardoo&mumm WA
l.Cmdidm ntpein:
a) making.map.or praline . 0
b) uti)p'ue yr kat c u
c) YYgal*Intxdnr poured e a
J
SECTION FOURTEEN;
I r
PAII.
X
SUMMARY OP INSPECTION I PASS 1
�/J"t wadsVblW AssesHteotsee Section IS on Beat page)
INSPCI'pR g,gp I2J16/2I
DATE
SEE.TIONPIrrEEN:
Failed Visual Awtsslnatr
I
Failed Inspection Section ntmlb7: r--I
Evaluation Restdu:
Raonametd l Rnpoits Using Safe Work Prat
CAPER 79
OMB Co MtoI No:2506-0117(exp.09f3Q13)21)
82
Failed Visual Amea,mmt:
Failed inspection Section number: L_ 1
livoluation Results:
Re::ornmended Repairs Using Sate Work Fawkes:
Failed Visual Aascssmeot;
Failed Inspection Section number: I 1
Evaluation Results:
Recommended Repairs Using Safe Work Practices:
CAPER 80
OMB Co rd to l No:2506-0117[e xp.09f3Q13021]
83
/ s N.:i-.� CEPAAT616II Cf CONNWITYANO cCOxctcCoEVELOPI IR
t •' i1@ Office of lniOMemttADaS4%mex Sa1cz
`41 MS2,lE19111 Sr= larplfOOg Dlm:12'Ia41
!. Team.'Al9ISbro SBO3I 75me I:00 pm
i' ' MMoe(rs)A5dICl•fax Isae)575.61M limbos liumovenx
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
IEOMEEUYER:Renal
SELLER:YCHA
PROPERTY ADDRESS:510 Cherry Ave
PROPERTY AGE: 19 Yard
SECTION ONE:
sun.MNG EXTERIOR PASS PAIL COMMENTS
II Cccdit o orkrmdmico X
LCVadi4an ofroof X
3.Candidoo°Nslas•rails,re orate X
a.Cmmlllw OfCablayra;cu X
Islam sofa at)
S.Cmdlioe ofchimrey WA -
tffio cn ofpaim:
A erockins•=SLR or roans X a
b) chip;ere orkew X a
d ndegmkNlm1cd marcrod X u
SECTION TWO:
BNLDING SYSTeMS - PASS PAD. COMMENTS
LW:WmNuryoxm X
2Vmebhm•Cooliro X
1.Water ham X
a.Rouok yumtting X
S.Sewer X
6.Okemal ReviwWidns X
T. ssabe Deseaccs X - —
SECTION THREE:
LIVING ROOM PASS PAIL I COMMENTS
l.NoorcooS)irc X
2R5mWw memos X
1➢Oor avmh:.n X
a.Elavl:a fixtures X
S.Colinscacckc X
6.N•nll condition X
T.CcodKt ueTim:
O Oorkin4 scallce,or Tbiys X c
b) chippir or tome X e
O ndlguselly creol Creouercd X o
SECTION FOUR:
KITCHEN LPASS FAIL COMMENTS
I.E]oxcootlon X
2.9lmdow ooadinca X
3.0oor contjon X
dEe:oiod ammo X
S.Skkxoduac X
6.Cabies•CoumeaapoosYkes X
T,C lQy Retake X —
WNW condtlmi X
9.Ocodiirce ofpeke
c) stckistcaEnS•ccp6Xins X a
b) cleppEuor loom X o
eJ WocvaNY wooed cc w.eml X u
CAPER 81
OMB Co M to I No:2506-0117(e xp.09/30/20211
84
SECTION FIVE:
BATHROOM X2 PASS I FAIL COMMENTS
Ulm mamim X I
2.Wi,U..WId'nian X
3Dorroedieca X
4El.ebieel am ygVacIbtice X
5.T=1d a+A4bo X —
6.Wash burnbum:1-tharatrsomdiumle X
7-Nb Leshaae imicWMon X
7.QIIiemegnSl3a X
L.Woll nmdiecn X '
9.Cwdalan afminl: —
a) eradeeg Ica
or poei4 X c
b) ebeppilc an ma X o
e) adequately mad of cavred X o
SECTION SIX:
LAUNDRY ROOMfTR.ITS ROOM: PASS I FAIT. COMMENTS
ISlowcocdlan X
1Wteoa cwdaba NM
3.Dam manias -X
4.F.lamIal AMee&NrdluMa X
S.Cei&goedidw X
-&WWcnr:ilios X
7.Qedimn arp.in
a) cbcklns.Mike.m pmlin3 X a
b) d•2e gu bane X R
)__MA:ndv waned Nand X a
SECTION SEVEN:
BEDRfaOM NO I:loralma Mar I. PASS I PAIL I C'O)OJRN18
MdN candid/ X
2.Wiadoi.moan
3Domaad3ioc X
4.Placated ram X
_3.C$Iioacondiikc X
6.Woll oaks X I —
7.Cwdnke awe:
a) cracking,aa'aa,at pas X e
IS cIIpphg orla X a
c) admaveb'waled creowred X o
SECTION EIGHT:
BEDROOM MI 2:beadm Chid X3 PASS YAILIOMSMRNTS
Lilco(condlbe X
'A'indaawlldiliw X
ma:mccdloon X
I.EImlrir.flamna X
S.Cc.]o'Rcediem X
4.W.a Caalkkee X
7.Cwdl600 of pest i
a) mwkbg•snalink.m inksX n `
b) Nina orloom X a
cL MaLYMY need a*nwand X C
J
SECTION NINE:
BEDROOM NO 3:Iondao PASS PAIL COMMENTS
I Flom alidw I.X bl&N7D
2.1Ye.iwecm6tiw X —
3.! Lc!nditien X - —
a3Dat_ml Aaraca X
See)Masccndldon X
6.Wall coldilim X
7.ComYiw o.'p.inl: -
al cneeap.wall*or?N+aep I% c
Pi chippinge.laze X e
a) adwmei gaol or and X a
SECTION TEN:
MANIC ROOM ON DCONG AREA I.Naoreoodblao 1 PASSI FAIL I COMMENTS
I X
CAPER 82
OMB Co MmI No:2506-0117(exp.08f30.73)21)
85
2.WS0.0s make X
31arcon01100 X
briml team X
Man
C.i omaiean X
M
6.1VaJI n aeditim E
7.Caoihlon oriole
a) nmkg,scalln$cc walks X o
b) :hIppius a laic X s
i_c) adeQumNmgladamkred X o
SECTION ELEVEN:
O;HER�OMFAIL ROOM:Innrioa PASS I COMMENTS
1Rbmu coS'em -
3.0ae'wadiban
<Ekcrn[Sauna
Steaks weeks
Cm1 aka iond l. _ -
7.Cond0 al of pars
a) ennkinn octane,ac roans o
bl ccinearS t° n u
c) .,Uq y!rued(:mserod o ci
SECTION TWELVE:
MUM*HALLWAYS ORSTAIRCASES: PASS PAIL COMMENTS
I Slonrone41oa X
2 Taw
3.Eiatrkol flk iIx:-
Txamn X
a.L'0ninaoonarlae 'X
S.RrellcoMidon X
R A'.a da°Mry0::
a) chip b t,r Soma
Al00[64 X o
b) ehlpphpl or Soma X n
a1 Alammp•smnil ar coma X o
SECTION THIRTEEN:
UNNABITABLj ROOM& PASS PAIL VOMMENTS
_).P.Inar:UunMRimy WA
2.PmeuLdis haunt°.&man 11rA
3.Coodslm ofmim:
a) crocking,soft or wing o
b) chlppir. urbcic 0
a 0
c) (Woo mob.cranial or coveted
0 0
SECTION FOURTEEN:
LSITIMARV OF INSPECTION I PASS I PAL
Offailed
Visual AneawMet see Section IS On oeal page) X•O 12J16121
INSPECTOR SIGNATURE DATE
stertoN FIFTEEN:
Faied Visual Assessment:
Failed Inspection Section number. [j
Evaluation Results:,
Recommends!Repairs Using Safe Work?makes:
CAPER 83
OMB Co IR to No:2506-0117(exp.09f3012021)
86
Failed Visual Assemmne
