Corps of Engineers Civil Works Questionnaires Generic Clearance

COASTAL STORM DAMAGE QUESTIONNAIRE

(Personal Interview)

OMB 0710-0001

Expires: 30 September 2012

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COASTAL STORM DAMAGE QUESTIONNAIRE

(Residential)

1. Is this your primary residence?

1. NO

2. YES

1a. If not, is it a…

1. Second Home

2. Investment property

3. Other ________________________________________

2.. How many years have you owned this house?

________________ YEARS

3. How old is your home?

________________ YEARS OLD

4. Before the flooding from Hurricane ________ or the coastal storm of __(date(s))______ had your home ever been damaged by a coastal storm?

(CIRCLE)

1. NO

2. YES

5. Approximately how many times since you’ve lived here, including Hurricane ________ or the coastal storm of __(date(s))______, has your home had coastal storm damage?

______ TIMES

6. On average, how many months a year do you occupy your home?

______ MONTHS

7. On average, how many months a year is your home on the rental market?

______ MONTHS

8. Not counting your attic, garage, or the under portion of an elevated building how many square feet of living area are in your home? (If you are unsure, please give the dimensions.)

___________ SQUARE FEET or (_______FEET X __________ FEET)

9. What type of foundation does your home have?

____ Slab

____ Piling - If so, How many feet do they go below ground? ______ Feet

• How many feet do they elevate the structure above ground? _____ Feet

____ Concrete Block - If so, How many feet do they go below ground? ______ Feet

____ Other type of foundation, describe __________________________________

9. If you have an elevated building, is there an under the house enclosure,?

YES NO

If yes, please indicate the size of enclosed area devoted to each of the following uses:

Finished living area: ___________ SQUARE FEET or (_______FEET X __________ FEET)

Utility, laundry, workshop, or storage area:

___________ SQUARE FEET or (_______FEET X __________ FEET)

Garage: ___________ SQUARE FEET or (_______FEET X __________ FEET)

Other: Please describe: __________________________________________________

____________SQUARE FEET or (_______FEET X __________ FEET)

11. Please note any long-term flood proofing method, which may be used on this property.

(Check all that apply.)

Long-Term Flood Proofing Method	Original Construction	Retrofitted (after original construction)	Was Method Effective?
Elevated Construction
Reinforced piling
Extended piling
Bracing
Sandbagging?
Sealant or Shield What type? _______________________

12. Please indicate which utilities are elevated in your home in order to prevent flood damage and also indicate whether the elevating was effective:

(Please check all that apply.)

Utility	Elevated	Was method effective?
Air Conditioner	Yes No	Yes No
Furnace	Yes No	Yes No
Washer/Dryer	Yes No	Yes No
Water Heater	Yes No	Yes No
Other:	Yes No	Yes No

13. Other than in the under the house enclosure, do you have a garage on this property? (CIRCLE)

1. NO (Skip to 13)

2. YES

13a. Is the garage attached to the structure? (CIRCLE)

1. NO

2. YES

13b. How large is the garage in square feet? (If you are unsure, please give the dimensions.)

_________ SQUARE FEET Or ( ____ Feet X ___ Feet)

14. Where is your home situated? (pick one)

____ Oceanfront, if so how many feet is your home from the ocean at mean high

water line? _______ Feet

____ First row behind oceanfront

____ Ocean Block

____ Sound or Back Bay

____ Interior

PART II – EMERGENCY RESPONSE

The next group of questions is to determine how you learned about the approaching flood and how you responded at the time.

15. What actions, if any, did you take to safeguard your property immediately prior to

flooding and what were the damages prevented by each action?

(PLEASE CIRCLE ALL THAT APPLY AND INDICATED THE DOLLARS DAMAGES PREVENTED FOR EACH ACTION.)

Damage Preventive Action	$ Damage Prevented	Hours Spent on Damage Prevention	Cost of Materials for Prevention
1. Moved contents to higher ground
2. Elevated contents to a higher spot in the building
3. Turn off electrical equipment
4. Sandbagged the outside of the building
5. Used another type of temporary barrier
6. Moved vehicles to higher ground
7. Other action _______________________
8. None

PART III - COSTS AND DAMAGES

The next group of questions is to determine damages to different types of property from the Hurricane ________.

