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1. How long have you been
the owner of the property? _________ years
1a. How old is the home?
_____________ years
1b. How old are the
additions? _________ years
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2. Are you aware of any
remodeling, additions, alterations, repairs or
replacements done without building permits
(structural, electrical, mechanical or plumbing)
issued and final inspections completed by
municipal or governmental authorities?
[ ] No [ ] Yes, please explain:
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3. Does the house have a
history of WATER PENETRATION in the basement,
attic and/or crawl space(s)?
[ ] No [ ] Yes, please explain:
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4.
Does the home have a sump pump?
[ ] No [ ] Yes, how often is it
needed?
4a. Is the property located in a flood plain (is flood
insurance needed)?
[ ] No [ ] Yes
4b. Has the property ever been under water / flooded?
[ ] No [ ] Yes
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5. Does the home have a [
] public or a [ ] private
sewage disposal system?
5a. If
the home has a private system, has the Title V
inspection been completed?
[ ] No [ ] Yes
5b. Results of Title V inspection?
[ ] Passed [ ] Failed,
please explain:
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5c. If the home has a private system, when was it
last pumped out?
5d. If on a private system, are you aware of any
defects, deficiencies or problems with it?
[ ] No [ ] Yes, please explain:
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6. If
the home is connected to a public sewage system,
are you aware of any defects, deficiencies or problems
in regards to how it affects the building? (This
includes tree roots blocking the pipes or sewage
backups from other causes)
[ ] No [ ] Yes, please explain
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7. Has
the home ever been tested for RADON GAS?
[ ] No [ ] Yes
If yes, are the test results available?
[ ] No [ ] Yes
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8. Are
you aware of any history of prior FIRE or
SMOKE DAMAGE in the building?
[ ] No [ ] Yes
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9. Has
the house ever been inspected for TERMITES,
CARPENTER ANTS, POWDER POST BEETLES or any other
wood destroying organism?
[ ] No [ ] Yes
If “yes”, is the inspection report available?
[ ] No [ ] Yes
9a. Has the property ever been chemically
treated for termites, carpenter ants, powder post
beetles or any other wood destroying organism?
[ ] No [ ] Yes
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6.
10. Are you
aware of any environmental health or safety issues
around the building (such as UNDERGROUND OIL TANKS,
ABANDONED WELLS, ABANDONED CESSPOOLS OR ABANDONED
SEPTIC TANKS)?
9.
[
] No [ ] Yes
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11. Has
the home been INSPECTED by a private home
inspector before?
12 [ ] No
[ ] Yes
13
11a. If
“yes”, was the home inspected when you purchased it?
14
[
] No [ ] Yes
15
11b. Was an
inspection performed for another prospective buyer of
the property?
16
[
] No [ ] Yes
17
11c.
If “yes”, was something discovered during the
inspection that caused the prospective buyers to
rescind his/her offer to purchase?
19
[
] No [ ] Yes, please explain
21
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12.
Has the home ever been inspected for LEAD PAINT?
[ ] No [ ] Yes
12a. If “yes”, are documents available?
[ ] No [ ] Yes |
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13.
13. What is
the approximate age of the ROOF covering on the
main section of the building?
Primary ROOF? _______ years. Rear
wing? _______ years. Left wing? _______ years.
Right wing? ________ Porch? ________ years.
Garage roof ________ years.
Other area _______ years.
13a. Will you grant the inspector permission to
climb on the roof at his own risk?
[ ] No [ ] Yes
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14.
Are you aware of any previous water penetration from
the ROOF, CHIMNEY, FLASHINGS, SKYLIGHTS,
WINDOWS, DOORS, SIDING or any other part of the
building envelope?
[ ] No [ ] Yes, please explain
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15.
Approximate date CHIMNEY was last cleaned and
inspected?
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16.
Approximate age of FURNACE / BOILER OR HEAT PUMP
#one: __________ years
16a. Approximate age of FURNACE / BOILER OR HEAT
PUMP #two: __________ years
16b. Approximate age of FURNACE / BOILER OR HEAT
PUMP #three: __________ years
16c. What is the approximate date of last heating
system service? _____________
16d. Are you aware of any rooms that are not heated?