Fated inspection se ton numb=
Evaluation Results:_
Reemmmco&W Repairs Using Safe Work Practices:
Failed Visual Assessment
Failed Inspection Section number: I--;
Fvalsiminn neadh:
Recommended Regain Using Safe Wolk Practices:
CAPER 84
OMB oonlol No:2506-0117(exp.C913Q12021)
87
., 'OBkRTmtNr CP CO'XA,tUrr FAD rWIOMICCOALL NOT
if-: F. Otto of N60hxarcod DSCSmnoX Shim
.12Sada 3lgtOiSme: „MA`aien One:111611
%' Tagmi.Ntd114o 1 569X Time 1:00 pm
v ;: Fhare(909)S7Sd101 a Fax(SO3)5754176 Realtor f6r..Orclu
aY Pam
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
IHORO:RUYER:Renal
SELLER:YCRA
PROPERTY ADDRESS:512 Chem An
IPROPERTY AGE: 39 ma
SECTION ONE:
SUTISMKG EXTREME I PASS PAIL COMMENTS
).Cadmwrcm odmcn N
'Condition Nicer X
3.CAn&loaodeuke,mils..pathos X
4.0...1149-c.tc.ai 6n xwlxa X
•
(Udine.oak met
S.Cmdiean ufor my NIA
6Cwdluonorpwe
i) aarkt;,md'e,orp...ea X n
b) chippinta loam X 3
c) m-quuely mom:a covered X o
SECTION TWO:
SUIIDING SYSTEMS PASS I PAIL COMMENTS
I RoomNuipinmi X
2.Vmetla oa.Caolbie X
3.Waaaho w X
sRwubpkmbina X
1.S.Seww X
6.51u:trial reniouwnne X
7.Smnac Amman x T
SECTION THREE:
LIVING ROOM PASS I RAIL I C905MERTS
!Moor cmdjitm X
2.windur«naaon X
3.Ilmnooamdm X
a.Elmpktl fmree X —
S.CAI corditioa X
Lwall conatloo X
7.Comat{Io oipoim:
al Ladina,mmkt tumults X C
bd bippig orl:yw X u
c) mlemmN trailed or coleiad .X p
—
SECTION TOUR:
IE17CRRN PARS PAR. CArA WTS
I.plonrcoMflon X
].Windoe wididon x
3.1lOwoo eliOm X
{SRNknl Emmet X
S Sek mdiiico X
6.Ctbim.l-aunonw maims X
tCaike aedlmn X
CLWA acatim X
9.Cwdiiiun of plot
O aukiap,mdiaq a NAY X cr
btgapcnp(etc... X n
) 'dequw:ly cream]or covered X C
CAPER a
OMB Eon!No:2506-0117(e xp.09f3Q13121)
88
SECTION FIVE:
1 bcream:i .PASS PALL �OMMRNI'$
1 ini eoO M X X
3.Rrindowaadidon X
3Jnnr cxcatbs X -
' .Plechkal6xo:lcl.1•cmilekc X
3.7nlla carsick., X
6.Wet baei4tccaw.y 'ooeuckes X
T.Tab or shone ink condition X
7.Colin:ea:Haub X
tW'all oca ion X
9.Condinon Mails:
o) akiq scaling.cc ptelite X o
b) O:iccinp orUMoa X c
c) adrm:ottY Weed m warn&
X 14
SECTION SIX:
LACNDRYROOMR773UTY ROOM: PASS -RAIL 1 COMMENTS
!Nom eond'tico X
d.E9nAv O.Idido WA
'Dom co:dH:,¢ X
d.cletbkal Exenetvctciltdon X
3.Ceiliooemdtim X
6.Well todidan X
7.Cgadxke cepaim:
O cratem inks mpmieg X D
L) abppirarer bon X a
e) adtaoutla amlei or coveted X o
SECTION SEVEN:
BEDROOM NO 1:bombs blaster —PASS I PAIL COMMENTS
1.Flommadjdca X
2Wbxba cabala= X
3.Door ondWo X
d.Ekmkai Swot. X
S.Cotgcccdidoa X
6.WaBcmdplon X
:.Cccdl6e Oipake:
O creckhlg.acass or coding X o
b) chllpgc or kcec X o
c) akaub)f'naxJ orcmxTN tx a
I
SECTION EIGHT:
BEDROOM NO2a location Chad X3 PASS MIL I COMMENTS
INcor coWkion X
3.1MnJowcmdjDon X
].Elam oicaRil
Amh Moons
es X
S.CelllaaeaMhko X
6.Well conditionX
T.L'ocOAkea:polar
t) cratgneawalF{•atpolw5 X c
Lb) chppigo brae X a
c) ed(slbblmdeanreownd X a
SECTION NINE:
I BEDROOM NO3:location I PASS PALL COMMENTS
1.1'bor madito X
3.Windawrldoo v ;X
3lkar cmalkion X
c.Gfetoi al throat, X
S.CciL•nEondidon X
QWall omaltnw X
Lbnjilion ofryint -
..a) Rtttitg nem&or petting X o
b) dllppmy or lame X C
t c) adequately caned or covered X B
SECTION TEN:
DINING ROOM OR DIKING AREA IXASS I FAIL I COMMENTS
Irlomoardilicn
CAPER 86
OMB Coat toI No:2506-0117(exp.09f3Q12021)
89
1.WidomdiIiva 'X
.Ooor Maim X
4
.Bkavbn Nuns X
Star=emdtrea X
SA1411=403* X —
t.Ccndll)mufpalm
Ial CmdunE,ankta.a palin8 X a
b) cbippir et ibex X a
e) degmlelg trailed ar tamed X n
SECTION ELEVEN:
OTHER ROOM:Swam PASS FAR. COMMENTS
I/loaemdwon
2-1W3D eordbkr
7.Dos bmdiden
4.Elctrial Smut.
3.CeIllcbiHon
7.Welleadhiun
7.cmAkka apart
a) cradne.a:JbRa peat/ a u
b) ehippirc et base a a
o) ad:pwmlv=Ned a towed ,a P
SRCIION TWELVE:
ENTRIES HALLWAYS OR STAIRCASES: PASS PAIT. COMMENTS
l Flow rmdidem x
10.w umdidea X
].menial fullma X
4.Celina waistX
Swill coSidnn X
e.C®aki arc:
e) cr tr4.r.o in eY pedte X a
h) chippinge•L'w X a
0 admuuely'mud a wvercd X o
SECTION THIRTEEN:
UNNAMEABLE ROOMS: PASS I PAR. COMMENTS
I.Plemiod ordidono NA
1.Pmmliallv'smedm.famcm NM
p.CoMldoa ufpais
a) esakins.seWne.aCaeluls a D
it ehpec{or lops a n
0) edeatutOy armed a mans.] _C a
NECffoN FOLRTEEN:
SEMMARY OF INSPECTION I PASS I PAR,
(If failed Visual Assessment sec Section:S on neat page)
lZll¢fyl
INSPECTOR SIGNATURE DATE
SECTION FTFTE&N:
F'ai od Visual Assessment
Failed Ingestion Section number. I 1
Innluatian Results:
Recommended Repairs Using Safe Work Pmaires:
CAPER 87
OMB Bonito!No:2506-0117(exp.09f3Qf2021)
90
Feil.d Visual Aamtmell:
Failed Impaction Sosioo number. I1
E ,1uation Reality`
Recommended Repairs Using Safe Work Practices:
EFailed Visual ASemane¢;
Failed Inspection Section number:
Evaluation Results_
Recommended Raba Using Safe Work?radices
CAPER 88
OMB Control No:2506-0117(exp.09f30/2021)
91
_ 1 DEPORTMENT OrCDOMIMDY KID
f' I" "'I.A\ Mea N6bMalmos Demo:nue Rakes iIOVP:BIf
:12 Sap.ffphdl Metkssywkvl Mum12/1ARI
11 Yak.,Wasme step_ Time I:C9 pm
Mace(SDS)$54101 a Fax(SDa)$p561/d R 0110c 'a ll'UnA
Munn
x .
