CITY OF LOCK HAVEN

CITY OF LOCK HAVEN

PROOF OF INSPECTION FORM

This form must be completed by a Certified Inspector and returned to the Inspection Compliance Official at the City Code Office as required by Ordinance 670, Chapter 11

For proper completion of this form the Inspector shall indicate compliance of each Section with a check mark, if a Section is not applicable to the unit being inspected indicate with the letters n/a

ADDRESS:___________________________________________________________________________________

TOTAL NO. OF UNITS_______________ UNIT INSPECTED________________

THE BOCA NATIONAL PROPERTY MAINTENANCE CODE/1993

GENERAL REQUIREMENTS

Exterior Property Areas

CONFORMING CONFORMING

PM-302.1 _____________ PM-304.16 ______________

PM-302.2 _____________ PM-304.17 ______________

PM-302.3 _____________ PM-304.18 ______________

PM-302.4 _____________ PM-304.18.1 ______________

PM-302.5 _____________ PM-304.18.2 ______________

PM-302.6 _____________ PM-304.18.3 ______________

PM-302.7 _____________

PM-302.8 _____________

PM-302.9 _____________ Interior Structure

PM-305.1 ______________

Swimming Pools, Spas & Hot Tubs PM-305.2 ______________

PM-305.3 ______________

PM-305.4 ______________

PM-303.1 ______________ PM-305.5 ______________

PM-303.2 ______________ PM-305.6 ______________

Handrails and Guardrails

PM-306.1 ______________

Exterior Structure

Rubbish and Garbage

PM-304.1 ____________

PM-304.2 ____________ PM-307.1 ______________

PM-304.3 ____________ PM-307.2 ______________

PM-304.4 ____________ PM-307.2.1 ______________

PM-304.5 ____________ PM-307.2.2 ______________

PM-304.6 ____________ PM-307.3 ______________

PM-304.7 ____________ PM-307.3.1 ______________

PM-304.8 ____________ PM-307.3.2 ______________

PM-304.9 ____________

PM-304.10 ____________

PM-304.11 ____________ LIGHT, VENTILATION AND

PM-304.12 ____________ OCCUPANCY LIMITATIONS

PM-304.13 ____________

PM-304.13.1 ____________ Light

PM-304.13.2 ____________

PM-304.14 ____________ PM-402.1 ______________

PM-304.15 ____________ PM-402.2 ______________

PM-304.16 ____________ PM-402.3 ______________

SIGNATURE OF CERTIFIED INSPECTOR(S): ______________________________________________

. ______________________________________________

CONFORMING CONFORMING

Ventilation Sanitary Drainage System

PM-403.1 ____________ PM-506.1 ______________

PM-403.2 ____________ PM-506.2 ______________

PM-403.3 ____________

PM-403.4 ____________

PM-403.5 ____________ Storm Drainage

Occupancy Limitations PM-507.1 ______________

PM-507.2 ______________

PM-404.1 ____________

PM-404.2 ____________

PM-404.3 ____________ MECHANICAL AND ELECTRICAL

PM-404.4 ____________ REQUIREMENTS

PM-404.4.1 ____________

PM-404.4.2 ____________ Heating Facilities

PM-404.4.3 ____________

PM-404.4.4 ____________ PM-602.1 ______________

PM-404.4.5 ____________ PM-602.2 ______________

PM-404.5 ____________ PM-602.3 ______________

PM-404.5.1 ____________ PM-602.4 ______________

PM-404.5.2 ____________ PM-602.5 ______________

PM-404.6 ____________

PM-404.7 ____________ Mechanical Equipment

PM-603.1 ______________

PLUMBING FACILITIES AND PM-603.2 ______________

FIXTURE REQUIREMENTS PM-603.3 ______________

PM-603.4 ______________

Required Facilities PM-603.5 ______________

PM-603.6 ______________

PM-502.1 ____________

PM-502.2 ____________ Electrical Facilities

PM-502.3 ____________

PM-502.4 ____________ PM-604.1 ______________

PM-502.4.1 ____________ PM-604.2 ______________

PM-503.1 ____________ PM-604.3 ______________

PM-503.2 ____________

PM-503.3 ____________ Electrical Equipment

PM-503.4 ____________

PM-605.1 ______________

PM-605.2 ______________

PLUMBING SYSTEMS AND FIXTURES PM-605.3 ______________

Plumbing Systems and Fixtures

ELEVATORS, ESCALATORS AND

PM-504.1 ____________ DUMBWAITERS

PM-504.2 ____________

PM-504.3 ____________ PM-606.1 ______________

PM-606.2 ______________

Water System

DUCT SYSTEMS

PM-505.1 ____________

PM-505.2 ____________ PM-607.1 ______________

PM-505.3 ____________

PM-505.4 ____________

SIGNATURE OF CERTIFIED INSPECTOR(S): _______________________________________

. _______________________________________

FIRE SAFETY REQUIREMENTS

General

CONFORMING CONFORMING

PM-701.1 ______________ Fire-Resistance Ratings

PM-701.2 ______________ PM-703.1 ______________

PM-703.2 ______________

Means of Egress Fire Protection Systems

PM-702.1 ______________ PM-704.1 _______________

PM-702.2 ______________ PM-704.2 _______________

PM-702.3 ______________ PM-704.3 _______________

PM-702.4 ______________ PM-704.4 _______________

SIGNATURE OF CERTIFIED INSPECTOR(S): _________________________________________________

. _________________________________________________

® **WARNING: IF THIS PROPERTY HAS BUILDINGS CONSTRUCTED BEFORE 1978 THEY MAY

CONTAIN LEAD-BASED PAINT…

**AMENDED BY ORDINANCE

A SEPARATE FORM IS REQUIRED FOR EACH STRUCTURE

SIGNATURE OF CERTIFIED INSPECTOR(S): DATE OF FINAL INSPECTION:

_______________________________________ _______________________________________

OWNER(S): AGENT:

_______________________________________ ________________________________________

RESPONSIBLE PARTY – THE OWNER OF ANY RESIDENTIAL UNIT WHICH IS SUBJECT TO THE INSPECTION REQUIREMENTS OF ORDINANCE 670, CHAPTER 11 SHALL BE RESPONSIBLE FOR COMPLIANCE WITH THE PROVISIONS OF ORDINANCE 670, CHAPTER 11.

THIS FORM MUST BE COMPLETED AND SUBMITTED FOR APPROVAL TO THE CODE ENFORCEMENT OFFICE NO LATER THAN DECEMBER 31^ST OF THE YEAR IN WHICH THE INSPECTION IS REQUIRED.

UPON APPROVAL A CERTIFICATE OF COMPLIANCE WILL BE ISSUED TO THE OWNER.

THERE WILL BE A FIVE DOLLAR ($5.00) CHARGE FOR EACH CERTIFICATE ISSUED UNLESS SUBMITTED BEFORE JULY 1^ST OF THE YEAR IN WHICH THE INSPECTION IS REQUIRED.