4-Point Inspection
Personal Lines
(Edition 9/2012)
-
APPLICATION / POLICY #
INSURED/APPLICANT NAME
ADDRESS INSPECTED:
ACTUAL YEAR BUILT: DATE INSPECTED:
I
Minimum Photo Requirement:
Rear elevation
Front elevation
Open Main Electrical Panel and interior door
HVAC; heating systems equipment (with dated manufacturer's plate)
ALL hazards or deficiencies noted in this report.
A Florida Licensed inspector MUST complete, sign and date this form.
ELECTRICAL SYSTEM
(*SEPARATE DOCUMENTATION OF ANY ALUMINUM WIRING REMEDIATION MUST BE PROVIDED
AND CERTIFIED BY A LICENSED ELECTRICIAN)
Total Amps:
Year Last Updated:
Age of Main Panel:
I
I
Panel #2
Main Panel Amps
Wiring Type
Less
than 60 A Less than 60A Fuse
Romex, BX, or
Fuse
Conduit:
60A Fuse
60A Fuse
Active Knob & Tube
100A Fuse
or cloth wiring:
100A Fuse
100A CB
Aluminum*:
100A CB
200A CB:
Other (specify):
200A CB:
Other (specify):
Other (specify):
* If single strand (aluminum branch) wiring,
provide details of all remediation. Separate
documentation of all work must be provided
and certified by a licensed electrician.
Hazards Present
Over Fusing
Blowing Fuses or
Hazardous Panel
Breakers
Empty Breaker
Double Taps
Entire home rewired
Sockets
Exposed/Unsafe
with copper
Wiring
Loose Wiring
Connections repaired
Other (explain)
Improper
via COPALUM crimp
Grounding
Connections repaired
YesIs the electrical system in good working order? No (explain)
via AlumiConn
Use the Additional Comments/Observations Section below to provide
full
details of all updates, hazards, etc.
Central HVAC
Yes
No
Year Last Updated:
Age of System:
If not central,
indicate
primary
Hazards PresentAre the heating, ventilation and air
conditioning systems in good
working order?
heat source and fuel
Wood Burning Stove
type:
or central gas
Is the source
fireplace not
portable?
Yes
No
Yes
No
professionally
No (explain)
Yes
installed?
Space heater used
as primary heat
Yes
No
source?
Use the Additional Comments/Observations Section below to provide
full
details of all updates, hazards, etc.
- Insp4pt 09 12
Page 1
This form has been made available to verify the types, ages and conditions of a home's four major systems
HEATING SYSTEM
PHONE: (239) 770-4145
EMAIL: info@drathandassociates.com