1. Approximate Sq. Ft.: 1200 sq. ft.
Property Inspection
Checklist
Property Owner
Sample DOS
Property Address
10133 Hwy 59
City/St/Zip
Evansville, WI 53515
Insurance Carrier
WIAMPC001 - Ampul
Policy Number & Date
4766 4/12/2017
*The property is located on a rural Highway outside Evansville and Edgerton WI. Overall the property appears maintained.
Overall Risk Grade
A B C D F
Report Type
Home
Farm
Was the insured interviewed?
Yes (persons name) No
* Insured.
Is the property vacant?
Yes No
U/D
Nearest Fire Hydrant
<100 ft ft
>1000 ft
None
Nearest Resonding Fire Station
< 1 Mile 1- 5 Miles
> 5 Miles
* Edgerton FD
Dwelling Information
Approximate Sq. Ft.: sq. ft.
Approximate Age: 100+ yrs. for stone portion of dwelling, newer section approx 20 yrs.
# of Stories:
1 1 1/2
Below Grade 2
2 1/2 3
Tri-Level
Bi-Level
Other (state type)
Basement
Crawl
Slab
Open Foundation
Piers
Dwelling Condition
Very Good
Good
Average
Fair
Poor
Central Air
Yes No
Garage Type
Attached
Detached
* Built into basement at rear.
Roof Type
Asphalt Shingle
Metal
Rolled Roofing
Cedar Shake
Rubber
Other
Roof Age
0-5 years
6-12
12-18
19+
Roof Condition
Very Good
Good
Average
Fair
Poor

2. Electrical Service Size
Siding Type
Vinyl Alum
Wood
Hard Board
Brick (Veneer)
Brick (solid)
Asbestos Slate
Log
Other (state
type)
* Stone on older portion of the dwelling, vinyl siding on newer portion.
Siding Condition
Very Good Good Average
Fair
Poor
Window Condition
Very Good
Electrical Service Size
Good
Average
Fair
Poor
60 AMP
100 AMP
200 AMP
400 AMP
Unable to Determine
Electrical Service Condition
Type Of Furnace
Natural Gas
Propane
Oil
Electric
Other
Evidence of Solid Fuel
Yes No
U/D
Hot Tub
Yes No
U/D
Pool
Yes No
U/D
Trampoline
Yes No
U/D
Yard Maintenance
Very Good
Good
Average
Fair
Poor
Trip Fall Hazards
Yes (see photo) No
Dogs on Property
Yes No
# of Dogs
Breed: None
Nature of Dog's
Friendly
Number:
Pleasant
Protective
Aggressive
Attack if it Could
Unable to Determine (inside or barking)
Horses
Yes No
U/D
N/A
Horses on Property
Number: None
Livestock on Property & Type
Yes No
U/D
Fencing in Good Condition
Yes No
N/A
Farm Machinery on Site
Yes No
Business on Premises
Yes (type & name if known) No
Unknown

3. Overall Property Impression
1 2
Action Needed 3 4 5 6 7 8 9 10
Yes (describe) No
Follow-Up
* 1) Consider reduced or reducing coverage on the Hay shed due to conditions and possible collapse risk.

4. Address Verification
Front
Front

5. Side / Front
Side
Side

6. Rear
Side / Rear
Side

7. Side
Side
Electrical Service

8. Air conditioner unit
Electrical meter
Propane Tank

9. Machine shed
Machine shed
Machine shed

10. Machine shed
Machine shed
Hay Shed

11. Hay Shed
Hay Shed
Hay Shed

12. Hay Shed
Hay Shed
Hay Shed (missing siding pieces)

13. Hay shed (possible collapse risk)