APPENDIX A: FORMS
   1.   Complaint and notice of hearing before Building Inspector under Housing Code.
   2.   Affidavit; service by publication. (This form can be used in connection with Form #l or Form #4.)
   3.   Proof of service; complaint and notice of hearing.
   4.   Findings of fact and order.
   5.   Proof of service; findings of fact and order of Building Inspector.
   6.   A resolution directing the (City) (Town) Attorney to petition the Superior Court for an order requiring the owner of certain property to comply with the Housing Code and the order of the Building Inspector issued pursuant thereto.
   7.   An ordinance directing the Building Inspector to repair the property herein described as unfit for human habitation and directing that a notice be placed thereon that the same may not be occupied until repaired.
   8.   An ordinance directing the Building Inspector to remove or demolish the property herein described as unfit for human habitation and directing that a notice be placed thereon that the same may not be occupied.
   9.   Notice of appeal.
   10.   Notice of hearing of the Zoning Board of Adjustment on appeal from order of Building Inspector.
   11.   Affidavit; service by publication. (This form can be used in connection with Form #10 or Form #13.)
   12.   Proof of service; notice of hearing of the Zoning Board of Adjustment.
   13.   Order of Zoning Board of Adjustment.
   14.   Proof of service; order of Housing Appeals Board.
Editor’s note:
   Included in this appendix are suggested forms for the implementation of the Housing Code contained in this chapter. They derive unchanged from the 1978 edition of the “North Carolina Model Housing Code” as adopted by the North Carolina League of Municipalities.
FORM #1
                                                FILE NO.                               
COMPLAINT AND NOTICE OF HEARING BEFORE BUILDING INSPECTOR UNDER HOUSING CODE
TO:   Owners and parties in interest in the dwelling (unit) located at                                     in the (City) (Town) of                                          , North Carolina.
   YOU ARE HEREBY NOTIFIED that the dwelling (unit) located at the place designated above is in a condition that appears to be unfit for human habitation and to violate the (City) (Town) Housing Code in the following ways:
   1.   (Specify the violation and the applicable Housing Code Section.)
   2.   And the like.
   YOU ARE FURTHER NOTIFIED that a hearing will be held before the Building Inspector of the (City) (Town) of
                                             at his or her office in the (City) (Town) Hall at                   o’clock,                  .m on the                               day of                          , 20                               (a time not less than ten or more than 30 days after serving of the complaint) for the purpose of finding the facts as to whether or not the condition of the building falls within the scope of the above-mentioned sections of the Housing Code. At the hearing, you shall be entitled to offer the evidence which is relevant or material to the questions sought to be determined or the remedies sought to be effected.
   YOU ARE FURTHER NOTIFIED that if, upon the hearing, the Building Inspector shall find that the conditions in the above-described dwelling (unit) do in fact violate the Housing Code, and do in fact render the dwelling (unit) unfit for human habitation, the Building Inspector will issue and order in writing directed to the owner of the dwelling (unit) requiring the owner to remedy these conditions by repairing the same or by vacating, demolishing or removing the same, or by taking other steps as may make the other orders and take the other procedures as are authorized under the Housing Code and general statutes of North Carolina.
   Further information as to this matter may be obtained by contracting the undersigned.
   This the                           day of                                 , 20                             .
                                                                                                                 
                                          BUILDING INSPECTOR
FORM #2
   Note:   If the whereabouts of an owner are unknown, this affidavit form should be executed by the Building Inspector prior to publication in a newspaper. This form can be used in connection with publication of the complaint (Form #1) or the findings of fact and order (Form #4).
                                             FILE NO.                                         
SATE OF NORTH CAROLINA
COUNTY OF                                          )         AFFIDAVIT
(CITY) (TOWN) OF                                                         )         SERVICE BY PUBLICATION
IN RE ABANDONED STRUCTURE LOCATED AT                                                                           
   (Name of Building Inspector), being first duly sworn, deposes and says:
   1.   That he or she is the Building Inspector of the (City) (Town) of                                       , duly authorized to enforce the (City) (Town) Housing Code against the above-enlisted dwelling (unit);
   2.   That (name of owner(s) of dwelling (unit)) (is) (are) the owner(s) of the above-entitled dwelling (unit);
   3.   That, according to the information and belief of the Building Inspector, the whereabouts of the owner(s) are unknown and cannot be ascertained by the Building Inspector in the exercise of reasonable diligence; and
   4.   That service of the (complaint) (findings of fact and order) must be made by publication in a newspaper having general circulation in the (City) (Town), as authorized by G.S. § 160D-1206.
                                                                                             
