RESIDENTIAL COMPONENT TECHNOLOGY
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1 GENERAL INFORMATION Policy Number: Insured Name: Property Address: Property Zip: Agent: Branch: Current Coverage: _ Account Number: _ Number of Families: PROPERTY DATA Main Section Wing 1 Wing 2 Year Built: _ Pre-1930 Pre-1940 Standard Number of Stories: _ Year Built: _ Pre-1930 Pre-1940 Standard Number or Stories: _ Year Built: _ Pre-1930 Pre-1940 Standard Number of Stories: 1 Story 2 Story 3 Story Ranch Rambler Cape Code 1.5 Story 2.5 Story Bi-Level Bungalow Queen Anne Colonial Contemporary Mediterranean Federal Colonial Southwest Adobe Substandard/Subsidized Cottage Back Split Raised Ranch Split Foyer Split Level Tri-Level Town/Row House - Center Unit Town/Row House - End Unit Bi-Level/Row - Center Unit Bi-Level/Row - End Unit Tri-Level/Row - Center Unit Tri-Level/Row - End Unit Victorian Ornate Victorian Condo/Co-Op TOTAL LIVING AREA _ 1 Story 1 1/2 Story 2 Story 2 1/2 Story 3 Story Main Section additional 1 Story 1 1/2 Story 2 Story 2 1/2 Story 3 Story TOTAL LIVING AREA _ TOTAL LIVING AREA _ % Cathedral Ceiling % Slab % Crawlspace % Basement Daylight (Y/N) % Basement Finished Custom (Y/N) % Pier Foundation % Hillside Foundation NOTE: If hillside foundation is selected, you must specify both the slope and access. See the following page for your choices. Wing 1 additional % Cathedral Ceiling % Slab % Crawlspace % Basement Daylight (Y/N) % Basement Finished Custom (Y/N) % Pier Foundation % Hillside Foundation Wing 2 additional % Cathedral Ceiling % Slab % Crawlspace % Basement Daylight (Y/N) % Basement Finished Custom (Y/N) % Pier Foundation % Hillside Foundation Rev 2/05 1
2 Slope Access Special Conditions 0 to 15 Degrees 15 to 30 Degrees 30 to 45 Degrees More than 45 Degrees Flat Area/Easy Access Roads Slightly Congested Roads Narrow Roads/Hillside Area Difficult Access/Steep Terrain Island Access - Short Distance Island Access - Long Distance Elevator Access Isolated Rural Area Mountain Access Square Shape Rectangular Shape Irregular Shape Very Irregular Shape Elaborate Roof EXTERIOR Exterior Walls % Roofing % Clapboard Clapboard - Redwood Wood Siding Wood Shakes T-111 Siding New England Shingle Victorian Scalloped Shakes Plywood Siding (Only) Barn Plank Log Siding Log Siding - Custom Cedar Aluminum Siding Vinyl Siding Steel Siding Stucco on Frame Stucco on Block Brick Veneer Brick Veneer - Custom Brick and Block Brick and Block - Custom Solid Brick Solid Brick - Custom Stone Veneer Stone Veneer - Custom Stone and Block Stone and Block - Custom Stone Solid Stone Solid Stone - Custom Adobe Block (Painted) Painted Decorative Block Slump Block Poured Concrete 4-6 Concrete Walls Solid Brownstone Window Wall Greenhouse Wall Cement Fiber Shingles Hardboard Siding Exterior Insulation and Finish System 2 Architectural Shingles Asphalt / Fiberglass Shingle Wood Shake Slate Built-up Tar and Gravel Clay Tile Concrete Tile Mission Tile Spanish Tile Rubber Tin Steel Roofing Copper Wood Shingles New England Pine Shingle Victorian Scalloped Shake Fiberglass Panel Plexiglass Roofing Foam
3 EXTERIOR continued Attached Structures Attached Structures Attached Garage - 1 Car Attached Garage Car Attached Garage - 2 Car Attached Garage Car Attached Garage - 3 Car Attached Garage Car Attached Garage - 4 Car Attached Garage Car Attached Garage - 5 Car Built-in Garage - 1 Car Built-in Garage Car Built-in Garage - 2 Car Built-in Garage Car Built-in Garage - 3 Car Built-in Garage Car Basement Garage - 1 Car Basement Garage Car Basement Garage - 2 Car Basement Garage Car Basement Garage - 3 Car Carport - 1 Car Carport - 2 Car Carport - 3 Car Open Porch - Small Open Porch - Medium Open Porch - Large Screened Porch - Small Screened Porch - Medium Screened Porch - Large Closed Porch - Small Closed Porch - Medium Closed Porch - Large Open Breezeway - Small Open Breezeway - Medium Open Breezeway - Large Screened Breezeway - Small Screened Breezeway - Medium Screened Breezeway - Large Closed Breezeway - Small Closed Breezeway - Medium Closed Breezeway - Large Wood Deck - Small Wood Deck - Medium Wood Deck - Large Redwood Deck - Small Redwood Deck - Medium Redwood Deck - Large Patio Cover - Small Patio Cover - Medium Patio Cover - Large Solar Room - Small Solar Room - Medium Solar Room - Large Greenhouse - Small Greenhouse - Medium Greenhouse - Large Balcony - Small Balcony - Medium Balcony - Large Indoor Pool Hot Tub Swimming Pool - Fiberglass Swimming Pool - Concrete (Small) Swimming Pool - Concrete (Medium) Swimming Pool - Concrete (Large) Swimming Pool - Concrete (Extra Large) Attached Structures Attached Garage Attached Barn Attached Barn - Vintage Built-in Garage Basement Garage Carport Open Porch Screened Porch Closed Porch Open Breezeway Screened Breezeway Closed Breezeway Wood Deck Redwood Deck Composite Deck Patio Cover Solar Room Greenhouse Balcony Screened Pool Enclosure 3
