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 Info
For Prospective Home Buyer:
For your protection
and safety of the home inspector, answers to the following questions
should be obtained from the property owner prior to your scheduled
home inspection. This disclosure form is not a substitute for any
inspections, nor is it a warranty.
Questions
For Home Owner:
Your voluntary
responses will help the prospective homebuyer/s with their buying
plans and help the home inspector in evaluating conditions he/she
finds. This disclosure form is not a warranty of the property either
by you, (the seller) or by your real estate agent.
1. How long
have you been the owner of this property? _____________.
2. What is
the approximate age of the building?___________.
2b. Ages of
the additions, if any? ______________________.
3. Are there
any appliances, equipment or fixtures the inspector should not attempt
to operate?
[ ] No [ ] Yes, please explain:
4. Are there
any rooms or areas of the building the inspector should not enter?
[ ] No [ ] Yes, please explain:
5. Are there
crawl spaces or other areas in / under the building that the inspector
might not readily find?
[ ] No [ ] Yes, please explain:
6. 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, hornets or wasps?
[ ] No [ ] Yes, please explain:
7. Are you aware
of whether the property is located in a flood plain (is flood insurance
required)?
[ ] No [ ] Yes
7b. Are you
aware of whether any part of the property is in a designated wetland
area?
[ ] No [ ] Yes
 7c.
Are you aware whether the property has ever been under water / flooded?
[ ] No [ ] Yes, please explain:
7d. Are there
any sump pumps in the basement?
[ ] No [ ] Yes If yes, how many? _______
8. Are you aware of any exterior water penetration through the roof,
windows, doors, walls or through any other area of the building
or into the basement or crawl space (if any are present)?
[ ] No [ ] Yes, please explain:
9. Are you aware
of any exterior cladding / siding damage, defects or deficiencies?
[ ] No [ ] Yes, please explain:
10. Are you
aware of any structural problems / damage, defects or deficiencies
with the foundation, masonry walls, wood framing, metal framing
or any other part of the building?
[ ] No [ ] Yes, please explain:
11. What is
the approximate age of the roof surface on the main section of building?
____________
11b. On the
additions, if any? _________________________.
11c. Are you
aware of any roof surface repairs or replacements within the past
3 years?
[ ] No [ ] Yes, please explain:
12. What is
the approximate age of the heater / boiler / furnace or heat pump?
__________.
12b. Are you
aware of any heating system repairs or replacements during the past
3 years?
[ ] No [ ] Yes, please explain:
13. What is
the approximate age of the central air conditioning system? _________.
13b. Are you
aware of any central air conditioning system repairs or replacements
during the past 3 years, including the addition of refrigerate to
the system?
[ ] No [ ] Yes, please explain:
14. Are you
aware of any electrical defects, deficiencies, problems or safety
issues (this includes fuses that blow out or circuit breakers that
trip more than once)?
[ ] No [ ] Yes, please explain:
14b. Are you
aware of any electrical work having been done during the past 3
years?
[ ] No [ ] Yes, please explain:
15. What is
the approximate age of the water heater? ___________.
15b. Are you
aware of any plumbing problems, leaks, deficiencies, or plumbing
safety issues?
[ ] No [ ] Yes, please explain:
15c. Are you
aware of any plumbing work having been done during the past 3 years?
[ ] No [ ] Yes, please explain:
16. Are you aware of any remodeling, alterations, repairs or replacements
done without building permits, electrical permits, mechanical or
plumbing permits issued by the municipal or governmental authorities?
[ ] No [ ] Yes, please explain:
17. Are you
aware of the property having ever been inspected for termites, carpenter
ants or any other wood destroying insects or organisms?
[ ] No [ ] Yes, is the inspection report available [ ] No [ ] Yes
17b. Are you
aware of the property having ever been treated for termites, carpenter
ants or any other wood destroying insects or organisms?
[ ] No [ ] Yes, please explain:
18. Are you
aware of any history of fire or smoke damage in the building?
[ ] No [ ] Yes, please explain:
19. Are you
aware of any environmental health or safety issues within the building?
(Including but not limited to radon gas, lead paint, hazardous mold
or asbestos.)
[ ] No [ ] Yes, please explain:
20. Are you
aware of the building having ever been tested for radon gas?
[ ] No [ ] Yes, are the results available? [ ] No [ ] Yes
21. Are you
aware of the building having ever been inspected / tested for lead
paint?
[ ] No [ ] Yes, are the results available? [ ] No [ ] Yes
22. Are you
aware of the building having ever been inspected / tested for hazardous
mold?
[ ] No [ ] Yes, are the results available? [ ] No [ ] Yes
23. Are you
aware of any environmental health or safety issues around the building,
other than the items above (such as underground fuel oil tanks,
abandoned wells, abandoned cesspools or septic tanks)?
[ ] No [ ] Yes, please explain:
24. Is there
an on-site / private sewage system for the building (such as a septic
or cesspool?)
[ ] No [ ] Yes
24b. If on a
private system, are you aware of it being inspected during the past
3 years?
[ ] No [ ] Yes, is the inspection report available? [ ] No [ ] Yes
24c. If on a
private system, are you aware of any defects, deficiencies, or problems
with it?
[ ] No [ ] Yes, please explain:
24d. If on a
public / municipal sewage system, are you aware of any defects,
deficiencies or problems in regards to how it affects this building?
(This includes tree roots blocking the pipes or sewage backup from
other causes.)
[ ] No [ ] Yes, please explain:
25. Is there an on-site water supply system, such as a well?
[ ] No [ ] Yes, Is this water supply distributed to the building?
[ ] No [ ] Yes
25b. If yes,
are you aware of any defects, deficiencies, problems or health concerns
with it?
[ ] No [ ] Yes, please explain:
25c. Are you
aware of any water quality testing having been done in the past
3 years?
[ ] No [ ] Yes, are the test results available? [ ] No [ ] Yes
25d. If on a
public / municipal water supply system, are you aware of any defects,
deficiencies, or problems in regards to how it affects this building?
(This includes low water pressure or flow.)
[ ] No [ ] Yes, please explain:
26. Are you
aware (during your ownership) of whether the property / building
has been inspected by a private home inspector?
[ ] No [ ] Yes
26b. If yes,
was this inspection conducted for another prospective buyer of this
building / property?
[ ] No [ ] Yes
26c. If yes,
was something discovered during the inspection that caused the prospective
buyer to rescind his/her offer to purchase?
[ ] No [ ] Yes, please explain: |
