Borough ofSt. Clair Residential Rental Property Inspection Form To Be Completed By Applicant: Note: Inspection Fee of$30.00 (eaçh unit) and a $10.00 initial registration fee, subsequent registration (change oftenant or annually) of $5.00 must be paid at time of application. Owner/Agent: Occupant: Address: Address ofUnit(s): Phone No: Phone No: Date of Occupancy: MUST BE: FILLED OUT BY APPLICANT (WILL BE VERIFIED DURING INSPECTION BY THE BOROUGH CODE OFFICIAL). BASIC FACILITIES YES NO ELECTRIC SERVICE YES NO 1.Kitchen Facilities 1.Minimum of( (2) wall outlets Sink and (1) light in each habitable Stove room (all kitchen countertop, Refrigerator bathroom and at-grade recep- Cabinets ticles must be GFCI protected. 2.Room affording privacy 2.Smoke Detectors (one in every with properly operating.. sleeping area and min. one on Toilet every level, including basement) Lavatory sink 3.Electrical Service Bathtub or Shower capacity (amps) 3.Hot and Cold Water supply SAFE SANITARY YES NO to kitchen and bathroom MAINTENANCE 4.heating System 1.Every public walkway, driveway Type entrance and curb is free of cracks, 5.Central Air breaks, and tripping hazards and in 6.Safe unobstructed means good repair. to exit leading directly to 2.Every foundation, roof, exterior ground level wall, door, skylight and window 7.Structurally sound handrails in good repair balusters, stairways, decks and 3.Every interior wall, ceiling, stairs, porches and appurtenances are safe and in 8.House number clearly displayed good repair. 9. Minimum one (1) CO detector 4.Sump Pump Date Appliçant Inspected: Date Codes Official Inspected: Applicant's s Signature Inspector's Signature Applicant's Name Printed Inspector's Name Printed Borough ofSt. Clair 16 South Third Street St. Clair, Pennsylvania 17970 Phone: 570-429-0640 Fax: 570-429-2829 Rental Registration Owner(s) of Reçord: Owner' s address: City: State: Zip: Phone: Tenant(s) of Record: Tenant's Phone: Registration Fee: Inspection Fee: (Amount Paid) (Amount Paid) Rental address: St, Clair, PA 17970 Number of Bedrooms: Total Occupant Load: This property has been registered by the Code Enforcement Officer and is subject to the provisions of Ordinançe No. 392 of the Borough of St. Clair. This the day of 200 Liçense No. Valid thru the 31st day of January, 20 Issuing offiçer: Signature Print