4 EXTERIOR continued Detached Structures Special Items Detached Garage - 1 Car Detached Garage Car Detached Garage - 2 Car Detached Garage Car Detached Garage - 3 Car Detached Garage Car Detached Garage - 4 Car Detached Garage Car Detached Garage - 5 Car Detached Garage w/fin. Area - 1 Car Detached Garage w/fin. Area - 2 Car Detached Garage w/fin. Area - 3 Car Detached Garage w/fin. Area - 4 Car Detached Garage w/fin. Area - 5 Car Shed - Small Shed - Medium Shed - Large Tennis Courts - Asphalt Unlighted Tennis Courts - Asphalt Lighted Tennis Courts - Clay Unlighted Tennis Courts - Clay Lighted Tennis Courts - Grass Unlighted Tennis Courts - Grass Lighted Basketball Court - Lighted Basketball Court - Unlighted Swimming Pool - Fiberglass Swimming Pool - Concrete (Small) Swimming Pool - Concrete (Medium) Swimming Pool - Concrete (Large) Swimming Pool - Concrete (Extra Large) Atrium Windows Picture Windows Bay Windows Bow Windows Greenhouse Windows Stain Glass Windows - Small Stain Glass Windows - Large Exterior Storm Shutters Atrium Doors Sliding Glass Doors Skylight - Small Skylight - Large Solar Panels Special Items Skirting (Hillside) Detached Structures Detached Garage Detached Garage w/fin. Area Screened Pool Enclosure 4
5 INTERIOR Partitions % Drywall Drywall - Textured Plaster Plaster - Textured Plaster - Horsehair Studs Only Plywood Only Block Brick and Block Stone and Block Adobe Solid Brick Solid Stone Wall Coverings % Paint Sponge Coat Marble Paint Vinyl Wallpaper Foil Wallpaper Grass Cloth Paper Ceramic Tile Imported Ceramic Tile Marble Tile Sheet Paneling Solid Wood Paneling Tongue & Groove Millwork Bookcase Walls Knotty Pine Mirrors Brick Facing Stone Facing Terrazzo Carpet Corkboard Pegboard Ceilings % Drywall Drywall - Textured Plaster Plaster - Textured Plaster - Horsehair Acoustical Spary Acoustical Texture Wood Tongue & Groove Millwork Plank Plywood Only Tin Mirrors Carpet Stucco Finish Recessed Lighting Marble Metal Flooring % Hardwood Carpet over Hardwood (Acrylic/Nylon) Carpet over Hardwood (Custom Acrylic) Carpet over Hardwood (Wool/Berber) Wall to Wall Carpet (Acrylic/Nylon) Wall to Wall Carpet (Custom Acrylic) Wall to Wall Carpet (Wool/Berber) Vinyl Ceramic Tile Ceramic Tile - Imported Laminated Flooring Parquet Plank Plywood Only Marble Tile Mural Tile Flagstone Brick Slate Terrazzo Tile Stone Granite Cork 5
6 INTERIOR continued Interior Items Kitchen - Basic Kitchen - Builder s Grade Kitchen - Semi-Custom Kitchen - Custom Kitchen - Designer Full Bath - Basic Full Bath - Builder s Grade Full Bath - Semi-Custom Full Bath - Custom Full Bath - Designer Half Bath - Basic Half Bath - Builder s Grade Half Bath - Semi-Custom Half Bath - Custom Half Bath - Designer Three Quarter Bath - Basic Three Quarter Bath - Builder s Grade Three Quarter Bath - Semi-Custom Three Quarter Bath - Custom Three Quarter Bath - Designer Fireplace - Single Fireplace - Double Fireplace - Triple Wood Stove - Free Standing Fireplace - 0 Clearance Insert Gas Fireplace Direct Vent Fireplace Kiva French Doors (count each door) Hot Tub Jacuzzi Wet Bar Vanity - Custom Installed Metal Spiral Staircase Wood Spiral Staircase Finished Attic Interior Items HVAC % Heating System - Average Cost Central Air Conditioning - Average Cost Heat & Central Air Conditioning - Avg Cost Heating - Electric Heating - Gas Heating - Oil Heating - Gas Hot Air Heating - Gas Hot Water Heating - Oil Hot Air Heating - Oil Hot Water Heating - Oil Hot Water with Radiators Heating - Propane Gas Hot Air Heating - Propane Gas Hot Water Radiant Floor Heating System Central Air Conditioning - Same Ducts Central Air Conditioning - Separate Ducts Whole House Fan HVAC Electric Heat Pump Evaporative Coolers Evaporative Coolers, Window Units Additional Furnace NOTE: Do not include small window air conditioning units Miscellaneous Systems % Interior Sprinkler Systems Central Burglar Alarm System Central Vacuum System Intercom System Central Fire Alarm System Central Stereo System 6
7 MISCELLANEOUS Write-In Components % Write-In Components FIELD SURVEY NOTES 7
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GENERAL INFORMATION Policy Number: Insured Name: Property Address: Property Zip: Agent: Branch: Current Coverage: _ Account Number: _ Number of Families: 1 2 3 4 PROPERTY DATA Main Section Wing 1 Wing
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