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMRBUYER Rental
SELLER;YCIIA
PROPERTY ADDRESS:902 I:wt Booth
PROPERTY AGE: 39 This
SECTION ONE:
BUILDING RXTRRIOR I PASS i PAD, COMM5NTS
I.Cwl4raa o'MuWNion X
2Ctndifpl*hoof
X I Caglitan ant.rsiis,&Wain ac X
ACnnJ.,;,.of cMalor agar
_ 0Mke.soffit.et)
S.Coodikmarckitcey _6.Cxd&vr af4t:O a#kinc.scd m
e,Orelins rAVA
a
r{;SI chiRor'san L c) e&n&y akd or°weal o o
SECTION TWO:
BDILOINC NVmM.S PASS PAIL I COMMPaNTS
IJhan4caui000= X
2 VcaiIaton'Cnalkc X
2.Waa Mar X
kibosh NumFem X 1
&Senn X 11
6Xdemial ticv)w'W'IrIO1 X
75aN:u Deoeaas X
SECTION THREE:
UVINC ROOM PASS PAIL C)MMENTS
I.FIens amdttnn X
2Whma cund im, X —
2.Dorecoadlton X
1Ekcu,ea Swum X
S mcll °m-0cn' X
6.W41cmatIon X -
7LbnJJkn OtNi.4
O tanking.umrp or mime X a
5) ens^e.c maws X n
e) alglaleN teal m cowiod i X 9
SECTION FOUR
k2X ITCHES (PASS PAIL ICDDIIRRNTB
LIC ocrcon•Ricia X
.Window condition X
1Dooroonkka X
AEloaricel Ixlures -X
-s_stIc andincn X
6.Cnbiva4:ncwmpa alilime X 1 -
'Wa:lC6a00Wl -X
tW,Econaa.. X —
9.Candid&O afprx
'0 auYise.sml
Nttr DatXrB X D
c) +drguaem:ame X
y snnadacovered X C
CAPER 89
OMB Co ono No:2506-0117(exp.00f3Qf3121)
92
SECTION FIVE:
BA MCCTNROOh, I PAPS FAIL COMMENTS,I MCC rerldidea X
7.1imdowortoidioa I X
].Ooar rundinaf I X
1.131eciatcol fu.moNealgliun X
S.Tatlntecdnism X
S DLh Iatln.Labrn,my modilioos X
7.Tub cc shoaw tcaMhlnn X
7.Whim coMxbe X
a.won roedimn X
9.C3ndhlona print
a) «aYq,scallnp•at Mal* X a
b) chipping a loose X e
o) adwPaNly pens{(ornud X a
SECTION SIX:
LAL'NDRYROOMNT11JFY R00M: I PASS PAR I COMMENTS
I.Fdoor conditionX
1.Aluduw madinon WA
3.Doorc°e3i:ia X 1
daecWwl lirwrea•Vmdlmise X
Selina cendn1On X
4VialI madam X
tecadldun of peat
a) aMhinc,palinp.m poplins X a
bl n%apy;w hose X a
c) u'uv10.4 treated at oenemd X a
SECTION SEVEN:
BEDROOM NO I:location ahoy PASS PAL COMMENTS
137wwowrdiiion X
1.04mdowcoaatico X
].Doe ccodiden X
a.E a%Kati X
S.CRTnm wr,nun X
&Wall currii:ia X
7.0:cdlcnl croak':
r) cmmint..et:4 or Fowling X a
b) chlppbx orkott X a
c) Aaepinkly mated pi cowred X a
SECTION EIGHT:
roEDROODINO k memo Mid PASS FAA. COMMLVfs
l Thx ocoditlon X
Y.Wklowcaoeriu -X
3.0cce rnodiliun X '
a.Eletelml Cans* X
S.Ceisq ondilion X
.d-Wal;oaO:aDn X
7.CondNpl ofp=c
a) omlins,:cakno.or pathos X D
b) dipping or:con X a
c edaaaouA rerrted orvnaad R o
SECTION NINE:
BEDROOM NO3e location ,� PAIL I COMMENTS i
I.b3:vrcoMnion WA
].Wlnduw¢adlgpl WA
3.1)oarcoosiic NA
a.F]aaical Pwnnca VA
d.Celllnaconii:ia WA
Gwall emda n WA
ttorAt6ni ofrym[ WA
a) mcm.CRahn.et milks
b) chlppily or Iowa
a
i A adcpuicly cream)or covered a
a
a
SECTION TEN:
IDLVDiC ROOM OR OWING AREA P PAS. CCMhIRVTc —___j
CAPER 90
OMB Coat toI No:2506-0117(exp.09f3Q13)21)
93
1.WRdoweocake X
3.War mndilon X
a.6kmic l emr> X —
S.Ceilmaamdilna X
&Wall mur aan X
7.Caaflen of pane
a) tnekcg,sealing,cc peke X r
b) dipping*,lour X c
al adeemely wade-mare) X n
—
SECTION ELEVEN:
OIlIER ROOM.laatkn PASS I PAN- COMMENTS
I.Flomam4i,,n
2.Wlndo,.ecodl::ea
3Dn Irk taica
&Fi nsal axnuu
3.CeiIhcot c
—
&Wall mn9Mn
7.Comtirc apart:
al Nddcap,smllyd,urpacyng a I
b) chipping lam u R
c) adryuuelrema2araaw-rd u a
SECTION TWELVE:
XI:TWES,RALLWATS Om STAIRCASIN: PASS FAIL COMMENTS
Inca candilie X —
3.D. ...Whim.
3.Bkctioe?Mow X
I.Ce3iaemcdiecn X
aroleuadi:iea X -_
6CmdiCun dram
a) er tdcing.xd it.La Mime X 1 o
Si abimrg or Xare X o
c) uhamon axed W aosmud X o i
SECTION THIRTEEN:
uNNAB3TABI.E ROOMS: PASS 5
.PaewiS rpaim: seemuet WA
3.Conteiwapaim:
a) ctMkp,s:allrp.W mete n o
b) ebippingctIw: a e
c) ad mmmlvadlWmanwvW D .o
SECTION FOURTEEN:
SUMMARY OF INSPECTION I PASS I PAN.