                     BUILDING INSPECTOR
Sworn to and subscribed before me, this the                                day of                                                   , 20                                .
                                                                                             
                     NOTARY PUBLIC
                     My Commission Expires:
                                                                                             
FORM #3
                        FILE NO.                                         
PROOF OF SERVICE
COMPLAINT AND NOTICE OF HEARING
Service of the attached complaint and notice was made on the                                            day of                                                    , 20                                  , by:
   1.   Delivering a copy of complaint and notice to                                                    at                                          
OR
   2.   Mailing a copy of complaint and notice by registered or certified mail to                                         at                                                        
OR
   3.   The name or whereabouts of the owner were unknown and could not, after due diligence, be discovered. This notice and complaint was served by publication after proper affidavit, as authorized by G.S. § 160D-1206 and by posting a copy thereof on the outside of the dwelling (unit) located at                 on the date mentioned above (specify date of posting if different from above).
                                                                                                                                                  
      DATE                           BUILDING INSPECTOR
Note:   If the complaint is served by registered or certified mail, keep the return receipt with this form. If the complaint is served by publication, keep the publisher’s affidavit of publication with this form.
FORM #4
                                          FILE NO.                                                
FINDINGS OF FACT AND ORDER
TO:   Owners and parties in the interest of the abandoned dwelling (unit) located at                              in the (City) Town) of                                                     , North Carolina.
The undersigned Building Inspector of the (City) (Town) of                                                                 , pursuant to law, conducted a hearing at the time and place stated in the complaint and notice heretofore issued and served, or at a time to which the hearing was continued with previous notice to the above-mentioned owners and parties in interest of their agents or attorneys. At the hearing, the answer, if any, filed by the owners and parties in interest was read and considered, and the evidence, contentions and views of the owners and parties in interest were carefully analyzed and considered by the undersigned. In addition to other evidence presented, the undersigned personally inspected the dwelling (unit) described above, and the inspection and examination has been considered, along with the other evidence offered at this hearing.
Upon the record and all of the evidence offered and contention made, the undersigned Building Inspector does hereby find the following facts:
   1.   The above-named owners and parties in interest with respect to the dwelling (unit) located at the place specified above were duly served as required by law with written complaint and notice of hearing which set forth the complaint that the dwelling (unit) located at the above address is unfit for human habitation, and violative of the (City) (Town) Housing Code, and the particulars thereof, and fixed a time and place for a hearing upon the complaint as provided by law. At the hearing, the following owners, persons in interest, their agents or attorneys, were present and participated therein: (insert names).
   2.   The building described above violates the (City) (Town) Housing Code, by reason of the following conditions found to be present and to exist in and about the structure:
      1.   (Specify the violation and applicable Housing Code section.)
      2.   And the like.
   3.   Due to these conditions, the building described above is found to be (deteriorated) (dilapidated) condition within the meaning of the City/Town Housing Code, and to be unfit for human habitation.
   IT IS THEREFORE ORDERED that the owners of the dwelling (unit) named above are required to bring the dwelling (unit) unto compliance with the Housing Code by repairing, altering or improving the deteriorated structure in order to render it fit for human habitation or by vacating and closing the structure as a human habitation (repairing), altering or improving the dilapidated structure in order to render it fit for human habitation by demolishing or removing the structure from the premises by a date not later than the
                                                        day of                                                  , 20                                            . (A date not more than 90 days from the date of this order.)
FORM #5
                        FILE NO.                                                
PROOF OF SERVICE
FINDINGS OF FACT AND ORDER OF BUILDING INSPECTOR
Service of the attached findings of fact and order was made on the                                     day of                                                 , 20                     , by:
1.   Delivering a copy of findings of fact and order to                                                               at                                                                                    
OR
2.   Mailing a copy of finds of fact and order to                                                                                                
to                                                              at                                                                                                  
OR
3.   The name or whereabouts of the owner were unknown and could not, after due diligence, be discovered. This findings of fact and order was served by publication, after proper affidavit, as authorized by G.S. § 160D-1206, and by posting a copy thereof on the outside of the dwelling located at                                                   on the date mentioned above (specify date of posting, if different from above).
                                                                                                                                                       
      DATE                           BUILDING INSPECTOR
Note:
   1.   If the findings of fact and order are served by certified or registered mail, keep the return receipt with this form. If the findings of fact and order are served by publication, keep the publisher’s affidavit of publication with this form.
   2.   If the whereabouts of the owner are unknown, publication should not be undertaken until the Building Inspector has executed an affidavit to that effect (see Form #2)
This, the                                           day of                                                       , 20
                                                                                                            
