Form 15 Sampel Work Write-Up - THDA



487362519050HO-6A00HO-6Acenter1274445REHABILITATION WORK WRITE-UP00REHABILITATION WORK WRITE-UPOwner: _____________________________________ Date: _________________ Physical Address: ___________________________________________________City _________________________ State ________ Zip Code ______________ Administrator: ___________________________ Grantee: __________________ Formatted in conjunction with the Uniform Physical Condition Standards ChecklistSITEFENCING & GATESFENCING & GATESDamaged/ Falling/ Leaning/ Holes/ Missing SectionsObservable deficiencies, action required, and description of materialsGROUNDSGROUNDSErosion/ Rutting/ Overgrown Vegetation/ Ponding/ Site DrainageObservable deficiencies, action required, and description of materialsMAILBOX/ SIGNSMAILBOX/ SIGNSMissing/ Damaged/ Address Numbers/ Missing/ DamagedObservable deficiencies, action required, and description of materialsMARKET APPEALMARKET APPEALGraffiti/ LitterObservable deficiencies, action required, and description of materialsPARKING/ DRIVEWAY/ ROADSPARKING/ DRIVEWAY/ ROADSCracks/ Ponding/ Potholes/ Loose Material/ SettlementObservable deficiencies, action required, and description of materialsREFUSE DISPOSALREFUSE DISPOSALBroken/ Damaged Enclosures/ Inadequate/ MissingObservable deficiencies, action required, and description of materialsRETAINING WALLSRETAINING WALLSDamaged/ Falling/ LeaningObservable deficiencies, action required, and description of materialsSTORM DAMAGESTORM DAMAGEDamage/ ObstructedObservable deficiencies, action required, and description of materialsWALKWAY/ STEPSWALKWAY/ STEPSBroken/ Cracks/ Settlement/ Spalling/ Missing or Damaged HandrailsObservable deficiencies, action required, and description of materialsBUILDING EXTERIORDOORSDOORSDamaged/ Frames/ Thresholds/ Hardware/ Surface/ Weather Stripping/ Caulking/ Storm DoorObservable deficiencies, action required, and description of materialsFIRE ESCAPESFIRE ESCAPESBlocked Egress/ Ladders/ Missing ComponentsObservable deficiencies, action required, and description of materialsFOUNDATIONSFOUNDATIONSCracks/ Gaps/ Spalling/ Exposed RebarObservable deficiencies, action required, and description of materialsLIGHTINGLIGHTINGBroken/ Missing/ Fixtures/ BulbsObservable deficiencies, action required, and description of materialsPATIO/ PORCH/ BALCONYPATIO/ PORCH/ BALCONYDamaged/ Missing/ Baluster/ Railing/ Decking/ SurfaceObservable deficiencies, action required, and description of materialsROOFSROOFSDamaged/ Soffit/ Fascia/ Vents/ Drains/ Membrane/ Shingles/ Gutters/ Downspout/ Ponding Observable deficiencies, action required, and description of materialsSTAIRSSTAIRSBroken/ Damaged/ Missing/ Steps/ Handrails/ GuardrailsObservable deficiencies, action required, and description of materialsWALLSWALLSDamaged/ Missing/ Cracks/ Gaps/ Holes/ Spalling/ Peeling/ Caulking/ ChimneysObservable deficiencies, action required, and description of materialsWINDOWSWINDOWSDamaged/ Missing/ Broken/ Frames/ Panes/ Sills/ Lintels/ Trim/ Screens/ Caulking/ PaintObservable deficiencies, action required, and description of materialsBUILDING SYSTEMSDOMESTIC WATERDOMESTIC WATERLeaking Central Water Supply/ Broken/ InoperativeObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMSELECTRICAL SYSTEMSAccess/ Damaged/ Missing/ Breakers/ Covers/ Wires/ Corrosion/ Evidence Water Leaks Observable deficiencies, action required, and description of materialsHOT WATER HEATERHOT WATER HEATERInoperative/ Leaking/ Rust/ Corrosion/ Missing/ TPRV/ Vent/ Chimney/ Combustion Air Observable deficiencies, action required, and description of materialsHVACHVACInoperative/ Noisy/ Vibrating/ Leaking/ Rust/ Corrosion/ Missing/ Vent/ Chimney/ Covers Observable deficiencies, action required, and description of materialsSANITARY SYSTEMSSANITARY SYSTEMSBroken/ Leaking/ Clogged/ Missing/ Cleanout/ Manhole Covers Observable deficiencies, action required, and description of materialsUNITBATHROOMBATHROOMBATHROOM Cabinets/ Top/ Sink/ Plumbing/ Tub/ Shower/ Ventilation/ Water Closet Observable deficiencies, action required, and description of materialsCEILINGCEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materials WALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsKITCHEN KITCHENKITCHENDamaged/ Missing/ Cabinets/ Countertop/ Sink/ Faucet/ Plumbing/ Appliances Observable deficiencies, action required, and description of materials CEILING CEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materialsWALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsBEDROOMBEDROOMBEDROOMDamaged/ Missing/ Smoke Detector/ Ceiling Fan/ Closet/ Egress Observable deficiencies, action required, and description of materials CEILING CEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materialsWALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsHALLWAYHALLWAYHALLWAYDamaged/ Missing/ Smoke Detector/ Closet/ Attic Access/ Egress Observable deficiencies, action required, and description of materials CEILING CEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materialsSTAIRSSTAIRSBroken/ Damaged/ Missing/ Steps/ Handrails/ GuardrailsObservable deficiencies, action required, and description of materialsWALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsLIVING ROOMLIVING ROOMLIVING ROOMDamaged/ Missing/ Smoke Detector/ Ceiling Fan/ Closet/ Entry Observable deficiencies, action required, and description of materials CEILING CEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materialsWALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsDINING ROOMDINING ROOMDINING ROOMDamaged/ Missing/ Smoke Detector/ Closet Observable deficiencies, action required, and description of materials CEILING CEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materialsWALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsLAUNDRY AREALAUNDRY AREALAUNDRY AREADamaged/ Missing/ Dryer Vent/ Sink/ Plumbing/ Exhaust Fan/ Closet/ Shelving Observable deficiencies, action required, and description of materials CEILING CEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materialsWALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsOTHER ROOMOTHER ROOMOTHER ROOMDamaged/ Missing/ Smoke Detector/ Ceiling Fan/ Closet/ Entry/ Stairs/ Egress/ Observable deficiencies, action required, and description of materials CEILING CEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materialsWALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsGARAGEGARAGEGARAGEDamaged/ Missing/ Smoke Detector/ Stairs/ Closet/ Opener Observable deficiencies, action required, and description of materials CEILING CEILINGBulging/ Buckling/ Cracks/ Holes/ Peeling/ Damaged/ Missing/ Tile/ Panels/ Water StainsObservable deficiencies, action required, and description of materials DOORSDOORSDamaged/ Missing/ Frames/ Threshold/ Lintel/ Hardware/ Surface/ PaintObservable deficiencies, action required, and description of materialsELECTRICAL SYSTEMELECTRICAL SYSTEMInoperable/ GFCI/ Damage/ Missing/ Wire/ Cover Plates/ Light Fixture/ Evidence Water LeaksObservable deficiencies, action required, and description of materialsFLOORSFLOORSBulging/ Buckling/ Damaged/ Missing/ Covering/ Tile/ Deteriorated Subfloor/ Water StainsObservable deficiencies, action required, and description of materialsWALLSWALLSBulging/ Buckling/ Damaged/ Trim/ Paint/ Water Stains/ Mold/ MildewObservable deficiencies, action required, and description of materials WINDOWSWINDOWSCracked/ Broken/ Missing/ Panes/ Sill/ Caulking/ Hardware/ Paint/ Water Stains/ ScreensObservable deficiencies, action required, and description of materialsGENERAL CONDITIONSSCOPE OF WORKSCOPE OF WORK It will be the responsibility of the contractor to meet the requirements of the 2009 International Existing Building Code and all other applicable codes, regulations, and ordinances that apply to the jurisdiction where the work is being performed. The contractor shall obtain all necessary permits and inspections required by all laws, regulations, or public authority having jurisdiction. The contractor shall pay all permit fees, tap fees, temporary utility connection charges, and other expenses in connection therewith this project. The contractor shall obtain certificates of all inspections and submit a copy of each to the project administrator before final payment is made. All materials and construction to comply with THDA’s Minimum Design Standards. CODE OF CONDUCT & WORK SITE RULESCODE OF CONDUCT & WORK SITE RULESContractor shall conduct themselves in a professional manner and maintain a neat and orderly job site at all times. Upon completion of daily work, contractor will organize materials and dispose of trash and construction debris broom swept. The Project Administrator may charge for labor services to clean job site if such services are required and implemented. Contractor is responsible for the actions of their sub-contractors and employees on the job site at all times. Contractor and their sub-contractors shall maintain normal working hours between 7 AM and 5 PM Monday through Saturday as to be respectful to owner and neighbors. No smoking or eating in the home at any time.446087517272000-666754572000Prepared by:Date: ................
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