X
Of failed Visual Assessment see Steam:15 ea oast page)
INSPR -T2� 12/16/21
DATE
-SECTION FIFTEEN:
i Failed Visual AssmRcene
Failed laspeaion Swim)°amber. I
Evaluation Results
Raooe°nended Repairs Using Safe Watt Preeik
CAPER 91
OMB CO MAXI No:2506-0117(exp.O9/3Qf3)21)
94
Failed Visual Aas ocu:
Failed Inspcc1ion Section number. r
Evahation&sule<
Recortuacudud Retails Iusing Sale Wads Fmedees:
Failed Visual Assessment
Failed Inspection So Mon number:
F.axl:u6rm Results:
Reeoxmxr4ed Repairs Using Sa@ Work Prsclises:
CAPER 92
OMB Co nctoI No:2506-0117(exp.0Sf3Qt3121)
95
�. UENATMDR Or COMMUYrIT AWEDNOCNIC CO
(A. Olflcear lkkhtaboxICddnpxrn-SnMcef
T
•- c1:2 Seth s+3nt Semi InspvxWanrn:la'I6R1
3 'Lc: T2Om9,'Ak9frgRn 9Bi3: lima ID)pm
5� fore(9rA)5Ae101•Fax Reshot xaxWNON
Rom
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMEBUYER Rental
SELLER YCRA
PROPERTY ADDRESS:904 East Beech
PROPERTY AGE:39 Teen
SECTION ONE:
B roco EXTERIOR I PAS; FAIL COMMENTS
1.Ikndilica rlrf(wda&O X
2.Coodbion of KM' - X
3.Condkbn astir,.mils.&peaches
e.Caetdm eC*,Yrirmrae x _
(sidint soda ea)
S.Omditonorplmney IVA
6.CnMilio adesim:
a) cmdcing.ma*,orrodine X c
p) dnppte of lope X o
a) teapelel•towed at owed X o
SECTION TITO:
BGILDINC SYSTEMS I PASS TAR. COMMENTS
IJlmrme%ulpmr X
—
7.vrndlwioncmlin6 J.X
3.WS lever X
alattl,pll®yg X _
t$tlq XX
SEINIrkWseMoo1VDer
.'.Smoke Dowers X _
1
SECIWNTHREE:
LINNN:ROOM PASS I PAIL I COMMENTS
I.Pltotcondelm X
?Minden.pgWMm X
]Dear acodaim X
;3leotkel fiance. X
5.Cs2naanAaim X
6.'A'il eoadkicc X —
iCecditen apt
a lIitp eelmq,ospepul(¢ X
b) ltypine.e Zoneo
X
_0) ,k o Rased et worm
SECTION POUR:
_WOMB PASS TAW COMMENTS!Axe...WilmaIx
2.31/Coov0oodidm X
3.13mrtundtim X
Myprmlml Emmet X
F''SSlok aadidm X
6.CAbbnt•Covmencpocctaocs X
7.Qr3rymldi4m
Mall ccdicl X
Pemeheon ofpmc X ,
.
ea oa,T,MIND,&q podia X o
h) a`gp(fSrlmw IX c
c) AdayVsely tx,S o.covered X is
—
CAPER 93
OMB Council No:2506-0117(exp.09/3Qf2023j
98
SECTION FIVE:
BATHROOM I PASS FAIL I COMMENTS
j'k ecaulllon X
3.W
3.Doxco...oiow X
s.FJaimlEauraNmliWw XSTOW<AMMO —
X
—
6.Waal Lass exucey cmlBima I X —
T.Tmmwadidon at Row uadidon —
7.Ccil cootek dnn X —
aAYallCom axdinal X
9.Cnndkivn o&lubn:
I.
a) aakire cabs.apalkg X o
b) rbirFlnaaloom X c
O edava<Iy wrNdacarapd X to
SECTION SIX:
LAUNDRY ROOMJ7RHITY ROOM: I PASS FAIL. COMMENTS
IFloonxeCcix! X
LWiodaaao Jilion NM
3.eac caldlEva X
a.Clewk6J fidlm•Vlpolyda X
S.Cdim oednin; IX _
6.Wii)mak+n
ECOndilim nrMcc' X
o) amkinpb,colinl.mpalins t X a
b) 424.1.4.E.awls X a
C RSPERY Rolled o•b,,ced IX c
SECTION SEVEN: _
BEDROOM NO 1:lacks Mawr IpASS FAIT.I COMMIXES f
I.r•IareaDEdw X
a.Windm o)Midw X
kloaandrt:.n X
AElecukid Tumor X
d.Cuilieadiria X
6.WRII<nn*Io. X 1
7.C.wija evoke
a) cradcinp.ncdap•a rOIinp X a
b) C Halls erkwse X Il
C) & AW',tread In aaead X O
SECTION EIGHT:
BEDROOM NO2;heads Cblld XI PASS PAIL COMMENTS
I.Floaoasakn X
2.WtiMnusndilis X
3.:Mar meal. X
e.IJkcmeal Lamm X
3_Citi3.Nadi6a x
6.Wiloccal a; X
(7.Con:Sian of luau:
a) assllq+,cal*,a moire X c
b) dlippig5.v lam X n
I <) aa:vuacle:runt a<uwred X a
SECTION NINE:
r1EDROOMNO);Mallon I PARS FAIL COMMENTS
1.Thor<eadieon X
2.Wndow6aA&o I X
3.Owr maim x - ,
a ElveOJml Smarts
S.CeiliaccaAMw
X
6.Wall condilinn X —
7.Cosaka Generic:
rI) cnddnp.knl'ng or pedal X a
b) chppc8 or kat x a
of Steam ne d tam cm x a
CAPER 94
OMB CO MtoI No:2506-0117[exp.03f3012021)
f37
SECTION TEN:
I DINLYO ROOM OR DINING AREA I PARS FAD,I CX33LMRh9S
I.Fbanmditan X
2.Olauluw oxditou X
3lbartoodkioe X
4J52ealml Soares st
Cbia merman X
a Wan wnditgn X
%Caodbionofpalm
a) nt4ig scallo;orpe Sag X c
b) chipping a lww X
• adecuutllycww atanned X u
SECTION ELEVEN:
OTAERR003l:Ineaebn _Anti I FAIL COMMENTS
Ulna:uc thoet
2Windwo cuniyea
3.Qaaandlaen
allmlrial cbww
S.Ceiltrg u.ndilim
&Wallconakbn
7.Ccc&ern uCps c:
a) aching.s'a36g,wpwlms u o
b) ubryma or Soma e D
a) sdsamwly awed or cowed o e
SECTION TWELVE:
IETRI8s.HALLWAYS OR STAIRCASE& PASS PALL COMMITS
I.Hoo:coottier. X
2.Doorcondtiem X
3Sectk l fares X
4.Ckilinn<aR6aio X
3.Wtll molten X
6.Coldid nofpunt
a) cckbp,stalk ar pee* I X o
b) Nipping or taro. X R
c) adeauredv road ee:warm X a
SECTION THIRTEEN:
11.701ABWABLR ROOMS: PASS FAD, COMMENTS
LEecaiml wndiliam WA
22oa:iiall !madam hams WA
3 Cmditonofpobt
a) me:king.wallas a paellas L o
b) chipping*elbow
:) adba qIy wawa aoovcoaS n n
la
SECTION FOURTEEN:
SUMMARY OFINSPRCIION I PASS I FAIL
(if failed Vk ual Aaawmebt see Section 15 am neat page)
12116f21
INSPECTOR SIGNATURE. DATE
SECTION FIFTEEN:
Failed Visual Amassment:
Failed Inspection SettioR number; L
EYaluxlion Results:
CAPER 96
OMB Co MmI No:2506-0117(exp.0Sf3Q13)21)
98
Rec0mmendcd Repairs Using Sere xaerk Pm:tiers:
Foiled Visual Assyseene
Failed tnspceioa Section number: r J
Evaluation Results:
