Inspection Form
City of Lynn Inspectional Services Department, Lynn City Hall, 781-598-4000
SSC 105 CMR 410.000: Chapter II, Minimum Standards of Fitness for Human Habitation
Date Time # Occupants # Children < 6 Years
Address Unit # City/Town
Occupant Name Phone #
Owner Name Phone#
Owner Address City/Town Zip Code
# Dwelling/ Rooming Units in Dwelling # Stories Floor Level of Unit
# Sleeping Rooms # Habitable Rooms (.400)
Inspector Title
If violations are observed and checked, describe them fully on Page 3.
Area or Type of Violation Possible Code Vif Responsible Party
Element Use blank boxes for ones not listed Section(s) Violation
Observed
heed [oes SCS
& Porch Posting, ID, Exit signs/emergency lights Ee
Handrails, steps, doors windows, roof Ee
Rubbish—storage and collection a
FMaintenanceofarea ss C—C<“—~—~—‘“‘“‘“‘<;zr SCT
Common —_| Light, windows [2sa2sasn [|
ress & Entry [Egress Sid
Interior Halls | Floors, walls ceilings Ee ee
& Stairs | Hallways, railings, stairs Es
bs wine Ee
Bedroom 1 Location (circle): Front Rear Middle Left Middle Right Floor Level of Unit
a
Ceiling height Lo
[Windows screen CC‘“~“~‘“<~S*~‘“‘<~S*s SSS
Bedroom 2 Location (circle): Front Rear Middle Left Middle Right Floor Level of Unit
ventilation C—CSC—C—S |
Ceiling height a
[Windows screen SSOSC—C—~SCS~—CS~s SPT
Bathroom Toilet, sink, shower, tub, door Es es
Smooth, impervious surfaces Es
Lights, outlets, ventilations
leloorsfwalsSsS—CSS—i|
Sink, stove, oven; good repair, impervious and smooth, 100
| space refrig
Lights, outlets, ventilation, windows, screens [251,280,505 | |S
Rev. 11-4-2021 Page 1 of __