                                             BUILDING INSPECTOR
Note:   If necessary, the Building Inspector’s order may also require the dwelling or dwelling unit to be vacated and closed until the necessary repairs are made.
FORM #6
                                          FILE NO.                                                
A Resolution directing the (City) (Town) Attorney to petition the Superior Court for an order requiring the owner of certain property to comply with the Housing Code and the order of the Building Inspector issued pursuant thereto.
   WHEREAS, the (governing body) of the (City) (Town) of                                                    finds that the dwelling herein described is unfit for human habitation under the provisions of the Housing Code, and that all of the procedures or the Housing Code have been complied with; and
   WHEREAS the owner of this dwelling has failed to comply with a lawful order of the Building Inspector to repair the same to meet the requirements of the Housing Code, or to demolish the same, within the time therein prescribed;
   NOW, THEREFORE, BE IT RESOLVED by the (governing body) of the (City) (Town) of                                  , that the (City) (Town) Attorney is hereby authorized and directed to proceed, as authorized by G.S. § 160D-1208(e), to petition the Superior Court of                                                  County for an order requiring the owner of the dwelling located at                                                              in the (City) (Town) of                                                                      , North Carolina to take the steps as may be necessary to comply fully with the order of the Building Inspector issued on the                                                          day of                                                 , 20                                              .
                                                                                                               
                                             MAYOR
 
ATTEST:
                                                             
(CITY) (TOWN) CLERK
FORM #7
                                             FILE NO.                                        
An ordinance directing the Building Inspector to repair the property herein described as unfit for human habitation and directing that a notice be placed thereon that the same may not be occupied until repaired.
   WHEREAS, the (governing body) of the (City) (Town) of                                                          finds that the dwelling described herein is unfit for human habitation under the (City) (Town) Housing Code, and that all of the procedures of the Housing Code have been compiled with; and
   WHEREAS, this dwelling should be repaired to meet the requirements of the Housing Code, as directed by the Building Inspector, and should be placarded by placing thereon a notice prohibiting use for human habitation; and
   WHEREAS, the owner of this dwelling has been given a reasonable opportunity to bring the dwelling up to the standards of the Housing Code in accordance with G.S. § 160D-1203(4) pursuant to an order issued by the Building Inspector on                                                 , and the owner has failed to comply with the order:
   NOW, THEREFORE, BE IT ORDAINED by the (governing body) of the (City) (Town) of                                    , that:
   Section 1.   The Building Inspector is hereby authorized and directed to place a placard containing the legend:
   “This building is unfit for human habitation; the use or occupation of this building for human habitation is prohibited and unlawful”.
on the building located at the following address:                                                                                                                                                                        
   Section 2.   The Building Inspector is hereby authorized and directed to proceed to repair, alter or improve and (if necessary) to vacate and close the above described dwelling in accordance with the order to the owner thereof dated the                                                           day of                                                , 20                                             , and in accordance with the Housing Code and G.S. § 160A-443.
   Section 3.   The cost of repairs, alterations or improvements, or of vacating and closing shall constitute a lien against the real property upon which the cost was incurred. The lien shall be filed in the office of the (City) (Town) Tax Collector, and shall have the same priority and be collected in the same manner as the lien for special assessments in G.S. Article 10 of Chapter 160A. Upon completion of the required repairs, alterations or improvements, the Building Inspector shall certify the cost of same to the Tax Collector.
   Section 4.   It shall be unlawful for any person to remove or cause to be removed the placard from any building which it is affixed. It shall likewise be unlawful for any person to occupy or to permit the occupancy of any building therein declared to be unfit for human habitation.
   Section 5.   This ordinance shall become effective upon adoption.
   Adopted this                                       day of                                      , 20                                     .
                                                                                                                        
                                          MAYOR
ATTEST:
                                                                      