16. Please indicate how high in feet and inches did any standing water get relative to the first floor of the inside of your home?

______FEET; ______INCHES (ABOVE, BELOW) FIRST FLOOR LEVEL

[CIRCLE]

17. Please indicate how high in feet and inches did any waves get relative to the first floor of your home?

______FEET; ______INCHES (ABOVE, BELOW) FIRST FLOOR LEVEL

[CIRCLE]

18. Please indicate the primary sources of damage to your home, excluding wind damage?

(CIRCLE ONE)

1. STORM SURGE (a sudden flow of water associated with a storm event)

2. WAVE RUNUP (the rush of water up a structure, associated with the breaking of a wave)

3. INUNDATION (the buildup of water overflow or ponding)

4. EROSION

5. OTHER

19. Did the flooding make it necessary for you or other occupants of your home to stay in temporary residence due to evacuation or while your home was being repaired?

(CIRCLE)

1. NO (Skip to 19)

2. YES

19a. How many days did you or other occupants of your home to spend in temporary residence due to the evacuation or while flood damage to your home was being repaired?

_____ DAYS

19b. How much money did your household spend on travel, beyond your normal travel expense, and lodging due to your evacuation(s) Hurricane ________?

______ DOLLARS

19c. Due to your evacuation, how much money did your household spend on food in excess of what you normally would have spent?

______ DOLLARS

20. Was there erosion damage to your lot?

20a. If so, how many square feet of your lot were eroded?

_______ Square Feet?

20b. What percentage of the lot directly under your home was eroded?

_______ Percent

20c. If your home was destroyed by erosion, is feasible to build another home on the same lot?

___ Yes ___ No

20d. What were the costs to repair the erosion damage?

$ _______

21. For each motor vehicle, including sedan, vans, sports utility, sports cars, station wagons, pickup trucks, boats, jet skis, golf carts, and motorcycles located at this residence during the flood, please indicate the dollar value, whether or not it was moved, the amount of damage to the vehicle, if any, and the level, in feet and inches, that the flood water reached above the bottom of the vehicle’s wheels.

Motor Vehicle Category and Year (Categories include: sedan, vans, sports utility, sports cars, station wagons, pickup trucks, boats, jet skis, golf carts, and motorcycles)	Dollar Value	Was it Moved to a safe location? (Yes or no)	Dollar Damage	Depth Above Ground At Vehicle
Vehicle 1:
Vehicle 2:
Vehicle 3:
Vehicle 4:
Vehicle 5:
Vehicle 6:

The following questions are to determine the dollar cost and unpaid hours for repair and cleanup of your home, and repair, replacement, and cleanup to the contents of your home that resulted from Hurricane ________.

22. What was the cost of the structural damage to your home? (Structural damage is defined as damage to any building components, including foundation, walls, floors, windows, roof, electrical systems, heating and cooling systems, plumbing, attached carpeting, attached shelves and cabinets, and built-in equipment and appliances.)

$_______________

22a. Which of the following is the primary source of your structure damage value?

(Circle one)

1. Contractor estimate (before repairs)

2. Contractor invoice (after repairs)

3. Your own assessment

4. Other _______________________

22b. What was the dollar cost to you for labor and supplies to clean up your home after the hurricane?

$________

22c. What was the total number of unpaid hours that you and others spent on repair and cleanup to your home?

______ HOURS

23 a.	Please itemize your total structural damages into the following categories.
b.	Please also itemize any additional time that was spent on repairs other than paid labor hours.

