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Dwelling
This registration form has been published and is now live
Dwelling
Is this a high value?
*
Yes
No
What is the building value (this is the building amount the customer gave to us on the order).
*
Give a detailed description of the dwelling.
*
Who is the dwelling used by?
*
Owner
Tenant
Guest
Caretaker
Farm manager
Employee
Used for storage
Vacant not used
Description of Dwelling
Dwelling Information
What type of dwelling?
*
Single Family Dwelling
Bunk House
Approximately what year was it built?
*
How was year built determined?
*
Insured
Estimated
Tax records
What is the number of stories?
*
1
1 1/2
2
2 1/2
3
3 1/2
What is the total living area?
*
Check all exterior wall constructions materials that apply.
*
Brick veneer
Wood siding
Hardiplank
Stucco
Concrete block
Stone veneer
Wood shake
Aluminum siding
Vinyl siding
Metal siding
Log
Asbestos siding
Percentage of brick veneer:
*
Percentage of wood siding:
*
Percentage of Hardiplank:
*
Percentage of Stucco:
*
Percentage of Concrete block:
*
Percentage of Stone veneer:
*
Percentage of Wood shake:
*
Percentage of Aluminum siding:
*
Percentage of Vinyl siding:
*
Percentage of Metal siding:
*
Percentage of Log:
*
Percentage of Asbestos siding:
*
Total Percentage of siding.
*
What is the construction type?
*
Frame
Joisted Masonry
Non Combustible
Log Cabin
Solid Brick
Other
Describe the other type of construction framing.
*
What is the overall condition of the dwelling?
*
Excellent
Good
Average
Fair
Poor
Why in poor condition?
*
Number of fireplaces?
*
0
1
2
3
4
5
6
7
8
9
How often are the chimney(s) cleaned?
*
Gas fireplace not needed
Semi annually
Yearly
As needed
Number of bathrooms?
*
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Has the dwelling been remodeled?
*
Yes
No
Foundation
What type of foundation?
*
Concrete slab
Crawl space open
Crawl space closed
Pier & Beam
Basement
Elevated Pier
Other
Is the basement finished out?
*
Yes
No
What other type of foundation?
*
Roof
What is the predominant roof construction?
*
Wood
Metal
Concrete
What Is the predominant roof covering?
*
Shingles Asphalt/Fiberglass
Rolled roof/Single ply
Rubber
Shakes Wood
Shingles Architectural
Slate
Steel
Steel Standing Seam
Tile Concrete
Tin
Tar and Gravel
Other
What is other type of roof cover?
*
How was the roof viewed?
*
Physically viewed
Viewing not accessible
What was the roof condition?
*
Excellent like new
Good
Average
Fair needs improvement soon
Curling
Blistered
Torn or missing shingles
Poor needs immediate attention
Approximately how many are torn or missing?
*
1
2
3
4
5
6
7
8
9
10
Over 10
Why was roof in poor condition?
*
Has the roof been updated?
*
Yes
No
Unknown to Insured
Years since last roof update?
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Over 40
How was the roof updated?
*
Complete replacement
Partial replacement
Patched/Repaired
Other
What was other roof updates?
*
HVAC
What type of HVAC?
*
Central Heat/Air
Heat pump
Split units
Window units
Central and Window units
None
How is the HVAC powered?
*
Natural gas
Propane gas
Electric
Has the HVAC system been updated?
*
Yes
No
How many years since last HVAC update?
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Over 40
Done as needed
Electrical
What type of electrical wiring?
*
Romex
Conduit
Romex and Conduit
Knob and Tube
What type of electrical wiring conductor?
*
Copper
Aluminum
Aluminum Pigtail
Aluminum CO/ALR
Other
What other type of electrical conductor?
*
What type of electrical panel protection?
*
Circuit Breakers
Fuses
Circuit Breakers and Fuses
Have there been any electrical updates?
*
Yes
No
Unknown to Insured
How many years since last electrical update?
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Over 40
What is the overall condition of the electrical system that can be seen?
*
Good
Average
Poor
Explain reason for poor condition.
*
Did this dwelling have any excessive extension cord use, Multi-tap outlets or temporary wiring?
*
Yes
No
Plumbing
What type of plumbing?
*
Copper
Galvanized
Copper & Galvanized
PVC
PEX (plastic flex tubing)
Other
Describe other type of plumbing.
*
Have there been any plumbing updates?
*
Yes
No
Unknown to Insured
How many years since last plumbing updates?
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Over 40
Garages and Carports
Is there a garage?
*
Yes
No
What type of garage?
*
Attached with breezeway
Detached no breezeway
Attached (nothing above)
Builtin (living area above)
What size is the garage?
*
1 car
2 car
3 car
4 car
What is the garage condition?
*
Excellent
Good
Average
Fair
Poor
Reason for poor garage condition?
*
Is there a carport
*
Yes
No
What size is the carport?
*
1 car
2 car
3 car
4 car
Condition of the carport?
*
Excellent
Good
Average
Fair
Poor
Why is carport condition poor?
*
Breezeway, Porches, Decks and Balconies
Are there porches?
*
Yes
No
Number of porches?
*
1
2
3
4
5
6
7
8
9
10
What is the total square footage for all porches?
*
Is there a breezeway(s)?
*
Yes
No
Number of breezeway(s)?
*
1
2
3
4
5
6
7
8
9
10
What was the total square footage of all breezeway(s)?
*
Is there a deck(s)?
*
Yes
No
What was the total square footage of all deck(s)?
*
Is there a balcony(s)?
*
Yes
No
What was the total square footage of all balconies?
*
Smoke Detectors
Are there smoke detectors?
*
Yes
No
What type smoke detectors?
*
Battery
Hardwired
Battery and Hardwired
Carbon Monoxide Detectors
Are there carbon monoxide detector(s)?
*
Yes
No
What type of carbon monoxide detectors?
*
Battery
Hardwired
Battery and Hardwired
Central Alarm System
Is there a central alarm system?
*
Yes
No
What type of alarm system?
*
Fire Alarm
Burglar Alarm
Fire and Burglar Alarm
Does the central station alarm have a service contract in place?
*
Yes
No
Name of the alarm monitoring company?
*
Sprinkler System
Does the dwelling have a sprinkler system?
*
Yes
No
Fire Extinguishers
Does the dwelling have adequate fire extinguisher(s)?
*
Yes
No
Are the extinguishers currently tagged?
*
Yes
No
Date on extinguisher tag?
*
Are the extinguishers the disposable type?
*
Yes
No
Protection Locks
Does the dwelling have double keyed deadbolt locks?
*
Yes
No
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