Flood and Coastal Storm Damage Surveys

OMB CONTROL NUMBER: 0710-0017

OMB EXPIRATION DATE: XX/XX/XXXX

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0710-0017, is estimated to average 20 minutes per survey, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

COASTAL STORM DAMAGE

Background Information

1. Is this your primary residence?

1. NO

YES

1a. If not, is it a… (CIRCLE ONE ANSWER)

1. Second Home

2. Rental

3. Other (PLEASE SPECIFY)________________________________________

2. How many years have you owned this house?

________________ YEARS

3. How old is your home?

________________ YEARS OLD

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

______ TIMES

5. Where is your home situated? (CHECK 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 (Within a block of the ocean)

____ On a sound or back bay

____ Interior, (More than a block from the ocean bay, or sound)

Structural and Outside Property Data

6. 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)

7. What type of foundation does your home have?

(PLEASE CIRCLE ONE ANSWER AND INDICATE NUMBER OF FEET, WHERE APPROPIATE)

1. Slab

2. Piling - If piling, how many feet do they go below ground? ______ Feet

3. How many feet do they elevate the structure above ground? ______ Feet

4. Concrete Block –

If so, how many feet do they go below ground? ______ Feet

5. Other type of foundation, please describe. ________________________________________________________

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

(CIRCLE YES OR NO)

YES NO

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

8a. Finished living area: ___________ SQUARE FEET or (_______FEET X __________ FEET)

8b. Utility space ___________ SQUARE FEET or (_______FEET X ________ FEET)

8c. Garage: ___________ SQUARE FEET or (_______FEET X __________ FEET)

8d. Other: Please describe: __________________________________________________

____________SQUARE FEET or (_______FEET X __________ FEET)

9. Do you have an attached garage that is not under the house?

(CIRCLE YES OR NO) YES NO

9a. If so, indicate the size of the attached garage.

____________SQUARE FEET or (_______FEET X __________ FEET)

10. Do you have a detached garage that is not under the house?

(CIRCLE YES OR NO) YES NO

10a. If so, indicate the size of the detached garage.

____________SQUARE FEET or (_______FEET X __________ FEET)

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

(CIRCLE ONE ANSWER)

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

12. Not counting any basement, attic, or garage, how many square feet of living area are in your home? (If respondent is unsure, ask for the dimensions and calculate.)

___________ SQUARE FEET

13. Does your home have a basement? (CIRCLE)

1. NO (Skip to 14)

2. YES

13a. If yes, please indicate the total basement area, in square feet, and the amount that is finished and unfinished? (If respondent is unsure, ask for the dimensions and calculate.)

TOTAL BASEMENT AREA: ________________ SQUARE FEET

FINISHED BASEMENT AREA: _____________ SQUARE FEET

UNFINISHED BASEMENT AREA: __________ SQUARE FEET

14. Do you have a carport? (CIRCLE)

1. NO

2. YES

14a. How large is the carport in square feet? (If respondent is unsure, ask for the dimensions and calculate.)

_________ SQUARE FEET

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

(CIRCLE ONE ANSWER FOR MOST PROMINENT SYSTEM)

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

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

(CIRCLE ONE ANSWER)

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

17. What is the primary roof covering of this building? (CIRCLE ONE ANSWER)

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

18. How many fireplaces are in this home? _________ FIREPLACES

_______ FIREPLACES

19. 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)

20. Do you have an elevator in your home?

___ Yes ___ No

21. How high is the first floor of your building above the lowest adjacent grade?

________FEET

22. How high is the first floor of your building above the where flood water would first enter your building (from considering windows and pipes into the foundation?

________FEET

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

(Please circle yes or no for each column.)

Long-Term Flood Proofing Methods	Original Construction	Retrofitted (after original construction)	Was Method Effective?
Elevated Construction	YES NO	YES NO	YES NO
Reinforced piling	YES NO	YES NO	YES NO
Extended piling	YES NO	YES NO	YES NO
Bracing	YES NO	YES NO	YES NO
Sealant or Shield What type? _______________________	YES NO	YES NO	YES NO

24. Please indicate 1) which utilities are elevated in your home in order to prevent flood damage and 2) indicate whether the elevating was effective:

(Please circle yes or in both columns.)

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

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

1. NO (Skip to 26)

2. YES

25a. Is the garage attached to the structure? (CIRCLE)

1. NO

2. YES

25b. How large is the garage in square feet? (If you are unsure, please give the dimensions.)

_________ SQUARE FEET Or ( ____ Feet X ___ Feet)

26. How high is the first floor of your building above the lowest adjacent grade?

________FEET

COSTS AND DAMAGES

The next group of questions is to determine damages to different types of property from the Hurricane __(NAME)_ or the coastal storm of ( DATE ).

27. Please indicate how high (in feet and inches) did any standing water in your home reach relative to the first floor of your home?

______FEET; ______INCHES (ABOVE, BELOW) FIRST FLOOR LEVEL

[CIRCLE]

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

______FEET; ______INCHES (ABOVE, BELOW) FIRST FLOOR LEVEL

[CIRCLE]

29. Please indicate the primary source 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 _______________________________

30. Did the flooding from this storm 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 31)

2. YES

30a. 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

30b. How much money did your household spend beyond your normal travel expense, on travel and lodging due to your evacuation(s) during Hurricane _(Name)_?

______ DOLLARS

30c. Due to your evacuation, how much money did your household spend on food in excess of what you normally would have spent?

______ DOLLARS

31. Was there erosion damage to your lot?

31a. If so, how many square feet of your lot were eroded?

_______ Square Feet?

31b. What percentage of the lot directly under your home (footprint of your home) was eroded?

