06-035 (2) 0 6 - 6 35
INSTRUCTIONS TO LANDLORD:
1 . Keep a copy of this completed form for your records .
2 . Provide a copy of this completed form t• - • - 1
Housing Agency. D
al DEC8t
(Sample Letter to Request Inspection)
DEPT DF BUILDWG I" c +
Date: 1- )6� 9 �-- NI,;- r0N A
To the Code Enforcement Department/Board of Health:
RE: Tenant Name: Pa"‘ Yarvt n Telephone: n_,rc
Address: -:yam "-t Le AT Mv4 oios3
Unit # :
Unit is: pc occupied unoccupied
1 am the owner of the rental property listed above. Because my
tenant at that address is a participant in the Massachusetts
Rental Voucher Program (MRVP) , I need to request an inspection of
the unit indicated. I am requesting that the inspection be
completed in as timely a manner as is possible.
So that I may provide the Local Housing Agency with proof that I
have made this request, please indicate the status of the
inspection request by completing the lines below, and returning a
copy to me.
Thank you for your assistance.
Sincerely,
Address: 7oA /L(ontoc)„c Rd '1/4,1e0deli ti'A &LY9
Phone: 5-b0 %LiY - b3`3
******************f*********************************************
An inspection of the above unit has been scheduled for (specific
date) :
OR
The inspection will be scheduled for (estimated date/week/month) :
Signed (Code/Health Dept. ) :
Municipal Agency:
Phone:
f Building Inspector's Office
212 Main Street
Northampton, MA 01060
Attention: Pat
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