Recommended Repairs Using Sane Work Practices'
Failed Visual Anrxrmem:
Failed Inspection Section number L
Rvalnation Rexene:
Recommemied Repairs Using Safe Work Fraction:
CAPER 96
OMB Co mioI No:2506-0117(exp.09f3Q12021)
99
C®IR1?e7 CC CONTLIBT(MO Kohl:OCCE,•T Moir
is. Otto of HeolLlOhadDeekgln SMACeI
{i• 1125adb HlNSnNt Empecion Com l2:101
i�>' �,' Vaim4lq{hnahxl MI Time:I:M{p
I�I� . :.'/lxm(509)53S61C:..eo(03)5358t% Rests ntnwvwn
flaw
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMEBUYRR:Renal
SRLLEIL YCHA
PROPERTY ADDRESS:966 Eau Reach
(PROPERTY AGE: 39 Yes
SECTION ONE:
—
-BUILDING EXTERIOR PASS I FALL comuct s
I.Conditien of(amdlum X
2.tortd icao(mof X
3 Ccadicen of maim rah&porches 7C esbndivan ercgu..slraces X
(xiShq,semi.cc)
—
S.Condbicoc(ebmwa• NA
GCeWium cepuca: _
d) cackle;,maims.cc pmliny X In
b) Mlppingaleo:c x le
o) admomehe tmmd auwrto! X o
SECTION TWO:
BUILDING SYSTEMS PASS PAIL.1 COMMENTS
I limingeeuipnenl X
2 Yws]mmd:oollnl X
3.1Var homer X
a.Rouye plumMrw +X
Ssnre X
6Tkmlml eervke'wbmE X
?Swam DixeclOrs
X
SECTION THREE:
rLIVING ROOM PASS PAIL I COMMENTS
FbaMlWilim —X
2.9Andew ooedick. X
3.Ileoremakkc
a.leonial Kamm X
S.Ceili coretko X
d.Wnaanlitiun X
:.Cs 46=°Crain:
11 n:wno.eca'cp•or tonne X c
b) Atonic Now X u
o) coast,}vowed ar cowed X a
SECTION YOUR:
IKITCHEN I PASS I FAIL
I.P cccnSleoe X _COMMENTS
2wptowmnaioe X
3.O:acee ocml, X
a.6ba6al(hum
SSmaarcdaion X
6.0Cecettecme.w7 ttusas
9.CeaM.almlGon X
LW.Ocas y X
9.Cawium ormicc
W cmcKcX aaliy crrse36E X a
b) ebtpinlm•loose X a
) Smugly acne!omen)] X n
CAPER 97
OMB COn IDI No:2506-C117(exp.0Sf30.(3021)
100
SECTION FIVE:
BATRROOM PASS FAIL.COMMENTS
I.Pbac:Miuon X
a.WyMaw&a ien X
3Doxamdaine X '
4.F/emital OwldVea6lolm X
STmielcmlmnn X
t Wabatiwlrbxwyco:Milaa k_TX7.Wash adorn nan coa _
7.Ce16raMjt.Wp.waleon:Siva9C9ncRicn nrlwiR:
a) casab..mike.,apaiml a
b) chisokawlose X 0
c) K-UWIa1'aeaxU W VTQW iX
SECTION SIX:
LAUNDRY ROOM/UTILITY ROOM:i.
I PASS PAIL COMMRIPI'3
I.FbarmadiIoa 1 X
7.widow oo:aka WA3.Doormnailim - X
a.M:a:itel Rv 'Veo Smon X
s.Carna tmldidan X
&WMt otr$ecn X
7.Cmdata.orpwnd
a) an:Ixi mline,a paellas X y
b) ttCPmece loon X a
c) Wmcartlynetadawvrml X c
SECTION SEVEN:
BEDROOM NO I:Inwdm Master PASS PAD. COMMENTS I
I.Pbacundidm X
2 Redow nxldbwn X
s.Donrcostica X
IElearlml 4wdn X
S.Cclllnecoodiam X
tWall odldilim: X
7.Condbim of shot '
a) eval.bp.tmllti or peolbw X c
b) cbipplras or lame X a
ci adwpmly meal a coytrcd X a
SECTION EIGHT:
BEDROOM NO la location C61MJ12 I PASS PAIL I COMMENrs
lSbr nadldm X
2Wbdawcadition X
3.Owl cmMienn X
4k aiia!loam X
SCenme caad'ninn X
&VAS pmdiram X
7.CoS ton of paint
b) asa ckim ka.cc aapp X O
vpinxa lore X y
c) akausteNaml0.acavaea X a
SECTION NIN E: t
BEDROOoI NOR:to adnn PASS FAIL I COMMENTS
I lbw aodieon X 'I
'Window eanEtica ,X
3.Oncr conditionX _
9JLbmloil alarm
suilslcwlanim X
twat excoama X
7.Conaiim of pans:
a) atelio&nanny a pem6B X a
b) tMppiada lone k c
c) atyuIRly amlM«covnW X n
—
SECTION TEN:
[DIVING ROOM OROINING AREA PASS FAIL]COMMENTS
I Slowpediwn E J
CAPER 98
OMB Corn to No:2506-0117(exp.0Sf3Qf2021)
101
2.Windowwodibm X
3J)eorcortipc X
lFb:Ii et Scores
[Ceihae<audition 'x
AMC=Alm X
'l.Llmd'nion of mint
a) rerakirc.sailing,or p<albg X u
b) dining N knit x c
CI WauaxlY Waled eccov0<d x 0
SECTION ELEVEN:
(mica ROOM:lyallon PASS FAIL COMMENTS
!Moor amnia,
2.Wbck a condition
3am ablicka
a.DackkM fwaxs '
S.Ceill g eoo&ioo
-
6.WallwndMan
7Cgid3kcapoko:
s) <namg,o:alitt apavng 0 e
o) chipplreor km's o e
el adeauuelfaaaled orcmaa-d 0 a
SECTION TWELVE:
WEES,NALLWAYS OR STAIRCASES: PASS FAIL COMMFATs
1.Flat wlldiem X
a Day:muluol %
3.eleattl 6x0anw X '
a.Ceiba°maim X
S.WallcoocBim X
6Cmdidm n(pnac:
a) era<klog. .ag,mradios X 1 0
b) et:Ami:gakae X n
e) Segauar owed or emtred X n
SECTION THIRTEEN:
UNI4MTABLE ROoM5: I PASS FAIL COMMENT
imeadialearditioas WA
a.Psecldivlusudcat teams WA
3.Condeinn of mint '
a) OaA=;-sallrg or memo n e
b) ehippintcc Com, o c
el adqunaly toil or covered 1 a
SECTION FOURTEEN:
SUMMARY OF INSPECTION PASS FAIL 1
X
// (If Idled Venial Aeaatueot see Settee 15 on next page)
` �6 ,1
INSPECTOR SIGNATURE ]z;1 Ai'21
DATE
SECTION FIFTEEN:
Failed Visual Asseam:en<
-
Failed Inrypzion Section number: r 1
Evaluation ReaclLS_
Recommended Repairs Using Sale Wodc Prnc iocs:
CAPER 99
OMB Co ntlOI No:2506-0117(exp.09f3Q12021)
102
I Failed Visual Ammon
Failed Inspection Sectionnumb= I I
fvnluation Results:
Recommended Repairs UsingSafe WorkPmctices.
Paned Vaud Assessment:
Failed Irtpcodon Section mnnber: L
Evaluminn Poodle:_
Reeuvmaeudod Repairs Using Sahli Work Practices:
CAPER 100
OMB oorntol No:2506-0117(exp.09f3Q12021)
103
E®IRTMEM or tpnBW1C MMeC MD EuLCPh1GPNERS
I 1'lt CRxe of ReghOXax.0 DkM WONJaarerWONa. �.; I12%Eh NMI+Stmt Thtax Ika OA IR•IA1021
l:.
yp. nkm V,SIn¢oo�05 fAS.
