Pursuant to Chapter 12, Article IX of the Rochester City Code, owners of rental properties are required to inspect rental units at the time of initial registration as a rental property and at the time a rental unit is vacated by a tenant. After the inspection, this form must be filled out and submitted to the Rochester Fire Department before December 31, 2011 as an initial registration or before the rental unit is occupied by a new tenant. Please read the Property Inspection Checklist Guide for descriptions of each item to be inspected. If you have any question, please contact the Fire Department Code Compliance Division at 248-651-4470 or fdcode@rochestermi.org. Completion of this Form constitutes the owner’s representation that all items have been inspected as required and that the information provided is accurate. Failure to comply with these requirements shall constitute a violation of Rochester City Code and may lead to the suspension of the certificate of occupancy for the rental property.

Property Information:

Building Address (Street #, Street Name):*

Unit Number Inspected (if applicable):

City:*

State*

Zip Code:*

Property Type:*

Condo Duplex Multi-Family Single-Family

Owner Information:

Owner's Full Legal Name (Last, First):*

Owner's Mailing Address:

Owner's Telephone Number (###) ###-####: *

Owner's Email: *

Agent/Representative Information:

Full legal name of Property Manager or individual responsible for the property, other than the owner, if any (Last, First):

Mailing address of Property Manager (Street Address, City, State, Zip Code):

Telephone Number of Property Manager (###) ###-####:

Email of Property Manager

Does the Property Manager have authority to enter and secure the premises (yes/no)?

If you answered yes, explain any restrictions on Manager's authority with regard to the property:

Condition of Property

Date rental this unit was inspected by you, MM/DD/YYYY:*

Date rental unit was vacated, MM/DD/YYYY (if applicable):

Please read the Property Inspection Checklist Guide.

Property Inspection Checklist Guide

Address numbers on the house:*

Compliant Not Compliant Not Applicable

Remarks:

Evidence of blight:*

Compliant Not Compliant Not Applicable

Remarks:

Ingress & Egress:*

Compliant Not Compliant Not Applicable

Remarks:

Door between living areas & garage:*

Compliant Not Compliant Not Applicable

Remarks:

Fire Separation:*

Compliant Not Compliant Not Applicable

Remarks:

Fuse/circuit breaker panel:*

Compliant Not Compliant Not Applicable

Remarks:

Usage of extension cords:*

Compliant Not Compliant Not Applicable

Remarks:

Electric cover plates:*

Compliant Not Compliant Not Applicable

Remarks:

Heating unit & water heating venting:*

Compliant Not Compliant Not Applicable

Remarks:

Combustion air:*

Compliant Not Compliant Not Applicable

Remarks:

Gas shut-off:*

Compliant Not Compliant Not Applicable

Remarks:

Water heater discharge pipe:*

Compliant Not Compliant Not Applicable

Remarks:

Smoke Detectors:*

Compliant Not Compliant Not Applicable

Remarks:

Window:*

Compliant Not Compliant Not Applicable

Remarks:

Basement sleeping room requirements:*

Compliant Not Compliant Not Applicable

Remarks:

Remarks must be provided for any Inspection Item that is checked as either "Not Compliant"or "Not Applicable."

Inspection completed by (Last, First):*

*Request for City Inspection: If a property owner is unable to determine the condition of their property, an owner may request the Fire Department Code Compliance Division inspect the property. The cost for the City to provide an initial or vacant unit inspection, at the request of the property owner, is $15.00 per rental unit. If you would like the City to provide the inspection service please complete the below section.

I, the aforementioned owner of this property, request the City to inspect my rental property and complete the "Rental Property Owner Self Inspection Form" as an alternative to me completing the self inspection.

I AGREE TO THE ABOVE STATEMENT REQUESTING CITY INSPECTION

Owner's Certification

I certify under penalty of perjury the information contracted on this document is true and correct to the best of my knowledge. I have read the Property Inspection Checklist Guide and that the inspection was in compliance with that Guide. I understand that the City of Rochester may conduct its own inspection of the rental property to verify the accuracy of the information I provided. I understand that if the statements made in this document are false or otherwise not accurate, I shall be in violation of the Rochester City Code. Further the certificate of occupancy for the rental property may be suspended.

I (the aforementioned property owner) certify the above statement to be true.