Amity Township Residential Rental Inspection Form

Amity Township Residential Rental Inspection Form
Date:

MonthDayYear
Date
All rental units are required to have Life Safety Inspections at Change of Occupancy or before an initial tenancy to receive a Certificate of Compliance. Rental units may also be subject to inspection based on complaints of violations and life safety concerns.
Rental Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Rental Units To Be Inspected:
Unit Number (s) (If applicable):
Inspection Requested For (select one or more):

Other
Name of Owner:

First NameLast Name
Mailing Address of Owner:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner Phone Number:

Area CodePhone Number
Alternate Phone Number:

Area CodePhone Number
If owner is a corporation, LLC, or partnership, list the responsible agent:
Owner Email:
example@example.com
Name:

First NameLast Name
Title:
Phone Number:

Area CodePhone Number
Email:
example@example.com
Local Property Manager/Agent (if different from Owner)
Property Manager/Agent:

First NameLast Name
Business Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Email:
example@example.com
Requested Inspection Information
Preferred Inspection Date:
Preferred Inspection Time:
Alternate Date/Time:
Special Access Instructions or Notes:
REQUIRED OWNER CERTIFICATION
1. I am the owner of the above-listed property or the duly authorized agent acting on behalf of the owner.

2. The information provided in this application is true and correct to the best of my knowledge.

3. I understand that this request is made pursuant to the Amity Township Residential Rental Property Inspection Program and applicable Township ordinances.

4. I acknowledge that the owner or authorized representative shall be present during the inspection and provide access to all required areas.

5. I understand that submission of this application does not guarantee a specific inspection date.

6. I understand that applicable inspection and re-inspection fees must be paid prior to inspection unless otherwise permitted.

7. I acknowledge that I have read and understand the Amity Township Rental Unit Inspection Guidelines.

8. I understand that if violations are identified, corrections must be completed within the timeframe established by the Township.
Owner/Authorized Agent Signature:
Printed Name:

First NameLast Name
Date:

MonthDayYear
Date

My Products

Inspection Fee (1-4 Units)$75.00

$75/unit

Quantity

Inspection Fee (5+ Units) $60.00

$60/unit

Quantity

Re-Inspection Fee$75.00

$75/unit

Quantity

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Amity Township Residential Rental Inspection Form

If owner is a corporation, LLC, or partnership, list the responsible agent:

Local Property Manager/Agent (if different from Owner)

Requested Inspection Information

My Products

INTERNAL OFFICE USE ONLY - DO NOT COMPLETE