• y.,. Rum(S09)GIS-GIOI•Fax(9)9)S21 I76 ea t
Pima:
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECITON CHECKLIST
HOMEBUYER:
Apartment N:Maple LeafTowaboaru tU IBR.2 RSA
PROPERTY ADDRESS•1205 N.2^t St
PROPERTY AGE:_42 Years
SECTION ONE:
BUILDING RXTTRJOR PARS FAIL COMM1NTS
I.Catdeko en truste=_ X
2C¢dilc enrol- X
}Vimake emirs Trig R sprawl X
aaxuodem nl=senor nate° X
Sul rofE ac _
5.teadilen ofelon 'WA
6.Caldidou errant
a) atckiw.scans.eepee0al us a
0) din*orlenx ::p o
e nerxd or tubed a o
SECTION TWO:
BVII.p)NGSISTEMS PASS I FAIL-I COMMFMS
I Maim o9uIpmnl X
2.Ve:ulalowtooling X
3.Waa hens X
LRouth p)wMnk _ X
5.Scxo X
&Elxukal ulniee•WRnR :X
I.Smake Oxymora I X
SECTION THREE:
UVCIG ROOM PASS I FAIL COMMENTS
I kloof*maim X
2 Window:oMmai X
JLomx.WJim X
•EWurkal Exam X
S.CeIIing eondkioe X
6.W'aIl o adidon X
T.Cu dilionot pane X
a) awkinr using•or pslill: a u
b) dtpinsccleose a O
o) Elessoivmaed x centered ox a
SECTION FOUR
lerrOIEN I PASS PAIL COMMENTS I
1.Pborc Idea X
2_Wew maimn X -IM es
3.UXrcandhlea X
a•BFuiW fonra x
SSink condition x
SeebineaCcunxxpcondiliuno X
7CeIlinr eunihion X
AWall nxditm X
9.Cbnditon*lexica:
al auk ht..mlingapclk nx u
h) ehlpprylurcme Oa o
e1 t&gsxiy mite cc mitred ex a
CAPER 101
OMB Co MIDI No:2506-0117(exp.09f30.12021)
104
SECTION PIVE:
1BATRBoob1 X3/Dock Roth Remodakd I PASS PAIL COMMENTS
b)Scp:diI oon X
1Wb4x.W:saka - - X
3.Doocc.:dllcn X
cElwnrkI fixbxaAM1'mlluikn X
S.TOIIM cwsim X
6.WAR NucAR:catm'ccdkkas X
7.Ed,ar eager Unit coalnico X
7.Calks o didca X
B.M'all cnnafIon X
O.Corrli]o c?p.ira
M cmckng Ka1Irg,o.mum CR c
b) cbippkyor Iona en e
el adcnaeli ttaalNawoeled ox n
SECTION SIX:
LAOXDRY ROOM/UTILITY ROOM: I PASS PALL COMMENTS
I.ikrcrcnd as 'X
3.Wiadow cactem I X _
3.DA c umdiBw X
dtlecticalltxm-nM1'eilibdln X
S.Codinecrtiac X
&Wall°manias X
7.CoMNna ambit. —
a'a uckkk,cellos.ce peeling m o
b) eblp1dnp a loan CDC C
e) M&')mkU lcaedc corral trc r
SECTION SEVEN:
)BEDROOM NO I:location Muter PASS PAIL COMMENTS
Lilac lxaditoa X
/Window cantkut X
3.1"Om pCdilim X
'dElclk&DRmme X
6.CYiluecopdkbm X
&Wan ucndbim i X
7.Ccedidnn angled:
a) a akin&stannicpalinp x n
b) charm or loofa tax n
c) olmalel)'fatted or awertJ ax o
SECTION EIGHT:
I!SDRoOM NO2:location PASS VAll. COMMENTS
I.Tloccoccdlbm X
2W1o6na con3i6xa X
Itlar condition 'X
a.Electiten Exluxs X
&cellintcflron X
&Wall oMdinicn X
7.COndriw«saint
O ctaxlq,molint,or walks rx c
b) claapins or loam an 0
N adNuadl meld c toovld ex n
SECTION NINE:
BEDROOM NO3 AMinraliao I PARc PALL COMMENTS
i.Pkercandblcn X
].Widow maim .X
3.Dncr condition X
c.BLwk,I fracas X
S.Cein endbion X
6.WSIcondklaa X
—
7.032d001orratx:
a) coAkim.scale,orkeclic a o
b) dipping co.!cost Can a
a) eda m:My.toad ercmara' I nx D
SECTION TEN:
DLWP ROOM OR WN NG AREA PASS i TAD. COMM MIS
!Boar maim X
CAPER 102
OMB CO nEmI NO:2506-0117(exp.OS/3013121)
105
2Winionamitiun X
1.noor median X
i.Elaskal fixnmc X
s.CtilinS cadbJo,. X
6.)Yall lxnditca X
Tuna:
7.Cuniiuon ofTu
a) cukir scaling,or pectin me c
h) chi :inn WA: cN L
o} da7naily Peed cc award pt c
SECTION El-RYEN:
II UTHRR ROOM:Jonah. N/A PASS ■AIL 00MMESIS
I I.Flux mason
2.W'lagvyahndikn
).Doc audition I -�
A.Elanbai fixboe
d.Ccilb.cmakn
e.Wall omdi:ian
7.Cndnion ermine
a) toothy,Harm;eeflailed n o
M ddprine rIooso p o
el Womanly nereda mural u c
SECTION TWELVE:
EN1RI►S.HALLWAYS OR STAIRCASES: I PARS NAIL COMMEETS
I.FUcn omdilim l 7.Doaaadlea, !X X
al
ACeMa cola.fixtures X
t.Celfl Laudable X
3.Walliden o Laudable X
d.a) emaofpiinl: x
a) aMAba,wall.$.a PeeR8 ox C
b) eb4Pinpalme CDCsr
a) &van&emend a Dos t3 rey C
SECTION THIRTEEN:
UNHORTAELE SOOM&N/A PASS FAIL COMMTNTS
1-mhmiml macadam
2Poneaellx burdens Inure
).Cmlinee awe
a) cnd:wt.acalisg,aaeling a n
b) chip7:nc urban 7 0
c) adnamb cumoecowrcd Io n )
SECTION FOURTEEN:
SUMMARY OF INSPECTION
PASS FAIL
VISUAL ASSESSMENT OF DETERIORATED PAINT: X
(If failed Visual Assam: et of Deteriorated Pallow Stctlon IS de Eat page)
10119/7A21
INSPECTOR SIGNATURE DATE
SECTION FIFTEEN:
Failed Visual Assesemeatntnctaiomtal Perot: J
Failed Inspactioo Section Dumber. L
F\aluatlon R. aIU: Ike rev Wino c,,*nix M*sW bednam wsa nxnndeled to meet Anse,walk-
,wall mount tinkand AIM mile
Re ceinmerded Repsin Using Safe Work Practicer
CAPER 103
OMB Co nt to l No:2506-0117(exp.0E130.13121)
103
Failed Visual Amens/neat ofDacimawd Paint:
Failed inspection Section num&g I
&valuation Resuln:
Recommended Repairs Using Safe Week Psarsios
Failed Visual Amesamem ofDeceibuuod Paint:
Failed Inspection Section atmta: I I
Evaluation licsulb:
Recommended Repairs Using Safe Work Pnctios:
CAPER 104
OMB Cora tot No:2506-0117(exp.09f3Q12021)
107
t D&PXThIENTCF COMLuh1•AND ECOaOPRCcEEURREm
p }•1� oraxefN haohXd
l� W Ded;matl.Str.ka Time 2:0 Da Il.W11
!' i 1125xN 98h:h SBEet
j Y; Tel a,Wathsten 90521 Time:1:80 pm
Ron(5D8)525.6:U1•Fax(sp)575d1M Ream,rink
Rm.:
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMERUYER Rental
SELLER:YCDA
PROPERTY ADDRESS:1630 S.16th AYE Apartments N105.I 06,109,208(All I BR)
(PROPERTY AGE:_RRtial
SECTION ONE:
Bmffpnl`G EXIXRIOR L PASS FAIL COMMENTS
I.Coed:noa effomdmx X —
2Ceditienafeaf X
xOnnn:vl of=IR a&porde X
ACcodh;N,vf.YuiA I*WW1 'x
(claim'OCR ex)
l.Lbeliliun of chimney -NM
d.Co/Manorwim:
I) tiedup.RaNre,et putax X u
h) chipping or kxaa X u
el azimuth/mmihf or cowed X o
SECTION TWO:
BPILDDIG SYSTEMS !PASS PAW COMMENTS
:.IkaME W:fm<at X
2.VenlilxiaCooIk% X
S.Wmutwer X
aAoadl PlunGfq X
5Sweer X
41ldto-ital emich'WIOM X —
7Satice Mamas -X
SECTION THREE:
I]VING ROOM PASS I FAO. COMMIX
l.fiamcopleio, x
2.Rlndor condition X
3 Dour main, X
d.Elwariml Dares 'X
!.Will Radio n X 1
GOiml Radium X
7.Condi:ian M ptnd:
II) atsktkI.scaling,ur reel% X u
h) <hipping Cr tame X n
c) Wwuraiv aeuol mmrmd X o
SECTION POUR
ITCU T.
