2007 Uniform Mitigation Verification Inspection Form (Page 2 of 2) in pdf

Other

Any other roof shape or combination of roof shapes including hip, gable, flat, gambrel, mansard and

other roof shapes.

5. Gable End Bracing: For roof structures that contain gables, please check the weakest that apply:

Gable End(s) are NOT braced.

Gable End(s) are braced at a minimum in accordance with the 2001 Florida Building Code.

Not applicable, unknown or unidentified.

6. Wall Construction Type: Check all wall construction types for exterior walls of the structure and percentages for each:

Wood Frame

_________%

Un-Reinforced Masonry

_________%

Reinforced Masonry

_________%

Poured Concrete

_________%

Other: ___________

_________%

7. Secondary Water Resistance (SWR): (standard underlayments or hot mopped felts are not SWR)

SWR

Self adhering polymer modified bitumen roofing underlayment applied directly to the sheathing or foam

SWR Barrier (not foamed on insulation) applied as a secondary means to protect the dwelling from water

intrusion.

No SWR

8. Opening Protection: What is the weakest form of wind borne debris protection installed on the structure? (Exterior openings

include, but are not limited to: windows, doors, garage doors, skylights, etc. Product approval may be required for opening

protection devices without proper rating identification)

Hurricane

All exterior openings are fully protected at a minimum with impact resistant coverings, impact resistant

doors and/or impact resistant glazing that meets the requirements of one of the following for “Large

Missile Impact:

Miami-Dade County PA 201, 202 and 203

Florida Building Code TAS 201, 202 and 203

ASTM E 1886 and ASTM E 1996 (Missile Level C – 9 lb)

Basic

All exterior openings are fully protected at a minimum with impact resistant coverings, impact resistant

doors and/or impact resistant glazing that meets the requirements for “Small Missile Impact”.

Not Rated

Only glazed openings are covered with; impact resistant coverings/products -OR- shutter protection

devices manufactured before 1994 that cannot be identified as Miami/Dade or FBC product approved.

This rating also applies to wood structural panels that do not meet the requirements of Section 1609 and

Table 1609.1.4 of the 2004 FBC (2006 supplement).

Wood Panels

Plywood/OSB meeting the requirements of Section 1609 and Table 1609.1.4 of the 2004 FBC (2006

supplement).

None

One or more exterior openings are not covered with wind borne debris protection. This rating also applies

to after-market window films.

ITIGATION INSPECTIONS MUST BE PERFORMED BY A

UALIFIED INSPECTOR

For a listing of Individuals and/or Companies meeting these qualifications contact your Insurance Agent.

In my professional opinion, based on my knowledge, information and belief, I certify that the above listed statements are true and correct.

Inspector Name:

License Type:

License #:

Inspection Company:

Phone:

Inspector Signature:

Date:

Homeowner/Applicant Signature:

Date:

OIR –B1- 1802 (Rev. 07/07)

*This verification form is valid up to five (5) years provided no material changes have been made to the structure.

2007 Uniform Mitigation Verification Inspection Form Page 2

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