Title Page
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Conducted on
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Inspected by
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Rental Address
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Number of Units
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Number of Occupants in Unit
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Year Built
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Total Square footage of Unit
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Owner Name
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Owner Address
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Owner Phone Number
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Owner Email Address
APARTMENT UNIT OR DWELLING (MSFC and CITY ORD. 60, 2nd Series)
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Smoke detectors present on every level and in good working condition. Located on every floor, every bedroom and hallway outside of bedrooms? (MN299F.362) (MSFC 9007.3.6, 907.2.9.3) 7 days
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Days to Correct
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Are smoke detectors less than 10 years old? (MSFC 1103.8.1) 30 days
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Days to Correct
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CO detectors within 10' of bedrooms and in good working condition? (MN299F.50) 30 days
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Days to Correct
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Extinguisher(s) provided? (MSFC 906.2) 30 days
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Days to Correct
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Extinguisher(s) maintained, tested and tagged/mounted/by exits? (MSFC 906.2) 60 days
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Days to Correct
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Extension cords used properly? (MSFC 605.5) 30 days
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Days to Correct
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Proper egress windows in sleeping rooms? (MSFC 1029.1) 90 days
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Days to Correct
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Escape windows free from obstructions? (MSFC 1030.2, 1030.3, 1030.7) 30 days
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Days to Correct
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No multi-plug adapters are in use? (MSFC 605.4) 7 days
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Days to Correct
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Is the oven free of storage? (MSFC 305.1) 30 days
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Days to Correct
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Provide and maintain fire barriers or fire walls to separate vacant spaces from the remainder of the building? (MSFC 311.2.3) 90 days
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Days to Correct
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Appliances working and maintained? (MSFC 605.7) 30 days
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Days to Correct
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Free of accumulation of excessive combustible waste? (MN299.F.18) 7 days
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Days to Correct
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Separation between house and garage? (MSFC 1106.3.1) 90 days
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Days to Correct
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Visible address 4" building number/contrasting color? (MSFC 505.1) 30 days
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Days to Correct
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Free of electrical hazards? (MSFC 605.1) 30 days
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Days to Correct
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Dryers properly vented to the exterior with metal pipes? (MSFC 603.5.2) 60 days
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Days to Correct
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Free of portable electric space heaters? (MSFC 605.10) 30 days
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Days to Correct
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Proper hardware/locking devices? (MSFC 1008.1) varies
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Days to Correct
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Every window, exterior door, and hatchway (or similar device) is free of insects? (City Ordinance)
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Days to Correct
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Exterior foundation, roof, wall, door, skylight and window is reasonably weather-tight, water tight, and damp free and is kept in sound condition? (City Ordinance)
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Days to Correct
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Exterior wood surfaces are protected from the elements and decay by paint or other protective coating/covering? (City Ordinance)
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Days to Correct
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Interior floors, walls and ceiling are sound and in good repair? (City Ordinance)
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Days to Correct
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Accessory structures present on the property are structurally sound, maintained, and free of insects and rodents? (City Ordinance)
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Days to Correct
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All plumbing fixtures and pipes are constructed and installed to conform with statutes, ordinances, and regulations of the Uniform Housing Code?
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Days to Correct
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All chimney, flue and smoke pipes are constructed and installed to conform with statutes, ordinances, and regulations of the Uniform Housing Code?
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Days to Correct
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All mechanical and electrical fixtures are constructed and installed to conform with statutes, ordinances, and regulations of the Uniform Housing Code?
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Days to Correct
WATER CLOSET (CITY ORD. 82, 2nd Series, 4-4-8, B)
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Water Closet is a non-inhabitable room to provide privacy?
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Days to Correct
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Each Water Closet is being used by no more than two (2) dwelling units?
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Days to Correct
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Water Closet is equipped with a flush water closet in good working condition?
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Days to Correct
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Flush water closet is equipped with easily cleanable surfaces?
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Days to Correct
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Flush water closet is properly connected to a sewer system which is approved by the City of Sleepy Eye?
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Days to Correct
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Flush water closet is properly connected to water system that provides adequate amount and pressure of water to function properly?
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Days to Correct
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Flush water closet is equipped with an operable window, mechanical ventilation or a fan?
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Days to Correct
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Water Closet is equipped with a lavatory sink in good working condition?
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Days to Correct
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Lavatory sink has adequate amount of heated and unheated running water under pressure?
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Days to Correct
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Lavatory sink is connected to a sewer system approved by the City of Sleepy Eye?
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Days to Correct
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Lavatory sink is in the same room as the flush water closet (or in an adjoining room, located nearest to the door leading into the flush water closet)?
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Days to Correct
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Water Closet is equipped with a bathtub or shower in good working condition?
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Days to Correct
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Bathtub/Shower is properly connected to a water supply approved by the City of Sleepy Eye?
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Days to Correct
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Bathtub/Shower has adequate amount of heated and unheated running water under pressure?
