4-Point Insurance Inspection Form
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1
24-Point Insurance Inspection – #___________
(2014 Edition)
INSURED/APPLICANT NAME: _____________________________________
APPLICATION / POLICY #___________________
ADDRESS INSPECTED: ____________________________________________________________________________________________
ACTUAL YEAR BUILT: _______________________________________
DATE INSPECTED: _________________________________
Minimum Photo Requirements:
Front Elevation
Back Elevation
Left Elevation
Right Elevation
Open Electrical Panels and Interior Wiring
HVAC Equipment & Dated Manufacturer’s Labels
TPR Valve
Washing Machine Plumbing/Hoses
Plumbing Under All Sinks
Water Heater
2 Roof Coverings (Detailed to capture general condition)
ALL hazards or deficiencies noted in this report.
A Florida-licensed inspector MUST complete, sign and date this
form.
E
S
LECTRICAL
YSTEM
(Separate Documentation Of Any Aluminum Wiring Remediation Must Be Provided And Certified By A Licensed Electrician)
Interior Panel:
Exterior Panel:
Overall Electrical System:
Year Last Updated: __________
Panel Amps: __________
Panel Amps: __________
Total Amps: __________
Panel Type: __________
Panel Type: __________
Electrical system in good working order? ___
Panel Amp Type: __________
Panel Amp Type: __________
Wiring Type(s) Present:
Panel Age: __________
Panel Age: __________
Copper
Condition: __________
Condition: __________
Aluminum
Romex, BX, or Conduit
Estimated 5 Yrs. Remaining: ____
Estimated 5 Yrs. Remaining: ____
Active Knob & Tube
Cloth Wiring
Other (specify): _________________
Circuit Breaker Manufacturer(s): __________________________________
Aluminum Wiring:
Hazards Present:
If Aluminum wiring is present, where:
* If single strand (
wiring,
aluminum branch)
Blowing Fuses or
Over Fusing
Main Feed or Between Panels
provide details of all remediation. Separate
Breakers
documentation of all work must be provided
In Breakers (Branch Wiring)
and certified by a licensed electrician.
Hazardous
Empty Breaker
Main Feed/Between Panels & In Breakers
Panel
Sockets
Entire home rewired with copper
If in Breakers, Amp Size & Appliance:
Double Taps
Loose Wiring
CB1: _____ Amps Supplies: ______________
Connections repaired via
COPALUM crimp
CB2: _____ Amps Supplies: ______________
Improper
Exposed/Unsafe
Connections repaired via AlumiConn
Grounding
Wiring
CB3: _____ Amps Supplies: ______________
Other (explain)
Use the Additional Comments/Observations Section on page 2 to provide full details of all updates, hazards, etc.
H
S
VAC
YSTEM
Overall HVAC System:
Heating Hazards Present:
Year Last Updated: __________
Wood Burning Stove or central gas fireplace not professionally
HVAC system in good working order? ___
installed?
Central HVAC Present? __________
Space heater used as primary heat source?
If no, primary heat source/ fuel type: ____________________
If no, Is the source portable? __________
Age of Heat System: __________
A/C Unit(s):
Unit #1 Type: _______ Age: _______ Condition: _______ Ton/BTU: _______ Remaining Life: _______ Heated: _____
Unit #2 Type: _______ Age: _______ Condition: _______ Ton/BTU: _______ Remaining Life: _______ Heated: _____
Unit #3 Type: _______ Age: _______ Condition: _______ Ton/BTU: _______ Remaining Life: _______ Heated: _____
Unit #4 Type: _______ Age: _______ Condition: _______ Ton/BTU: _______ Remaining Life: _______ Heated: _____
Use the Additional Comments/Observations Section on page 2 to provide full details of all updates, hazards, etc.
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