Area of Damage	Value of Damages
	In % of total Or in dollars		Unpaid Hours to repair or install, in addition to $ spent
1. Built-in shelves and appliances	%	$
2. Electrical	%	$
3. Plumbing	%	$
4. Exterior walls, windows, doors (painting included), and roofing	%	$
5. Footings and foundation	%	$
6. Interior doors and walls (painting included)	%	$
7. Interior floors, carpet and ceilings	%	$
8. Mechanical systems - heat, A/C, sump pump, built-in vacuum	%	$
Porches and decks	%	$
Chimneys and fireplaces	%	$
12. Garages and outbuildings	%	$
13. Outside property and landscaping	%	$
14. Septic, sewer, and water systems	%	$
Total	100 %	$

23. What was the dollar cost of damage to the contents of your home, garage, and shed, excluding motor vehicles? (Only include content replacement and repairs, do not include repairs to the structure of the house).

$___________________

(Content damage refers to damage to personal property kept inside the home or the garage that is not permanently affixed to the home.)

24. What was the total number of unpaid hours that you and others spent on repair of appliances, furniture, and other contents of your home?

______ HOURS

25. How much, if anything, did each of the following cost you in actual dollar expenditures as a result of Hurricane ________?

a) Costs for moving furniture and other belongings? $______

b) Costs for storing furniture and other belongings? $______

c) Vandalism, looting, or theft costs? $______

d) Costs from flooding-related medical problems? $______

e) Any other costs due to Hurricane ________. $______

Describe: ______________________________ $______

______________________________________ $______

26. Is there a swimming pool on your lot?

____Yes ____No, Go to Question 32

27. Was your swimming pool damaged by Hurricane ________?

____Yes ____No, Go to Question 32

28. What were your repair costs from Hurricane ________ associated with your swimming pool? (If the pool was destroyed, please estimate the replacement cost.)

$_____________

29. What are the dimensions of your swimming pool?

Size Range of Depth

___ feet X ___feet ___feet at shallowest point ___ feet at deepest point

30. Is your swimming pool on the oceanfront side of your home?

____Yes ____No

31. List any valuable extras associated with your swimming pool, such as hot tub, tile works, etc. that may have been damaged by Hurricane ________.

Item $ Damage

__________________ ___________

__________________ ___________

32. What is the five-digit zip code of this home?

_____________

33. What category best describes the style of this building?

(CIRCLE)

1. One-Story 5. 1-1/2 Story Finished 9. 3-1/2 Story Finished

2. Two-Story 6. 1-1/2 Story Unfinished 10. 3-1/2 Story Unfinished

3. Three-Story 7. 2-1/2 Story Finished 11. Bi-Level

4. Split Level 8. 2-1/2 Story Unfinished

34. What category best describes the heating and cooling system in this building?

(CIRCLE)

Heating Only:

1. Forced Air 6. Ceiling, Radiant Electric

2. Gravity Furnace 7. Baseboard, Electric

3. Floor Furnace 8. Baseboard, Hot Water

4. Wall Furnace 9. Radiators, Hot Water

(No Heat Ducts) 10. Radiators, Steam

5. Floor, Radiant Hot Water

Heating and Cooling:

11. Warmed and Cooled Air

12. Heat Pump System

Cooling Only:

13. Evaporative Water Cooler (Single or Short Ducts)

14. Refrigerated, with Condenser and Ducts

35. What is the primary exterior wall covering on this building?

(CIRCLE)

1. Plywood 4. Siding 7. Common Brick

2. Hardboard 5. Shingle 8. Face Brick

Sheets 6. Masonry 9. Stone

3. Stucco Veneer 10. Concrete Block

36. What is the primary roof covering of this building?

1. Composition Shingle 5. Concrete Tile 10. Plastic Tile

2. Built-up Rock 6. Clay Tile

3. Wood Shingle 7. Galvanized Metal

(Embedded in Asphalt) 8. Slate

4. Wood Shake 9. Composition Roll

37. How many fireplaces are in this home?

_______ FIREPLACES

38. How many square feet of each of the following types of porches are there in this home? (If you are unsure of square feet, please give dimensions.)

Slab ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Slab with Roof ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Wood Deck ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Enclosed Slab Porch ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

Enclosed Wood Porch ___________ SQUARE FEET

Or ( ____ Feet X ___ Feet)

39. Do you have an elevator in your home?

___ Yes ___ No

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