I1.1 PASS I FA CO8016VIS
lcat make X
2.Windorcedidnn X
)1)nor°mllitrt X
i-IFlwvkal flmoto X
tSrk wbditim X
6.0tRatounenoo makes X
2.Cnmir¢ecdirot X
8.WOleon6fien X
o.(ieAitim efpdoc
30 em:kiog,waling,co peeling X n
bl Oilppina arlano X n
c OX wink trend oroowr,H _X et
CAPER 105
OMB Co MIDI No:2506-0117(exp.0973Qf3)21)
108
SECTION FIVE:
BATHROOM PASS FAIL I COMMENTS
IFloorotditlm X
2 lowanSxioa X r
3.Domca4itim X
A.Elrarkal flxennneaikeon X
&Toiletcondkka X
6.Wash buY.Lbaalon.emdilioos X
7.Tub or A Door nilmndiflon `X
7.(NIne rmd'nion X
&Wall coalition X
9.Coadlean of Wit •
a) m:Mng„giing a paellas X u
b) ebippvs¢:case I X a
e) 10001elverwAd unwired X a
SECTION SIX:
4AUADRY ROOMLET LITY ROOM: PASS FAIL'COMMENTS
ISkarc edisim WA
rYiMox coatis' 'WA
3.UomoaWigmr :WA
A.Elabicalflxeuoa aalssdm WA
I Cciliaccm:ion WA
6.W01 cendiltan WA
7Cobmin a'mia: WA
A) cilAcap.sake.a;NOB e
<n:ppnga Ix*: R
c) admusaly murataavued a
SECTION SEVEN:
BEDROOM NO I:tram Maoist PASS FAIL COMMENTS
I.Flarccadkioa X
2.1Nindou madidcn X
3Doorcomklao X
&Ekmiml Bum( X
S.Ceikngcondbion X
6.W111o=Ntlas X
7.Cadidenctps
a) cakl n aali ppg X u
b) Jnc mime X a
Alua
a) i3wlmlphtramd or cowed X o
SECTION EIGHT:
BEDROOM NO 2:barbs PASS WI COMMENTS
:.F-aar coalition WA
2.Wadowoa:dt ca WA
SQ5accaradua WA
&Elm:W Rosa EPA
S.C.i&a radlaml WA
AWgr or-aka WA
7.0a:diiun of pane WA
0 axkin&raging,a pCNlirg n
b) ctiTins ar lase a
c) altWsd[iYtraa:da w0!.9 a
SECTION NINE:
BEDROOM NO3:loatbn I PASS PAW COMMENTS
].Pbrr radilinn WA
2.Wkdowomtcbn - WA
WAX(volition WA
rmiml Au.rxe WA J
A.®
SCMtit nadlda WA
6 Wall amc:ke WA
7.0eadiba orath.i WA
a) ca:klnt.caEne.=paling a
b) 0133010rttee a
0 12.4S40cvcdm0o00
SECTIONTRN:
OININC ROOM OR DINING AREA z.VSSI PAIL I COMMRM7S
1 tMkamndiden
CAPER 106
OMB CoMmI No:2506-0217(exp.09f3Q13121)
109
2.Wtndon andbioo IX
;,noero03E1 m X
a Ebmial liven X
5.Ceiling condMon X
6.W11=Munn X
7.0xMidcoofpafnt
a) aakias scaling.ccpeelkd X o
a b) Wogtrkeno X o
cl odeaa$n lexM or conmo1 X e
SECTION ELEVEN:
MISR ROOM:beano* - PAW FAIL C030AFNrs
I.Floaaodca WA
IWlnfew cendktoa WA
3.Dow acdlrm N;A
4.5bcbkal flxmrur WA I
.1.04l4ccadi.i,. WA
6.Woll ounlioion WA
7.CoMi:ion of pnni:
a) atc ke,aalioc.arpceIrg n o
b) &Wog a tom 0 c
c) SQ6MZ,booked cc awed u e
SECTION TWELVE:
EBFRIES,RALLWAYS OR STAIRCASE& .PASS FAR. COMMINTS
1.F9ocrandilive X
2.Door caddies X
3.Elwbke.fixer X
a.Cefit,ealidco X
5.9441 condition X —
6.Coodiiocaipaint
e) croulM.wake.or Nt g X c
b) N,ippin:a lone X o
c) adm Italy:mroi or covered X o
SECTION TFIQCTE&N:
VMTA&TABU ROOMS: ly5,x PAR ICOIIM (FS
l.Elecl cUotaIaiax WA
2.Paaaid y ruav ou,Mums WA
3.lnr6Blico oepoinc
a) aarkt.Bell
b) cllippingarlo»rvW o a
d) adauanyaa,Mxranted b o
SECTION FOURTEEN:
I SUMMARY OF INSPECTION I PAX
&C I FA
/i/��7 (If TOW Visual Assessment see Samba IS on inn page) J
ely
7` IIi4i>_l
INSPECTOR SIGNATURE DATE
SECTION FIFTEEN:
Med Visual Amassment:
Exiled Inspection Section number: L
Evshmadoo Results:
Recommended Repairs using Safe Work Prnedces:
CAPER 107
OMB Co nttoI No:2506-0117(exp.09f3Q13)21)
110
Be0ed Visual Assessment:
Failed InmoRion Section number.