(CITY) (TOWN) CLERK
Note:   This ordinance must be recorded in the office of the Register of Deeds in the county where the property is located and must be indexed in the name of the property owner in the grantor index.
FORM #8
                                       FILE NO.                                                     
An ordinance directing the Building Inspector to remove or demolish the property herein described as unfit for human habitation and directing that a notice be placed thereon that the same may not be occupied.
   WHEREAS, the (governing body) of the (City) (Town) of                                                                    finds that the dwelling described herein is unfit for human habitation under the (City) (Town) Housing Code, and that all of the procedures of the Housing Code have been complied with; and
   WHEREAS, this dwelling should be removed or demolished, as directed by the Building Inspector, and should be placarded by placing thereon a notice prohibiting use for human habitation; and
   WHEREAS, the owner of this dwelling has been given a reasonable opportunity to bring the dwelling up to the standards of the Housing Code in accordance with G.S. § 160D-1203(5) pursuant to an order issued by the Building Inspector on                                                , and the owner has failed to comply with the order;
   NOW, THEREFORE, BE IT ORDAINED by the (governing body) of the (City) (Town) of                                    , that:
   Section 1.   The Building Inspector is hereby authorized and directed to place a placard containing the legend:
   “This building is unfit for human habitation; the use or occupation of this building for human habitation is prohibited and unlawful”.
on the building located at the following address:                                                                                                                                                                                                                
   Section 2.   The Building Inspector is hereby authorized and directed to proceed to remove or demolish the above described dwelling in accordance with his or her order to the owner thereof dated the                                             day of                                                      , 20                                                 , and in accordance with the Housing Code and G.S. § 160D-1203.
   Section 3.   (a)   The cost of removal or demolition shall constitute a lien against the real property upon which the cost was incurred. The lien shall be filed in the office of the (City) (Town) Tax Collector, and shall have the same priority and be collected in the same manner as the lien for special assessments in G.S. Article 10, Chapter 160A.
            (b)   Upon completion of the removal or demolition, the Building Inspector shall sell the materials of the dwelling and credit the proceeds against the cost of removal or demolition. The Building Inspector shall certify the remaining balance to the Tax Collector. If a surplus remains after sale of the materials and satisfaction of the cost of removal or demolition, the Building Inspector shall deposit the surplus in the Superior Court where it shall be secured and disbursed in the manner provided by G.S. § 160D-1203(7).
   Section 4.   It shall be unlawful for any person to remove for cause to be removed the placard from any building which it is to be affixed. It shall likewise be unlawful for any person to occupy or to permit the occupancy of any building therein declared to be unfit for human habitation.
   Section 5.   This ordinance shall become effective upon its adoption.
Adopted this                                      day of                                                   , 20                                       .
                                                                                                                
                                             MAYOR
ATTEST:
                                                                      
(CITY) (TOWN) CLERK
Note:   This ordinance must be recorded in the office of the Register of Deeds in the county where the property is located and must be indexed in the name of the property owner in the grantor index.
FORM #9
                                             FILE NO.                                         
STATE OF NORTH CAROLINA
COUNTY OF                                              )         BEFORE THE ZONING BOARD OF ADJUSTMENT
(CITY) (TOWN) OF                                  )
IN RE DWELLING LOCATED AT         NOTICE OF APPEAL
                                                                    )
To the Zoning Board of Adjustments and the Building Inspector of the (City) (Town) of                                                                      .
Take notice that the undersigned appeals to the Zoning Board of Adjustment of the (City) (Town) of                                                 from the order of the Building Inspector, dated the                                              day of                               , 20                               , relating to the dwelling located at                                                                                                                                                                         .
This appeal is taken for the following reasons:                                                                                                                                                                                                        
                                                                                                                                                                                                                                                                                  
                                                                                                                                                                                                                                                                                  
                                                                                                                                                                                                                                                                                  
This the                         day of                                , 20                                  .
                                                                                                           
                                                APPELLANT
Filed with the Building Inspector                                                                                                                              
                                                                                                            
                                             BUILDING INSPECTOR
Filed with the Zoning Board of Adjustment                                                                                                              
                                                                                                            
                                                CLERK
Note:   If a Housing Appeals Board has been created to hear appeals involving this code, then the words “Housing Appeals Board” should be substituted for the words “Zoning Board of Adjustment” throughout Forms #9 through 14.
FORM #10
                                          FILE NO.                                                
NOTICE OF HEARING OF THE ZONING BOARD OF ADJUSTMENT ON APPEAL FROM ORDER OF BUILDING INSPECTOR
TO:                                                                   
Notice is hereby given that the Zoning Board of Adjustment will conduct a hearing at                                                              o’clock                   .m. on the                           day of
                         , 20                          , at the (City) (Town) Hall, on your appeal from the order of the Building Inspector dated the                                  day of                                       , 20__, concerning the property located at                                                                                                                                        . At the hearing you may be heard in person, by agent or counsel upon all legal or factual questions relating to this matter and shall be entitled to offer the evidence as you may desire which is relevant or material to the order.
This the                                       day of                                     , 20                           .
                                                                                                                     
