Wind Mitigation Form OIR-B1-1802: Uniform Mitigation Verification Inspection Form

Enter the Inspection Date. Under Owner Information, enter the Owner Name, Contact Person, Address, Home Phone, City, Zip, Work Phone, County, Cell Phone, Insurance Company, Policy #, Year of Home, # of Stories and Email.

Check one: A if the code in force at time of permit application was the FBC 2001 & 2004; B if it was the FBC 2007 and later; C, for the HVHZ Only (Miami-Dade or Broward counties), if it was the SFBC-94; D if unknown or does not meet the requirements of Answer “A” or “B” or “C”. Enter the Year Built. For homes built in 2002/2003, provide a permit application with a date after 3/1/2002. For homes built in 2007/2008, provide a permit application with a date after 12/8/2006. For homes built in 1994, 1995, and 1996, provide a permit application with a date after 9/1/1994. Enter the Building Permit Application Date (MM/DD/YYYY).

Region: Location based on design windspeed. See ASCE 7-22 (700-year MRI) Risk Category 2. Check HVHZ, Region 1 (≥ 140 mph), Region 2 (130 mph - 139 mph) or Region 3 (< 130 mph).

For single-family homes with multiple slopes, indicate the slope that is at least two thirds of the main roof area when determining greater than or equal to 6:12, OR less than 6:12.

Roof Covering: Select all roof covering types in use. Provide the permit application date OR FBC/MDC Product Approval number AND Year of Original Installation/Replacement OR indicate that no information was available to verify compliance for each roof covering identified.

Check each Roof Covering Type in use. For each, enter the Permit Application Date, the FBC or MDC Product Approval # and the Year of Original Installation or Replacement, or check No Information Provided for Compliance.

4.2 Product Approval Listing: check A if all roof coverings meet the FBC with a FBC or Miami-Dade Product Approval listing current at the time of installation OR have a roofing permit application date on or after 3/1/02 OR the roof is original and built in 2004 or later.

Check B if all roof coverings have a Miami-Dade Product Approval listing current at time of installation OR (for the HVHZ only) a roofing permit application after 9/1/1994 and before 3/1/2002 OR the roof is original and built in 1997 or later.

Check C if one or more roof coverings do not meet the requirements of Answer “A” or “B.” Check D if no roof coverings meet the requirements of Answer “A” or “B.”

Roof Deck Attachment: check the box for the WEAKEST form of roof deck attachment.

Reinforced Concrete Roof Deck. Spray foam products with an uplift resistance of 110 PSF (FOS 1.5). (Spray foam must be installed along rafter deck intersections, all panel joints, etc.). Other: write it on the line. Unknown or unidentified. No attic access.

Roof to Wall Attachment: check the box for the WEAKEST roof to wall connection. Do not include attachment of hip/valley jacks within five (5) feet of the inside or outside corner of the roof in determination of WEAKEST type.

Structural: Anchor bolts structurally connected or reinforced concrete roof. Other: write it on the line. Unknown or unidentified. No attic access. Connection(s) not installed as intended.

Roof Geometry: check the box for the roof shape. Do not consider roofs of porches or carports that are attached only to the fascia or wall of the host structure over unenclosed space in the determination of roof perimeter or roof area for roof geometry classification.

Hip Roof: Hip roof with no other roof shapes greater than 10% of the total roof system perimeter. Enter the Total length of non-hip features in feet and the Total roof system perimeter in feet.

Flat Roof: Roof on a building with five (5) or more units where at least 90% of the main roof area has a roof slope of less than 2:12. Enter the Roof area with slope less than 2:12 in sq ft and the Total roof area in sq ft.

Other Roof: Any roof that does not qualify as either (A) or (B).

Sealed Roof Deck/Secondary Water Resistance (SWR): Applied as a supplemental means to protect the dwelling from water intrusion in the event of roof covering loss. Standard underlayment or hot-mopped felts do not qualify as an SWR.

No Sealed Roof Deck. Unknown or undetermined.

Opening Protection: check the box for the WEAKEST form of wind-borne debris protection installed on the structure. This category includes all openings in the wall and roof including windows, doors, sliding glass doors, skylights, and garage doors. Gable roof vents and other roof vents are not included. All openings (windows, doors, and skylights) must be in good condition. Buildings with openings that need replacement do not qualify for wind mitigation rate differentials, regardless of the presence/absence of other features.

Enter the Qualified Inspector Name, License Type, License or Certificate #, Inspection Company and Phone.

Check one active license the Qualified Inspector holds. Home inspector licensed under Section 468.8314, Florida Statutes, who has completed the statutory number of hours of hurricane mitigation training approved by the Construction Industry Licensing Board and completion of a proficiency exam. Building code inspector certified under Section 468.607, Florida Statutes. General, building, or residential contractor licensed under Section 489.111, Florida Statutes. Professional engineer licensed under Section 471.015, Florida Statutes. Professional architect licensed under Section 481.213, Florida Statutes. Any other individual or entity recognized by the insurer as possessing the necessary qualifications to properly complete a uniform mitigation verification form pursuant to Section 627.711(2), Florida Statutes.

Enter the print name of the qualified inspector who personally performed the inspection. Licensed contractors and professional engineers only: enter the print name of the employee who performed the inspection; the inspector agrees to be responsible for his/her work.

The Qualified Inspector signs the Qualified Inspector Signature line and enters the Date.

The Qualified Inspector who certifies this form shall be directly liable for the misconduct of employees as if the authorized mitigation inspector personally performed the inspection.

Homeowner to complete: the homeowner certifies that the named Qualified Inspector, or his or her employee, did perform an inspection of the residence identified on this form and that proof of identification was provided to the homeowner or the Authorized Representative. The homeowner signs the Signature line and enters the Date.

An individual or entity who knowingly or through gross negligence provides a false or fraudulent mitigation verification form is subject to investigation by the Criminal Investigations Division - Bureau of Insurance Fraud and may be subject to administrative action by the appropriate licensing agency or to criminal prosecution (Section 627.711(4)-(7), Florida Statutes).