Evslualion Rtluhz:
Itcwmm_nded Remiss Using Safe Wats Fraction-
Failed Visual Assessment:
Failed Inspection Section number. F 1
Ewdosition Results:
Recommended Reels&Using Safe Wick Practices:_ _
CAPER 108
OMB Co ntioI No:2506-0117(exp.09f3Qf2021)
111 AICENW7MENTCF 0)FFLI1DTf MDECO\CPCDRELPS M
_ �. Otrce anugnYArgcd Dredapmeat Robb Modica hole:11:411
89 ilt SOW TA Stew
a^ i/i Mims,%#Irstaa 90,3: Timm 2:00pm
(r Fan(599)5/58I01.Fax(SON ST56176 Waller TOM
phma:
HOUSING QUALITY STANDARDS,CODE REQUIREMENTS AND
DETERIORATED PAINT VISUAL ASSESSMENT INSPECTION CHECKLIST
HOMEBUYER:Rcntal 1
SELLER:YCHA
PROPERTY ADDRESS:1630 S.16th Ave,Studio Apartment/0105
PROPERTY AGE:Jahi&
SECTION ONE:
BUILDING EXTERIOR PASS I FAO. COMb1MOp6
I.Cotofamdmlon X
1.Comtakc of ma X
3:Ccctra:nfaxirs,rmla&povho X
*Goadsxn At CUtD%soruas X
rid' rotIi.ox)
JAbndition ofaimnea Na
6.Condbion ofpalne
e) auxxM%NINE a Noma X o
b) chipplasa Nome X c
cl ad owl Nadel amud X c
SECTION TWO:
r BLTLBING STSTFAIS -iPAaS ran, COMMENTS
Lblo:insamcimas X
T.Vemlliios'CoNica 'X
3.Wr m rater X
ARocdlphonbkg X
&sen.'r X
6Dkancol sovkkW'iries X
T4rAVaDgeRaS X
SECTION THREE:
LIVING ROOM PASS PAIL COMMENTS
I.E'Wr wn.ibian X
2.Wmdas P,,,di i n X
$Dcortondiliam X
433ta1a1 Rapms X
Scai' ceAdMea X
SWall tmdicca X
?Condition*SPINE
o) ractbg dud'ug«raft X o
b) cippIng a loot X c
• ad ly iNnaSceo»oti X I
SECTION FOUR:
KITCHEN PASS PAIL COMMENTS
tXicor tomtitX
2.WTndoumMMon X
331oor oc diilc X
4.Elrplal Iixarea X
S.Sck ecndleen X
6.C»ttitscocrmp auSiakos X
7.Ciac.ataadWan X
If.'ASJI cANtke.. X
9 C<udilal or pn4l.
a) .xkvli,sallI or pearly X o
IA .hippi'g Ai tcw X n
vaa mrl3 Nosed r mvld X n
CAPER 109
OMB CO IX 101 NO:2506-0117(e xp.0913Q/3)21)
112
SECTION FIVE:
BATNROOM PASS_FAIL COMMENTS
LPdcmardhiae X
2.Wmdon m:dlam X
—
3AnrantOre X
4.151xldual liwre3Nali1Niun X —
S.Toixl nndibm X
6 Wash bolMabmxocyconiblom X
•7.'Moe shows=cardbim Ix
3.Ceilinicoo3.ko X
S.Wan ccadieal X
9.Cuaihion of paint:
a) rcakire xali%ccrefire X o
b) cawing m loose X e
c) caXmor4 heated ce contol X C
SECTION SIX:
LAUNDRY ROOMAITMITy ROOM: PASY PAIL MOMENTS
I.Fbarmndldm WA
LWkaio.•cmd'o= 'WA
3.Dxr coadiliva N;A
a.rlonkai fbaufwV xiblim WA
&Celli awake MA
6.Wall:minion WA
7.0makompalm: WA
a) craeYe6,unl'P*.crTecate e
I) Mlppinyp Iwx e
c) admurxlyambld or coveted p
SECTION SEVEN:
BEDROOM Rot:laaldua PASS PAIL COMMENTS
I.Ppprcaa3isim WA
?.R nclaw cbdi4ml WA
3.Dmrconil:kan WA
—
aleaccd fivers WA
&Culls mldleco - NIA
6.W.Eu caa;:n WA
'r.Cccdimn arpaik: N.:A
3) aa:kIne,*albs.mpml:np a
b) chIppimurbeu n
e) admuebhaam or cowrcd I D
SECTION EIGHT:
BEDROOM NO2:beall(a PASS FAIL COMMTNTS
I.Flomccccscn WA
2Windca cmdilim WA —
3.0meuonditim WA
i,Elcmka:bxruna WA
3.Ceh'uacca-dlrtn WA
6.Wnll(aniibnn WA —
7.Caedmiac of pulyd: WA
a) gotta-scam.or peel= a
a) chippilrcalave o
_e) admumeh emlaa or cowed a
SECTION NNE:
BEDROOM NO 3:basin PASS I FAIL COMMENTS
I.Floorc 4 xs WA I
2.Wlndw;y dike N/A
1DomenNtioc WA
...Electrical Fxalm WA '
S.Callint cundiim WA
6.We11 uadbon WA
7.Comkian ofpaim: WA
a) asgli s.scaling,omits a
b) dlippio5m lame
a) odemmey uuaud cccomet o
D
SECTION TEN:
DIXMG TOR DIN G AREA PASS P IL CO�ML N,]g I
DINING ndxke J
CAPER 110
OMB Coat ioI No:2506-0117(exp.06f30.13)21)
113
2.WiWaweaaisim X
3.Ooacendiben X
4.Eksatt thaws X
S.Caal'akomditkc X
6.Wo11ean/ian X
7Cc drica e4palM:
a) aruedup.wakg•or wimp X a
b) cWOpigarIx" X n
a1 n.MOW1aly carted M cowed 'X a
SECTION ELEVEN:
0771FR ROOM:location PASS I FAIL COMMENTS
I.Moar oO:rzica N•A
2.Wtndan condlllso N'A
30�uacaellaa WA
4Eloabical&Aures N•A
d.[Rilinllaandtlian WA
&Wall omanG: WA
7.0ndilian of puns
o) cracking„staling.•a-peelirt8 a o
b) a2tpxgumtao n o
a) adeatoteAnwaol meowed a a
SECTION TWELVE:
ENTRIES.HALLWAYS OR STAIRCASES: PASS FAIL COMMENTS
rilrwrrnnlrim 7,•
7.Dos=a lai:a X
tElmbkal alum 7 X I
e.Cailingcardrim 'X
5.Well wnditian X
6.Cor.$mobgptlnt
a) melmc.Malmo atpealing X a
b) diming[noon X c
a) WabraMvensttdaennrad X is
SECTION THIRTEEN:
UNHABITAILS ROOMS: PASS FAIL COMMENTS
Ineemeol cooUom WA
2Pwanlinllyhamdmt Ricans 'WA
d.Cmdmnn w.It
w a) M 45.OAnalo ce mike u n
b) editing calms
a a O
e) romaawYbwad or covered o c
SECTION FOURTEEN:
SUMMARY OF INSPECTION I PASS FAII.I
X
(If fulled Visual Amasses: to Seedo 15 on nest page)
ie,(0 final
INSPECTOR SIGNATURE DATE
SECTION FIFTEEN:
Failed Visual Astmsoma:
F.kd Inspatioo Section number. L 1
Evtlmli(t Results:
Ro menend:d Repairs Using Sale Work Practicer
CAPER 111
OMB Co nt to I No:2506-0117(e xp.09/30/20211
114
Failed Viand Areeuta t:
Failed Inapgxian Section number. F I
Iivaluatlon Resuks:
Recommends.]Repairs:(Nang Safe Work Ftealcee:
L Foiled Visual Assess:mem
Failed Inspects Section numbs:
Evaluation Randle:
Recommendod Repairs(:sing Soh Work Maim:
CAPER 112
OMB Co MtoI No:2506-0117(exp.09f3Q13121)
115
HOME Match Report
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CAPER 113
OMB_m No:__ _gym
118
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CAPER 114
OMB_m NO:__ _gym