4-Point Inspection Personal Lines (Edition 9/2012)

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1 (Edition 9/2012) INSURED/APPLICANT NAME: Mr. and Mrs. America APPLICATION/POLICY #: ADDRESS INSPECTED: 1234 Surfing Villa Way, Riverview, FL ACTUAL YEAR BUILT: 1987 DATE OF INSPECTION: 5/09/2014 Minimum Photo Requirement: Front Elevation Rear Elevation Open Main Electrical Panel and Interior Door HVAC heating systems equipment (with dated manufacturer s plate) ALL hazards or deficiencies noted in this report A Florida-licensed inspector MUST complete, sign and date this form. ELECTRICAL SYSTEM (*SEPARATE DOCUMENTATION OF ANY ALUMINUM WIRING REMEDIATION MUST BE PROVIDED AND CERTIFIED BY A LICENSED ELECTRICIAN.) Age of Main Panel: Year Last Updated: Total Amps: 28 yrs Wiring Type Main Panel Amps Panel #2 Romex/BX or Less than 60A Fuse Less than 60A Fuse Conduit 60A Fuse 60A Fuse Active Knob & Tube 100A Fuse 100A Fuse Or cloth wiring 100A CB 100A CB Aluminum*: 150A CB 200A CB Other (specify): 200A CB Other (specify): Other (specify): Hazards Present * If single strand (aluminum branch) wiring Blowing Fuses or Over Fusing provide details of all remediation. Separate Breakers Hazardous Panel documentation of all work must be provided Empty Breaker Double Taps and certified by a licensed electrician. Sockets Exposed/Unsafe Entire home rewired Loose Wiring Wiring with copper Improper Other (explain) Connections repaired Grounding via COPALUM crimp Is the electrical system in good working order? Yes No (explain) Connections repaired via AlumConn HEATING SYSTEM Age of System: Year Last Updated: Central HVAC Yes No 28 yrs 1986 If not central, indicate primary Are the heating, ventilation and air Hazards Present heat source and fuel type: conditioning systems in good Wood Burning Stove or central gas na working order? fireplace not professionally installed? Is the source Yes No (explain) Yes No portable? Yes No Space heater used as primary source? Yes No Page 1 of 3

2 (Edition 9/2012) PLUMBING SYSTEM Age of System: 28 yrs Year Last Updated: 2007 Deficiencies (check all that apply Type of Pipes Active leak Copper: Is the plumbing system in Indication of prior leaks PVC: good working order? Connections/Hoses leaking Galvanized: Yes No or cracked Polybutylene: Water Heater (explain) Other (specify): Other (explain) ROOF WITH 2 PHOTOS, THIS PORTION CAN TAKE THE PLACE OF THE ROOF CONDITION CERTIFICATION FORM (CIT RCF-1) Age of Roof Predominant Covering Material: Roof Useful Remaining Life: 20 yrs (years): 7 yrs Raised Metal Seam Roof Date of Last Date of Last Roofing Overall Condition of Roof: Update: 2007 Permit: unknown Excellent If updated Any visible signs of damage/ Good (check one): deterioration? Yes No Fair Full Replacement (e.g. curling/lifted/loose/ missing Poor (explain) Partial shingles or tiles, sagging or Replacement uneven deck) % of Replacement: Any signs of visible leaks? Yes No ADDITIONAL COMMENTS OR OBSERVATIONS: Roof- leak detected at South valley flashing. I CERTIFY THAT I PERSONALLY INSPECTED THE PREMISES AT THE LOCATION ADDRESS LISTED ABOVE ON THE INSPECTION DATE NOTED. I CERTIFY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT. Owner/Chief Inspector HI12 5/09/2014 INSPECTOR SIGNATURE TITLE LICENSE NUMBER DATE Page 2 of 3

3 (Edition 9/2012)

4 Front Back Side Main Panel

5 Sub Panel Heating System Cooling Systems

6 Main Valve Sink Piping Sink Plumbing Water Heater

7 Roof Roof Leak

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