# of bedrooms
Location of bedrooms
# of people residing at the home
Application Type
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Property Details
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
www.brandonvermont.gov
Tax Map #
Total # of units in the building
Address
{[PNAME]}
Unit #
  • Instructions
  • Contacts
  • Annual Statement of Compliance
  • Attachments/Certification
Notice to Tenants
    • The property owner or their agents must have access to the unit to make the repairs required by the rental housing inspection report.

  • To make repairs, the property owner may enter the unit with your consent, or with 48 hours’ notice. 9 V.S.A. § 4460
Notice to Property Owner
    • Until the violations described in the rental housing inspection report are corrected, you are prohibited from renting the affected unit(s) to new tenants. 18 V.S.A. § 603(a)(2)(iv)

    • A fine of up to $200 per day may be imposed for each violation not corrected by the deadline provided in this report or if an affected unit is rented to a new tenant before the violation(s) are corrected. 18 V.S.A. § 603(b)

Contact Information
    • Vermont Department of Health (VDH) - Environmental Health phone numbers:
      • Weekdays from 7:45 AM to 4:30 PM: 800-439-8550.
      • All other times: 800-640-4374.

    • Department of Public Safety (DPS/DFS) phone number to call varies based on property region:
      • Region #3 – Rutland Office:1-888-370-4834.

  • Department of Environmental Conservation (DEC) regional and main phone numbers:
    • Enforcement Office (to report violations) – 802-828-1254.
    • Montpelier (Main) Office – 802-828-1556.
    • Rutland Office – 802-786-5900.
  • Additional information on issuing an Emergency Health Order can be found here.
  • Town Health Officer Manual can be found at https://www.healthvermont.gov/sites/default/files/Env_THO_THOManual.pdf
Instructions
Owner Details
Same as applicant?
City
Address
Tenant Details
Name
ZIP
Same as owner?
State
ZIP
Phone #
Email
Address
State
Address
City
Total # of Tenants
Contact Person Details
Additional Tenants Details
City
Email
Applicant Details
Email
Name
ZIP
ZIP
Address
Name
Phone #
Title
Name
Phone #
City
State
Email
State
Phone #
If other, please specify
Type Full Name :
Sign With Hand
Type Full Name :
Sign With Hand
Does this unit have a fire extinguisher, visible & accessible, with current agency inspection tag? NFPA 1-13.6.
Does each sleeping room have an egress window? Easily opened, at least 20” wide & 24” tall and provide an opening of at least 5 sq. Ft, less than 44” from bottom above the floor. NFPA 101-24.2.2.1.
Please take the time to perform this basic safety inspection of your rental unit. If you are unable to complete the inspection yourself, you may appoint an agent.
Is there an exception applied on the unobstructed exits?
Does the property comply with the Brandon Street Naming and Addressing Ordinance? Address number posted near the entrance, visible from the road, and of the proper size and coloring?
Does this unit have access to at least two separate unobstructed exits? NFPA101-31.2.4.1.
Is it Owner or Agent Signature?
Is it Witness or Tenant Signature?
Is there compliance with Housing Health Code Sections, such as proper lighting, ventilation, wiring, heating, sanitation, and structural conditions?
Signature
Does the property comply with the Vermont Lead Law? Has an EMP been filed with the Vt DOH within the past 12 months? (required for all rentals built before 1978) Notice to Tenants been provided? 18 VSA Chapter 38, ss 1759.
Does this unit have working smoke alarm(s), on each level of the dwelling, including basements, and within each bedroom or room used for sleeping? Hardwired with battery backup, Photoelectric type. NFPA 101-31.3.4.5.
Does this unit have a working Carbon Monoxide Alarm, in the immediate vicinity of each sleeping room? A CO alarm is also required in each sleeping room that contains a fuel burning appliance. NFPA 101-31.3.4.6.
Has a wood or solid fuel appliance been installed since the Certificate of Occupancy was issued?
Signature
If yes, please explain
Annual Statement of Compliance Details
Who completed the inspection?
Type Full Name :
Sign With Hand
Application Fee
Signature
By signing below, I the applicant certify that all of the information provided in this application is true and accurate.
I certify that I have physically inspected the above rental unit and have found that it is in compliance with the Brandon Rental Housing Code.
Attachments
Certification
Amount Due
Please attach any supporting documents.