Basic Tools
Heading
Text Box
Text Area
Drop Down
Radio Button
Check Box
Advanced Tools
Full Name
Email
Address
Phone
Date Picker
Home
Save
Publish
Light
Dark
Amwins Building Addon
Building Addon
Address:
*
Street address
Street address 2
City
State / Province
zip code
Building identifier:
*
Heating and Electrical
Heating/Cooling type:
*
Central
Window units
Space heater
Suspended wall furnace
None
Fuel type:
*
Electric
Gas
HVAC storage protection in place?
*
Yes
No
Wiring type:
*
Copper
Aluminum
Knob and tube
Not confirmed
Fuse or circuit breakers:
*
Circuit breakers
Fuses
Circuit breakers and fuses
None
Name of electrical panels installed:
*
Federal Pacific/Stab-Lok
General Electric
Schneider
Zinsco/Kearney
Square D
Westinghouse
GTE-Sylvania
Cutler Hammer
Challenger
Siemens
Magnetrip
Eaton
Other brand
Label not visible
Electrical panel not accessible
Name of other brand of electrical panel:
*
Plan to replace panels confirmed?
*
Yes
No
Mounted space heaters?
*
Yes
No
Missing covers on electrical equipment?
*
Yes
No
Temporary wiring in electrical room?
*
Yes
No
Combustible material in electrical room?
*
Yes
No
Building Information
Verify type of contents:
*
Other contents?
*
Yes
No
Explain other contents:
*
Historical building?
*
Yes
No
National or Regional:
*
National
Regional
Both
Unable to determine
Building square footage:
*
Year built:
*
Heat updated in what year?
*
Wiring updated in what year?
*
Plumbing updated in what year?
*
Construction type:
*
Frame
Joisted Masonry
Non-Combustible
Masonry Non-Combustible
Modified Fire Resistive
Fire Resistive
Foundation:
*
Concrete Slab
Pier and Beam
Crawl Space Open
Crawl Space Closed
Elevated Pier
No foundation
Basement
Roof shape:
*
Open gable
Box gable
Hip
Mansard
Flat
Dormer
Hexagon
Gambrel
Other
Other roof shape:
*
Roof type:
*
Composition Asphalt Shingle
Built-up
Metal
Rubber Membrane
Steel
Tile
Wood Shake
Other
Not confirmed
Other roof type:
*
Roof age (In years):
*
Roof support:
*
Verification of root support by:
*
Fire separation?
*
Yes
No
None observed
Trash or dumpster area?
*
Yes
No
None observed
Exposure(s) on North:
*
Other exposures on North?
*
Yes
No
Explain other exposures on North:
*
Exposure(s) on South:
*
Other exposures on South?
*
Yes
No
Explain other exposures on South:
*
Exposure(s) on East:
*
Other exposures on East?
*
Yes
No
Explain other exposures on East:
*
Exposure(s) on West:
*
Other exposures on West?
*
Yes
No
Explain other exposures on West:
*
Active fields on your form can be edited in the box below.
Form Properties
Title
Theme
Black
Dark Red
Notification Email
Confirmation Msg
Thank you for signing up
Field Properties -
Text
Label
Max Characters
Required
False
True
Hide Control
No
Yes
Control Action
--Please Select--
Show
Hide
Options
Selected Option
Hint
Property Lens
Minimum Age
100
99
98
97
96
95
94
93
92
91
90
89
88
87
86
85
84
83
82
81
80
79
78
77
76
75
74
73
72
71
70
69
68
67
66
65
64
63
62
61
60
59
58
57
56
55
54
53
52
51
50
49
48
47
46
45
44
43
42
41
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Maximum Age
100
99
98
97
96
95
94
93
92
91
90
89
88
87
86
85
84
83
82
81
80
79
78
77
76
75
74
73
72
71
70
69
68
67
66
65
64
63
62
61
60
59
58
57
56
55
54
53
52
51
50
49
48
47
46
45
44
43
42
41
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Valid Extensions
Max. File size (kb)
Min. File size (kb)
Help Text
Recommendations
Advance Setting
Auto-saving
Copy Embed Script
x
Close
(or press ESC or click the overlay)
×