                                             CLERK
                                       ZONING BOARD OF ADJUSTMENT
FORM #11
Note:   If the whereabouts of an owner are unknown, this affidavit from should be executed by the Clerk to the Zoning Board of Adjustment prior to publication in a newspaper. This form can be used in connection with publication of the notice of hearing (Form #10) or an order of the Board (Form #10).
                                          FILE NO.                                                
STATE OF NORTH CAROLINA
COUNTY OF:                                                     )      AFFIDAVIT
(CITY) (TOWN) OF                                           )         SERVICE BY PUBLICATION
IN RE DWELLING LOCATED AT
                                                                             )
(Name of Clerk to Zoning Board of Adjustment), being first duly sworn, deposes and says:
1.   That he or she is the Clerk to the Zoning Board of Adjustment of the (City) (Town) of                                                                              , the body which is authorized to hear appeals arising under the (City) (Town) Housing Code; and
2.   That (name of owner(s) of dwelling) (is) (are) the owner(s) of the above-entitled dwelling; and
3.   That according to the information and belief of the Clerk, the whereabouts of the owner(s) are unknown and cannot be ascertained by the Clerk in the exercise of reasonable diligence; and
4.   That service of the (notice of hearing) (order) of the Zoning Board of Adjustment must be made by publication in newspaper having general circulation in the (City) (Town), as authorized by G.S. § 160D-1206 and by posting a copy thereof on the outside of the dwelling at the location stated above.
                                                                                                                   
                                             CLERK
                                       ZONING BOARD OF ADJUSTMENT
Sworn to and subscribed before me, this the                                       day of                                               20                           .
                                                                                                                   
                                          NOTARY PUBLIC
                                    My Commission Expires:
                                                                                                                    
FORM #12
                                             FILE NO.                                         
PROOF OF SERVICE
NOTICE OF HEARING OF THE ZONING BOARD OF ADJUSTMENT
Service of the attached notice was made on the                                           day of                                                      ,
20                                    , by
1.   Delivering a copy of the notice to                                                                                                                                                        .
OR
2.   Mailing a copy of notice by registered or certified mail to                                                                                                                           .
OR
3.   The name or whereabouts of the owner cannot, after due diligence, be discovered, and this notice was served by publication, after proper affidavit, as authorized by G.S. § 160D-1206 and by posting a copy thereof on the outside of the dwelling at the above-stated location on the above-mentioned date (specify date if different from above).
                                                                                                           
                                                      CLERK
                                             ZONING BOARD OF ADJUSTMENT
Note:   If the notice of hearing is served by certified or registered mail, keep the return receipt with this form. If the notice of hearing is served by publication, keep the publisher’s affidavit of publication with this form.
FORM #13
                        FILE NO.                                                
STATE OF NORTH CAROLINA
COUNTY OF                                               ) BEFORE THE ZONING BOARD OF ADJUSTMENT
(CITY) (TOWN) OF                                  )
IN RE DWELLING LOCATED AT
                                                                     )   ORDER
This appeal in the above-entitled matter having been heard after due notice, the Zoning Board of Adjustment in its discretion finds, and it is hereby ordered, that the findings of fact and order of the Building Inspector dated the                                             day of                                                                 , 20                                          , are (affirmed) (reversed) (modified) in the following respects:                                                                                                                                                                                                                                                     , for the following reasons:                                                                                                                                                                                                                                                               .
This the                                                   day of                                            , 20                                         .
 
                                                                                                              
                                          CHAIRPERSON
                                       ZONING BOARD OF ADJUSTMENT
                                                                        
      CLERK
FORM #14
                                          FILE NO.                                               
PROOF OF SERVICE
ORDER OF HOUSING APPEALS BOARD
Service of the attached order was made on the                                     day of                                             ,
20                                       , by:
1.   Delivering a copy of the order to                                                                                                                                                         
                                                                                                                                                                     
OR
2.   Mailing a copy of the order by certified or registered mail to                                                                                                                    
OR
3.   The name or whereabouts of the owner cannot, after due diligence, be discovered, and this order was served by publication, after proper affidavit, as authorized by G.S. § 160D-1206 and by posting a copy thereof on the outside of the dwelling at the above-stated location on the above-mentioned date.
                                                                                                       
                                                CLERK
                                             ZONING BOARD OF ADJUSTMENT
Note:
      1.   If the notice of hearing is served by certified or registered mail, keep the return receipt with this form. If the notice of hearing is served by publication, keep the publisher’s affidavit of publication with this form.
      2.   If the whereabouts of the owner are unknown, publication should not be undertaken until the Building Inspector has executed an affidavit to that effect (see Form #11).
(2009 Code, Ch. 153, App. A) (Ord. 2021-Z-19, passed 6-22-2021) Penalty, see § 153.99