Lisburn Online Forms - Fitness Inspection Application

Fitness Inspection Application

Application to Conduct an Inspection for Fitness (Landlord Application)

The Private Tenancies (Northern Ireland) Order 2006

Article 33

Lisburn City Council will send a copy of this application form to the tenant. Please see the attached guidance notes.

guidance notes

This applicaton has a cost of £50.00

For further information please contact ehealth@lisburn.gov.uk +44 (0)28 9250 9394

Lisburn City Council, Environmental Health, Island Civic Centre, The Island, Lisburn BT27 4RL

Data Protection Act 1998

Lisburn City Council collects the Data on this form for the purposes of the management and application of the LG (MP) (NI) Order 1985. This data may be passed to other relevant Government agencies

Address of dwelling house/flat
Street number and name:
City or Town:
Post Code:
Dwelling:	Occupied Unoccupied
Name of tenant
Title:
First name:
Last name:
Main telephone number:	+
Other telephone number:	+
Date current tenancy commenced (dd/mm/yyyy):
Rent payable:	Weekly Monthly
If other please specify:
Name of landlord
Title:
First name:
Last name:
Street number and name:
City/Town:
Post Code:
Main telephone number:	+
Other telephone number:	+
Name if agent (if any)
Name:
Street number and name:
City/Town:
Post Code:
Main telephone number:	+
Other telephone number:	+
Does the tenancy include property other than the dwelling/house?
For example, garage or other separate buildings or land:	Yes No
If yes give details:
Has a notice of refusal been issued in respect of this dwelling? (see note 6):	Yes No Don't know
Description of dwelling/house
Tick which is applicable or provide details as appropriate: Year of construction:
House type
House type:
Rooms
Number of reception/living rooms:
Number of double bedrooms (minimum floor area 9.3 sq m):
Number of single bedrooms (minimum floor area 3.7 sq m):
Heating
Full central heating (ie radiators in all rooms):	Yes No
Partial central heating (ie radiators in some rooms):	Yes No
Facilities
Tick all applicable:	Fixed bath or shower WC inside WC outside only Wash hand basin Hot water supply Piped cold water supply Kitchen sink
If shared with another household give details:
Is the property let furnished?:	Yes No
Is the landlord responsible for repairs in accordance with Article 7 and 9 of the Private Tenancies (Northern Ireland) Order 2006 (see note 7):	Yes No If no please forward tenancy agreement
Have any improvements been carried out by the tenant or on the tenants behalf (for example insulation of central heating, replacement of kitchen or bathroom fittings?:	Yes No
If yes give details:
Signed:
Please state:	Landlord Agent
Date (dd/mm/yyyy):