Owner Information
Full Legal Name:
Is:
Individual
Corporation
Partnership
LLC
S Corp
Mailing Address:
Inspection Contact: Name
Phone:
Fax:
Mortgagee Name and Address:
Mortgage Loan #:
Location Information
Location Address:
Year Built
# Units
Construction
# Stories
Owner Occupied?
Yes
No
Describe any vacancies
Total Square Footage Area above foundation
Any basement units?
Yes
No
If yes, number and square footage area
Any non-residential occupancies?
Yes
No
If Yes, describe
Date Property Purchased
Year Updated
Roof
Electrical
Plumbing
Heating System
All circuit breakers?
Yes
No
Any aluminum or knob-and-tube wiring?
Yes
No
Protection Information
Hard-wired smoke detectors in all units and hallways?
Yes
No
If Yes, do they have battery back-up?
Yes
No
Fire extinguishers in all units?
Yes
No
Carbon Monoxide detectors in all units?
Yes
No
Any fire sprinklers?
Yes
No
If Yes, where?
Distance to nearest building:
Left:
Right:
Rear:
Occupancy of nearest building:
Left
Rear
Right
Other
Name of current insurance company
How long with them?
Describe all losses/claims last five years
Do you operate a business from this location?
Yes
No
If Yes, describe
Annual cost of work subcontracted out
Do you require certificates of insurance from subs and do you keep them for more than one year?
Yes
No
Amount of building insurance requested
Annual Rents