| 1.
Street Address:
2.
City:
3.
State:
(Not
available in CT and MA) 4.
What is the ZIP code of your home?
-
5.
Is your home located within 1,000 feet of a fire
hydrant?
Yes
No 6.
Is your home located within 5 miles of a fire
station?
Yes
No 7.
How many rooms are in your home?
(Count
all rooms -- garage, central A/C, slate roof, etc., are also counted as rooms. See list at right.) 8.
What year was your home built?
(Please enter a four-digit year) 9.
Which category best describes your home?
| | Room | | Count | | Aluminum Siding | 1 | | Finished
Attic | 1 | Finished Attic
(Less
than 150 sq. ft.) | 1/2 | | Partially Finished Attic | 1 | | Unfinished
Attic | 1/2 | | Finished Basement | 1 | | Partially
Finished Basement | 1 | | Unfinished Basement (With or w/o built-in garage) | 1/2 | | Full
Bathroom(s) | 1 | | Half Bathroom(s) | 1/2 | | Bedroom(s) | 1 | | Enclosed
Breezeway | 1 | | Large Open Breezeway | 1/2 | | Brick
Exterior Walls | 1 | | Brick Venger (From wall) | 1/2 | | Central
A/C | 1 | | Den | 1 | | Dinette | 1/2 | | Dining
Room | 1 | | Dressing Rack | 1/2 | | Entrace
Hall | 1/2 | | Family Room | 1 | | Standard
Fireplace | 1/2 | | Large Well Fireplace | 1 | | Attached
One-Car Garage | 1/2 | | Attached Two-Car Garage | 1 | | Built-in
Two-Car Garage | 1/2 | | Kitchen | 1 | Laundry
Room
(Over 150 sq.ft) | 1 | Laundry Room(s)
(Under
150 sq. ft.) | 1/2 | | Living Room | 1 | Mud
Room
(With separate entrance) | 1/2 | | Partitioned
Breakfast Nook | 1/2 | | Enclosed Porch | 1 | | Large
Open Porch | 1/2 | | Recreation Room | 1 | | Clay
Top Roof | 1 | | Slate Roof | 1 | Sewing
Room(s)
(Over 150 sq.ft) | 1 | Sewing Room(s)
(Under
150 sq. ft.) | 1/2 | | Stone Exterior Walls | 1 | | Stone
Venger (From wall) | 1/2 | | Study Office | 1 | Utility
Room(s)
(Over 150 sq.ft) | 1 | Utility Room(s)
(Under 150 sq. ft) | 1/2 | | Vinyl
Siding | 1 | | Walk-In Closet | 1/2 |
|