_______ Percent

31c. What were the total costs to repair the erosion damage to your lo/t and your home?

$ __________

32. 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 dollar 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? (CIRCLE YES OR NO)	Dollar Damage	Depth of Water from the Bottom of the Vehicle
Vehicle 1:	$_______	YES NO	$_______	______ FEET
Vehicle 2:	$_______	YES NO	$_______	______ FEET
Vehicle 3:	$_______	YES NO	$_______	______ FEET

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 _(NAME)_.

33. 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.)

$_______________ DOLLAR COSTS OF STRUCTURE DAMAGE

33a. Which of the following is the primary source of your structure damage repair costs?

(Circle one)

1. Contractor estimate (before repairs)

2. Contractor invoice (after repairs)

3. Your own assessment

4. Other _______________________

33b. What was the dollar cost to you for labor and supplies to clean up your home after the hurricane?

$________

33c. What was the total number of unpaid hours that you and others spent on repair and cleanup to your home?

______ UNPAID HOURS

34.		Please itemize your total structural damages and any additional time that was spent on repairs other than paid labor hours into the following categories.
	Portion of Structure		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		_____%	$______	__________ UNPAID HOURS
	2. Electrical		_____%	$______	__________ UNPAID HOURS
	3. Plumbing		_____%	$______	__________ UNPAID HOURS
	4. Exterior walls, windows, doors (painting included), and roofing		_____%	$______	__________ UNPAID HOURS
	5. Footings and foundation		_____%	$______	__________ UNPAID HOURS
	6. Interior doors and walls (painting included)		_____%	$______	__________ UNPAID HOURS
	7. Interior floors, carpet and ceilings		_____%	$______	__________ UNPAID HOURS
	8. Mechanical systems - heat, A/C, sump pump, built-in vacuum		_____%	$______	__________ UNPAID HOURS
	9. Porches and decks		_____%	$______	__________ UNPAID HOURS
	10. Chimneys and fireplaces		_____%	$______	__________ UNPAID HOURS
	11. Garages and outbuildings		_____%	$______	__________ UNPAID HOURS
	12. Outside property and landscaping		_____%	$______	__________ UNPAID HOURS
	13. Septic, sewer, and water systems		_____%	$______	__________ UNPAID HOURS
	Total		100 %	$______	__________ UNPAID HOURS

35. What was the dollar 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.)

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

______ UNPAID HOURS

37. How much, if anything, did each of the following cost you in actual dollar expenditures as a result of Hurricane (NAME) ?

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: ______________________________ $___________

______________________________________ $___________

38. Is there a swimming pool on your lot?

____Yes ____No, Go to Question 39

38a. Was your swimming pool damaged by Hurricane (NAME) ?

____Yes ____No, Go to Question 39

38b. What were your repair costs from Hurricane (NAME) associated with your swimming pool? (If the pool was destroyed, please estimate the replacement cost.)

$_____________ SWIMMING POOL REPAIR COSTS

38c. What are the dimensions of your swimming pool?

Size Range of Depth

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

38d. Is your swimming pool on the oceanfront side of your home?

_ Yes ______No

39. List any additional features, such as hot tub, tile works, etc. that may have been damaged by Hurricane (NAME) .

Item $ Damage CIRCLE N/A, IF NOT APPLICABLE

HOT TUB $__________ N/A

TILE WORK $__________ N/A

DECKING $__________ N/A

OTHER (SPECIFY_________________) $__________ N/A

Flood Warning and Response

40. Just before (DATE) storm, how did you first become aware that flooding might reach your business? (CIRCLE ONE ANSWER)

1. E-MAIL

2. TEXT MESSAGE

3. SOCIAL NETWORKING WEBSITE (FACEBOOK, TWITTER, SNAPCHAT, etc.)

4. TV

5. RADIO

6. TELEPHONE BY A PUBLIC OR EMERGENCY WORKER

7. TELEPHONE BY OTHER

8. FACE TO FACE BY PUBLIC OR EMERGENCY WORKER

9. FACE TO FACE BY OTHER

10. LOUDSPEAKER

11. SIREN

12. C.B., HAM RADIO or POLICE SCANNER

13. NEWSPAPER

14. OBSERVING THE CREEK OR RIVER WATER LEVELS

15. OTHER ______________________________________

41. How many hours were there between the time you first became aware that flooding might reach your property until when the water actually reached your property?

______ HOURS

42. What actions, if any, did you take to safeguard your business property immediately prior to flooding and what were the dollar damages prevented by each action?

(PLEASE CIRCLE YES OR NO FOR EACH ACTION LISTED BELOW AND INDICATE THE DOLLARS DAMAGES PREVENTED FOR EACH ACTION.)

Damage Preventive Action	Took Preventive Action	Dollar Damage Prevented (PLEAS FILL IN $ DAMAGES PREVENTED OR CIRCLE DK FOR DON’T KNOW.)
1. Moved contents to higher ground	YES NO	$__________ OR DK
2. Elevated contents to a higher spot in the building	YES NO	$__________ OR DK
3. Shut off electrical equipment	YES NO	$__________ OR DK
4. Sandbagged the outside of the building	YES NO	$__________ OR DK
5. Used another type of temporary barrier	YES NO	$__________ OR DK
6. Moved vehicles to higher ground	YES NO	$__________ OR DK
7. Other action _______________________ _______________________	YES NO	$__________ OR DK
8. None	YES NO

43. Emergency Measures/Plans:

43a. What emergency measures/plans, if any, would you take to reduce damage if you were forewarned of another coastal storm?

43b. What is your estimated cost to implement these emergency measures?

$

43c. How much time (in man hours) is required to implement these emergency measures?

MAN HOURS

COASTAL STORM DAMAGE 15