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Days to Correct
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Bathtub/Shower is connected to a sewer system approved by the City of Sleepy Eye?
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Days to Correct
FOOD PREPARATION AREA (CITY ORD. 82, 2nd Series, 4-4-8, A)
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A room or a portion of a room in which food may be prepared in?
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Days to Correct
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Room/area has adequate air circulation?
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Days to Correct
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Food prep area is equipped with a kitchen sink in good working condition?
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Days to Correct
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Sink is properly connected to a water supply approved by the City of Sleepy Eye?
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Days to Correct
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Sink has adequate amount of heated and unheated running water under pressure?
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Days to Correct
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Sink is connected to a sewer system approved by the City of Sleepy Eye?
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Days to Correct
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Food prep area is equipped with cabinets or shelving for storage of utensils and non-perishable food?
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Days to Correct
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Cabinets or Shelves are of sound construction?
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Days to Correct
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Cabinets or Shelf surface(s) can be easily cleaned, and surface is not toxic or harmful to food when in contact?
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Days to Correct
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Food prep area is equipped with a countertop or table for food preparation?
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Days to Correct
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Countertop or table area of sound construction?
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Days to Correct
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Countertop or table surface(s) can be easily cleaned, and surface is not toxic or harmful to food when in contact?
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Days to Correct
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Food prep area is equipped with a stove (or similar device) for cooking food?
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Days to Correct
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Stove (or similar device) is properly installed with all necessary connections?
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Days to Correct
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Food prep area is equipped with a Refrigerator (or similar device) for safe storage of perishable food?
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Days to Correct
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Refrigerator (or similar device) is properly installed with all necessary connections?
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Days to Correct
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Refrigerator stores food at less than 40 degrees Fahrenheit, but more than 32 degrees Fahrenheit?
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Days to Correct
APARTMENT BUILDING (MSFC and City ORD. 60, 2nd Series)
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Is storage at least 18 inches below fire sprinkler head deflectors? (MSFC 315.3.1) 7 days
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Days to Correct
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Building has at least two (2) means of egress? (MSFC 1015.1)
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Access to and from each dwelling unit is provided without passing through any other dwelling unit?
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Knox box/keys work? (MSFC 506.1) 60 days
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Days to Correct
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Dumpsters not within 5' of walls, roof eaves, and openings? (MSFC 304.3.3) 30 days
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Days to Correct
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No blocked exits inside and out/ice or snow/other obstructions? (MSFC 1030.3) 7 days
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Days to Correct
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Sprinkler connections/control values are visible and/or marked with strobe horn? (MSFC 903.4.2) 30 days
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Days to Correct
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Sprinkler/standpipes have protective caps? (MSFC 107.1, 903.3.7) 30 days
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Days to Correct
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Sprinkler - tested annually/copy to Fire Department? (MSFC 901.6.1) 60 days
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Days to Correct
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Proper hardware/locks on egress doors and windows? (MSFC 1008.1.8) 30 days
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Days to Correct
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Pull stations in working condition/not blocked? (MSFC 907.4) 30 days
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Days to Correct
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Exit lights with battery backup? (MSFC 1011.1) 60 days
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Days to Correct
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Emergency lights in working condition? (MSFC 1006.3) 60 days
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Days to Correct
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Hallway smoke detectors in good working condition? (MN299F.362, MSFC 907.3.5) 7 days
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Days to Correct
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No holes in sheetrock/fire stop? (MSFC 703.2.3) 90 days
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Days to Correct
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Fire rated doors on mechanical/laundry? (MSFC 703.2) 60 days
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Days to Correct
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No storage in the boiler room/mechanical room? (MSFC 315.2.3) 7 days
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Days to Correct
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One hour rated enclosures under stairway (exception-single family)? (MSFC 1009.9.3) 60 days
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Days to Correct
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No clutter/combustibles within the corridors? (MSFC 304.1) 7 days
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Days to Correct
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Proper handrails - No more than 30" - 42" off floor? (MSFC 1104.13) 30 days
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Days to Correct
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Electrical boxes covered, no storage within 36"? (MSFC 605.3) 30 days
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Days to Correct
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Alarm Panel - tested annually/copy to Fire Department? (MSFC 907.20.2) 60 days
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Days to Correct
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Flexible gas lines? (MSFC 102.7, 603.1) 60 days
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Days to Correct
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Self closers on laundry door? (MSFC 103.2, 1008.1.8.3) 60 days
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Days to Correct
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No combustible/flammable material or liquids inside the building? (MSFC Chapter 57) 7 days
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Days to Correct
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Fire apparatus access road? (MSFC 503.1.1) 90 days
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Days to Correct
ADDITIONAL COMMENTS
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Additional Findings?
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Days to Correct
Violations
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All violations are to be corrected within the specified time period. The Inspection Code Violation Certificate must be submitted by the date listed here:
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