Transcription of Acord Homeowner Application - Abram Interstate
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Acord CORPORATION 1981-2006. All rights 1 of 4 The Acord name and logo are registered marks of ACORDACORD 80 (2006/10)COMP. DATE:COCFARMSEASONALSECONDARYPRIMARYUSAG E TYPEGROUNDSWIMMING POOLYESNOAPPROVEDFENCEDIVINGBOARDABOVEGR OUNDIN -SLIDENONEOIL STORAGE TANK LOCATIONABOVE GROUND ONMASONRY FLOORABOVE GROUND NOTON MASONRY FLOORABOVEGROUNDBELOWGROUNDINDOORSOUTDOO RSFIRE DISTRICT / CODE NUMBERFIRE / EC RATEFIRE EXTNEIGHBORSVACANTUNOCCDEADBOLTVISIBLE TOTENANTOWNEROCCUPANCYHOUSEKEEPING CONDITION# WKSRENTEDNOYESOCCUPIED DAILY?SPECCLASSRATING# ROOMS# APTS$MARKET VALUE$REPLACEMENT COSTHEAT TYPENONEPRIMARY:SECONDARY:ROOF MATERIALNONECLOSEDOPENFOUNDATIONCIRCUIT BREAKERSNOYESFUSESNOYESYR BUILTSQ FTSUBURBWITHIN PROTFIRE DISTWITHINCITY LIMITSWITHINDWELLING LOCATIONNUMBER OFFIREDIVSUNITS INFIRE DIVTERRCODEDATE HEATING SYSTEMLAST SERVICEDNUM OF AMPS(ELEC SYST)ALUMINUM WIRINGYESNOKNOB & TUBE ORCONDITIONPLUMBING SYSTEMANY KNOWN LEAKSYESNOPLUMBING SYSTEMDATE/PRICEPURCHASERESHSEHLD#ILIES# FAM-RENOVATION TYPEWIRINGPLUMBINGHEATINGROOFINGEXTERIOR PAINTPART COMP YEARLOCALDIRECTCENTRALBURGLARTEMPSMOKESY STEMPROTECTION DEVICE TYPEPROTECTCLASSDISTANCE TOHYDRANTFIRESTATIONFTMICO-OPROWHOUSETOW NHOUSECONDOAPARTDW
partial sprinkler tax code grade bldg code inspected? yes no condition of roof rating/underwriting if replacement cost applies, acord 42 attached: basement sq ft breezeway sq ft sq ft garage features windstorm loss mitigation * not applicable in nc dwelling other structures personal property loss of use personal liability medical payments ...
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