Section 1 — Property address, inspection date, and parties

Property Street Address

City

ZIP Code

Inspection Date

Purchaser of Service (Section 2)

Name of Person Purchasing Inspection

Seller

Agent

Buyer

Management Co.

Other

Owner / Seller Name

Report Forwarded To (Section 4)

Title Company or Mortgagee

Purchaser of Service

Seller

Agent

Buyer

Structures Inspected

Type of Construction (5B)

Foundation

Slab

Pier & Beam

Pier Type:

Basement

Other:

Siding

Wood

Fiber Cement Board

Brick

Stone

Stucco

Other:

Roof

Composition

Wood Shingle

Metal

Tile

Other:

Inspector (7A)

Inspector License Number

Others Present (7B)Apprentices, Technicians, or Certified Applicators Name(s) and Registration/License Number(s)

Notice of Inspection Posted At (8A)

Electric Breaker Box

Water Heater Closet

Beneath the Kitchen Sink

Date Posted (8B)Date the notice of inspection was posted