[ ] No [ ] Yes, please explain:
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17.
Approximate age of the CENTRAL AIR CONDITIONING
SYSTEM? #1 __________ years
17a. Approximate age of CENTRAL AC SYSTEM?
#2 __________ years
17b. What is the approximate date of last AC systems
were last serviced?
_______________
17c. Are you aware of any rooms that are not cooled?
[ ] No [ ] Yes, please explain:
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18.
Are the heating and cooling systems in need of any
repairs?
[ ] No [ ] Yes, please explain
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19.
How old is the WATER HEATER? _________
years. [ ] Owned [ ] Rented
19a. Do you ever run out of hot water?
[ ] No [ ] Yes, please explain:
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20. Do
you have any problems with FUSES blowing or
CIRCUIT BREAKERS tripping?
[ ] No [ ] Yes, please explain:
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21. Is
a WOOD STOVE or COAL STOVE present?
[ ] No [ ] Yes. Is a PERMIT
available? [ ] No [ ] Yes
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22.
Has the local fire department inspected the home for
SMOKE DETECTORS prior to sale?
[ ] No [ ] Yes
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23.
Does the property have any COVENANTS,
EASEMENTS or other RESTRICTIONS?
[ ] No [ ] Yes, please explain:
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24.
Are any there any budgeted MAJOR EXPENSE REPAIRS
to be done?
[ ] No [ ] Yes, please explain:
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25.
How old are the KITCHEN APPLIANCES? Range
_________ Dishwasher __________
Disposer _________Wall oven _________ Microwave
__________ Other: __________
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26. Is
the ATTIC INSULATED?
[ ] No [ ]
Yes
26a. Are the WALLS INSULATED?
[ ] No [ ] Yes
26b. Is the BASEMENT CEILING INSULATED?
[ ] No [ ] Yes
26c. Are the BASEMENT WALLS INSULATED?
[ ] No [ ] Yes
26d. Is the CRAWL SPACE INSULATED?
[ ] No [ ] Yes |
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27.
Are there any appliances, equipment or fixtures
the inspector should not attempt to operate?
[ ] No [ ] Yes, please explain:
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28.
Are there any rooms or areas of the building
the inspector should not enter?
[ ] No [ ] Yes, please explain:
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29.
Are there any crawl spaces or other areas that
the inspector might not readily find?
[ ] No [ ] Yes, please explain:
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30.
Are you aware of any hazards an inspector might
encounter in the living areas, attic, fireplaces,
basement or crawl spaces, such as pets, raccoons,
rodents, bats, snakes, bees?
[ ] No [ ] Yes, please explain:
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31.
Are you aware of any exterior cladding / siding or
trim damage or deficiencies?
[ ] No [ ] Yes, please explain:
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32.
Are you aware of any structural deficiencies in
the foundation, columns, floor frame, wall frame, roof
frame or staircases:
[ ] No [ ] Yes, please explain:
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33.
Are you aware of any seasonal drainage problems
on the property (such as ponding water on the
walkways, driveway, or yard; or erosion problems)?
[ ] No [ ] Yes, please explain
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34.
Are you aware of any environmental health or safety
issues within the building?
(Including but not limited to radon gas, lead paint,
asbestos, U.F.F.I, mold or mildew)
[ ] No [ ] Yes, please explain:
Additional
Comments:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Thank you for your
cooperation in filling out this questionnaire.
Please print your name, sign and date this form.
_____________________________
_______________________________
______________
Owner’s name – Please
print
Owner’s name – Please sign
Today’s Date
_____________________________
____________________________
_______________
Seller’s agent – Please
print Seller’s agent – Please sign
Today’s Date
BUYER PLEASE READ:
IF THE SELLER OR THE
SELLER’S AGENT IS NOT AVAILABLE OR IS NOT COOPERATIVE,
IT IS STRONGLY RECOMMENDED THAT YOU, THE CLIENT,
OBTAIN THE ANSWERS TO THE ABOVE QUESTIONS PRIOR TO
CLOSING.
PLEASE RETURN THIS
COMPLETED QUESTIONNAIRE TO THE INSPECTOR |
