U.S. Department of Housing
OMB Approval No. 2502-0496
and Urban Development
of Plans, Specifications, & Site
Office of Housing
Federal Housing Commissioner
Property Address (street, city, State, & zip code)
Mortgagee's (Lender's) Name & Address (this is the lender who closed the loan)
FHA Case Number
1. Site Analysis Information: To be completed on all proposed and newly constructed properties regardless of LTV ratio.
a. Flood Hazards. Are the property improvements in a Special Flood Hazard Area (SFHA)?
1) Provide the community number and date of the Flood Insurance Rate Map (FIRM) used to document
your answer. Community Number
2) Is the community participating in the National Flood Insurance Program and in good standing?
3) If "Yes" to 1a. above, attach:
(i) a Letter of Map Amendment (LOMA) or;
(ii) a Letter of Map Revision (LOMR) or;
(iii) a signed Elevation Certificate documenting that the lowest floor (including basement) is built in compliance with 24
b. Noise. Is the property located within 1000 feet of a highway, freeway, or heavily traveled road?
Within 3000 feet of a railroad?
Within one mile of a civil airfield or 5 miles of a military airfield?
c. Runway Clear Zones / Clear Zones. Is the property within 3000 feet of a civil or military airfield?
If "Yes," is the property in a Runway Clear Zone / Clear Zone?
d. Explosive /Flammable Materials Storage Hazard. Does the property have an unobstructed view, or is it located within 2000 feet,
of any facility handling or storing explosive or fire prone materials?
e. Toxic Waste Hazards. Is property within 3000 feet of a dump or landfill, or a site on an EPA Superfund (NPL) list or equivalent State list?
f. Foreseeable Hazards or Adverse Conditions.
(1) Does the site have any rock formations, high ground water levels, inadequate surface drainage, springs, sinkholes, etc.?
(2) Does the site have unstable soils (expansive, collapsible, or erodible)?
(3) Does the site have any excessive slopes?
(4) Does the site have any earth fill?
If "Yes," will foundations, slabs, or flatwork rest on the fill?
If you marked "Yes" to any of the above questions in f, please attach a copy of the State licensed engineers' (soils and structural)
reports, designs, and/or certifications showing compliance with HUD requirements to ensure the structural soundness of the
improvements and the health and safety of the occupants. Refer to HUD Handbook 4145.1 and FHA Data Sheet 79g.
Complete this section when seeking eligibility for Maximum Loan-to-Value Financing. Items 2 and 3 must be checked.
HUD Minimum Property Standards in the Code of Federal Regulations at 24 CFR 200.926d.
HUD Handbook 4145.1, Architectural Processing & Inspections for Home Mortgage Insurance, including Appendix 8, Site Grading & Drainage Guideline.
CABO One- and Two-Family Dwelling Code, as listed in 24 CFR 200.926b.
CABO 1992 Model Energy Code
Electrical Code for One- and Two-Family Dwellings, as listed in 24 CFR 200.926b. (current edition; NFPA 70A/1984).
This is a manufactured (mobile) home and was constructed in accordance with the Federal Manufactured Home Construction & Safety Standards
(FMHCS). The label on the manufactured home shows compliance with the FMHCS. I hereby certify that the plans and specifications for all other
construction (i.e., site, foundation) comply with the applicable building code or HUD requirement listed above, including para. 3-4, Handbook 4145.1,
and the Permanent Foundations Guide for Manufactured Housing.
Builder or Builder's Agent: I hereby certify that the site analysis information above is true and accurate to the best of my knowledge and belief and
that the plans and specifications were designed to mitigate any foreseeable hazards or adverse conditions. On all properties eligible for maximum LTV
financing, I further certify that I have personally reviewed the plans, specifications, and site information submitted herewith. Based upon my review, I
hereby certify that such plans, specifications comply with the applicable building code specified above as well as complying with the HUD construction
requirements listed above. An "X" marked in the blank by each numbered item indicates that provisions from the marked code apply.
9 a. Name of Builder's Company or Builder's Agent (type or print)
10 a. Name & Title of Builder or Builder's Agent (type or print)
b. Street Address
b. Signature of Builder or Builder's Agent
c. City, State, & Zip Code
c. Telephone Number (include area code)
Previous editions are obsolete.
Page 1 of 3
ref. Handbook 4145.1
form HUD-92541 (4/2001)