SRCPA LogoHurricane Building Damage Form

If you have experienced storm damage to your house, building or other structure we need to know about it.

Tell us how to get in touch with you:
 Owner's Name
1Street Address of damaged building  
1City, State, ZIP Code 
1Parcel ID  
 Telephone
*E-mail

Your estimate of damage

              Minor
                       Shingle Loss
                       Siding Loss
          
             Shutters
                       Screen Enclosure
          
                  Damaged Destroyed 

                       Other (Explain Below)

                             

             Holes in roof or outside wall(s) (outside damage)

              Damage inside home from water/wind
                       Collapsed walls
                       Collapsed ceiling
                       Stained walls/floors
                       Mold/mildew
                       Electrical damage
                             Individual outlets  All 

                       Rooms affected (living room, master bedroom, kitchen, etc...)

                             

                     Other (Garage, Shed, Barn, etc) (Explain Below)

                             

               Building uninhabitable/condemned

             Building leveled/destroyed

            
             Estimated cost of repair  
             Estimated date repairs to be completed  

Additional Comments

           


1Address or Parcel ID Required
*Required Fields

Revised: October 15, 2004