Form Pc350 (Wpi-1) - Application For Windstorm Inspection Certificate Of Compliance - Texas Department Of Insurance
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2PC350 (WPI-1) | 0908
Print
APPLICATION FOR CERTIFICATE OF COMPLIANCE
Form WPI-1
Physical Address of Structure to Be Inspected
(Complete 9-1-1 Street address including house/building number):
_______________________________________________________________________ Tract or Addition
_______________________________________________________________________ Lot
Tract
_______________________________________________________________________ Block
City
Zip Code
County
Inside City Limits
Outside City Limits
Structure is located in:
Inland II
Inland I
Seaward
Is the structure located in a Coastal Barrier Resource Zone (COBRA):
Yes
No
Owner:
Name: ______________________________________ Telephone No.: ___________________ Fax No.: ____________
Mailing Address: ______________________________ City: ____________________________ Zip Code: ___________
Builder/Contractor (at time of construction):
Name: ______________________________________ Telephone No.: ___________________ Fax No.: ____________
Mailing Address: ______________________________ City: ____________________________ Zip Code: ___________
Engineer:
Name: ______________________________________ Telephone No.: ___________________ Fax No.: ____________
Mailing Address: ______________________________ City: ____________________________ Zip Code: ___________
E-Mail Address:_______________________________ Texas Registration No.: ________________________________
Commencement of Construction (date):
Date of Application:
1. Type of Building:
2. Type of Inspection:
Commercial
Entire Building (Type): ____________________________
Residential Dwelling
Entire Re-Roof (Type): ____________________________
___________________
Duplex
Re-decking
Garage Attached by Breezew
ay
Partial Re-roof (Type and Area): _
___________________
__________________
Detached Garage
Re-deckin g
Condominium (# of Units:______*)
Alteration (Type): ________________________________
Townhouse
(# of Units:______*)
Repair (Type): __________________________________
Apartments
(# of Units:______*)
Mechanical Only (Type): __________________________
* Per Building
Foundation Only (Type):___________________________
Farm & Ranch
Addition (Type): _________________________________
Metal Building
Retrofit of All Exterior Openings: ____________________
Other (Specify):__________________
(For windborne debris protection only (impact resistant exterior
opening products or shutters). All exterior openings shall include
windows, doors, garage doors, and skylights.
Comments:
Submitter Information:
SUBMITTER NAME (please print):________________________________________
DATE:_______________________
TELEPHONE NUMBER: ________________________________________________
PLEASE CHECK ONE:
Owner
Builder/Contractor
Insurance Agent
Engineer
Other (Specify)
_______________
FOR TEXAS DEPARTMENT OF INSURANCE INSPECTIONS: MAIL OR FAX TO YOUR LOCAL FIELD OFFICE
FOR INSPECTIONS BY ENGINEERS: MAIL OR FAX TO AUSTIN OFFICE: (512) 490-1051
Texas Department of Insurance |
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