Crawl Space: %
Is it a walkout? YesNo
What percentage is finished? %
If finished, finish style: StandardCustom
For each category indicate the percentage of each type of material used in your home. Please ensure each column adds to 100%. If your home contains a material not listed, please write-in the material name and percentage under "Other - Specify".
Wood Deck: Total Sq.ft
Composite Deck: Total Sq.ft
Porch: Total Sq.ft
15.Please indicate if any of your kitchens have the following special features:
17. Please indicate the number of bathrooms that have the following special features:
By submitting this form, I acknowledge that the information I have provided in this survey is accurate and complete to the best of my knowledge. I hereby release this information to be used by Capitol Benefits in reviewing the current Coverage A limit of my homeowners.
You only need to answer this question if your home was built prior to 1940. If your home was built in 1940 or later, please leave this question blank and proceed to Question 3.
Modern Materials - Select this option if your home was built prior to 1940 and you would like newer materials (such as drywall instead of plaster, etc) to be used to repair or rebuild your property in the event of a loss.
Exact Replica Materials - Select this option if your home was built prior to 1940 and you would like replica materials (such as plaster, rough lumber, etc) to be used to repair or rebuild your property in the event of a loss. By selecting Exact Replica Materials, you may increase the cost of rebuilding your home, coverage amount and premium on your policy.
Calculating Total Living Area:
The total living area is the size of your home (in square feet) based upon the outside measurements. It is the length of the home multiplied by the width of the home multiplied by the number of stories. It includes built-in garages but not basements, porches, decks or breezeways. You may know the square footage of your home from real estate or tax assessment documents. Please note: For 1-1/2 story homes, multiply the living area of the first floor by 1.65 and for 2-1/2 story homes, multiply the living area of the first floor by 2.65.
Foundation Type / Basement Selections:
Crawl Space - ½ the height of a basement, allowing entrance to space by crawling or crouching. Floor may be slab, dirt or plastic over dirt.
Slab - The frame of the home is built directly onto a slab of poured concrete or equivalent leaving no form of entrance and no room for storage below the first floor. Interior floor is built on top of slab.
Walkout Basement - Normally built on a sloping site where the foundation walls are partially exposed with windows and a door. Can also be referred to as a “daylight basement” or walkout cellar. It allows you to stand full height, is accessible by stairs within the house and can be entered from outside by walk-in door or sliders.
Finished Basement Types:
Standard - Generally has interior painted drywall partitions with hollow core doors, painted drywall ceiling, carpet and/or vinyl floor finishes and standard electrical outlets, lighting and heating.
Custom - Generally upgraded finishes to include ample interior drywall partitions with solid core doors, painted drywall ceiling and linear wood ceiling, partial millwork paneling and painted drywall finishes, high quality carpet, ample electrical outlets and lighting, heating and air conditioning systems.
Roof - For a roof with asphalt shingles, either completely covering the existing layer of shingles with a new layer of asphalt shingles, up to a maximum of 2 layers, or completely replacing the current layer of shingles. For metal, wood, tile, or slate roofs, enter the year it was removed and replaced.
Plumbing - The year plumbing was updated to conform to current local codes with new water supply lines or when new plumbing fixtures and components were installed throughout the dwelling.
Heating/Air Conditions - For heating, complete replacement of the heating plant or heat exchanger. For cooling, replacement of the central air conditioning unit or a/c compressor.
Electrical - Replacement of fuse or breaker boxes, and updating breaker boxes to conform to local codes and meet system demands, would be examples of updates. Other examples would include replacing switches, wiring, fixtures, and components necessary to meet system demands.
Shingles Asphalt/Composition - Shingles made of felt or inorganic fiberglass saturated with asphalt and surfaced with mineral granules. Also called composition shingles, these may be made in individual strips, interlocking and self-sealing. Asphalt shingles are normally applied on medium pitched roofs over solid sheathing and a vapor barrier.
Wood Shingles Shakes - Shakes split from a bolt of wood, generally in random dimensions. Wood shakes are normally installed over a pitched roof on spaced sheathing covered with a vapor barrier.
Clay / Concrete Tile - A roof made from different types of clay or thin pieces of concrete made from Portland cement, fine aggregate, and pigments. Clay/Concrete tiles are either tapered or straight and S shaped or barrel shaped with interlocking sidelaps or side joints.
Metal (Tin, Steel) - A thin gauge sheet of tin that is typically fastened with an interlocking standing seam system. The seams are either flat or raised. A steel roof consists of corrugated steel sheets applied over a pitched roof.
Slate - A dense, fine grained, metamorphic rock produced by the compression of various sediments, cut into thin tiles or slabs. Slate comes in any number of sizes, thicknesses and finishes.
Built-Up / Tar Metal Gravel - Three to five layers of roofing felt laminated with coal tar, pitch or asphalt, and topped with a layer of gravel or other aggregate material. Typically found on flat or low-pitched roofs.
Bay Window - A set of windows that projects from the wall of a home, forming a bay inside the home.
Bow Window - A set of several windows that projects from the wall of a home in the form of an arc.
Picture Window - A large framed window, typically 30-40 square feet, made of two layers of glass with a sealed air space between them. A dense, fine grained, metamorphic rock produced by the compression of various sediments, cut into thin tiles or slabs. Slate comes in any number of sizes, thicknesses and finishes.