PC350 (WPI-1) - Application for Certificate of Compliance
PC350 | 0421
Application for Certificate of Compliance
Form WPI-1
Address of structure to be inspected (Complete 9-1-1 street address, including house/building number):
________________________________________________________________________________________________ Tract or addition:
________________________________________________________________________________________________ Lot:
Tract:
________________________________________________________________________________________________ Block:
City:
ZIP:
? Inside city limits
County:
? Outside city limits
Structure is located in:
? Inland I*
? Inland II*
? Seaward*
* Use only if commencement of construction was prior to September 1, 2020
Is the structure in a Coastal Barrier Resource Zone?
? Yes
? No
Owner:
Name: ___________________________________________________ Phone no.:________________________________ Fax no.: __________________
Mailing address: _________________________________________ City: ______________________________________ ZIP: ______________________
Builder/contractor (at time of construction):
Name: ___________________________________________________ Phone no.:________________________________ Fax no.: __________________
Mailing address: _________________________________________ City: ______________________________________ ZIP: ______________________
Engineer:
Name: ___________________________________________________ Phone no.:________________________________ Fax no.: __________________
Mailing address: _________________________________________ City: ______________________________________ ZIP:
Email address: ___________________________________________ Texas registration no.: ______________________________________________
Commencement of construction (date):
1. Type of building:
Date of application:
2. Type of inspection:
? Commercial
? Entire building (type): _________________________________
? House
? Entire re-roof (type): ___________________________________
? Re-decking ___________________________________
? Detached garage
? House w/ garage attached by breezeway
? Townhouse w/ garage attached by breezeway
? Partial re-roof (type and area): ________________________
? Re-decking ___________________________________
? Duplex (unit no./letter: _____________)
? Alteration (type): ______________________________________
? Condominium (no. of units:______*)
? Repair (type): __________________________________________
? Townhouse
(no. of units:______*)
? Mechanical only (type): ________________________________
? Apartments
(no. of units:______*)
? Foundation only (type): _______________________________
? Bldg. no./name_______________
? Metal building
? Commercial
? Addition (type): ________________________________________
? Retrofit of all exterior openings: ______________________
? Residential
? Other (specify): ___________________________
* Per building
____
For windborne debris protection only (impact-resistant exterior opening
products or shutters). Exterior openings include windows, doors, garage
doors, and skylights.
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Comments:
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Who is submitting this form?
Name (please print):________________________________________
Date: ________________________________
Phone no.: ________________________________________________
Check one:
? Owner ? Builder/contractor ? Insurance agent ? Engineer ? Other (specify) ______________________________________
How to submit this form
For Texas Department of Insurance inspections, mail or email the completed form to your local Texas Department of
Insurance windstorm field office. Field office information can be found online.
For inspections by engineers, enter information into the Windstorm System online, or mail or email the completed form
to:
Texas Department of Insurance
Windstorm Inspections Program, PC-INSP
P.O. Box 12030
Austin, TX 78711-2030
Email: windstorm@tdi.
Questions?
Call the Windstorm Inspections Program at 1-800-248-6032.
Your rights: You can request information TDI has about you by emailing OpenRecords@tdi. or writing to: Public
Information Coordinator, Texas Department of Insurance, PO Box 12030 (mail code GC-ORO) Austin, Texas 78711-2030.
You also have the right to request TDI to correct information that is not accurate. To ask for a correction, send (1) your
name, mailing address, and your phone number, (2) details about what needs to be corrected, and (3) the reason or proof
showing why the information is incorrect. Send this by email to RecordCorrections@tdi. or by mail to: Record
Correction Request, Texas Department of Insurance, PO Box 12030 (mail code CO-AAL-CC), Austin, Texas 78711-2030.
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