Is the structure located in a Coastal Barrier Resource Zone (CBRA):
Owner
Name:
Phone:
Fax:
Mailing Address:
City:
ZIP:
Contractor
Name:
Phone:
Fax:
Mailing Address:
City:
ZIP:
Engineer
Name:
Phone:
Fax:
Mailing Address:
City:
ZIP:
Email:
Texas Registration No.:
Commencement of Construction Date
Date of Application
Type of Building
Inspections
1.
2.
3.
Comments
Submitter
Name:
Phone:
Date:
Submitter Type:
For Texas Department of Insurance Inspections: mail or email to your local
field office
For inspections by engineers: mail or email to Austin office: windstorm@tdi.texas.gov
Texas Department of Insurance Windstorm Inspections Program P.O. Box 12030 Austin, TX 78711-2030
Texas Department of Insurance | www.tdi.texas.gov 1/2
PC350(WPI-1) | 0908
NOTICE ABOUT CERTAIN INFORMATION LAWS AND PRACTICESWith few exceptions, you are entitled to be informed about the
information that the Texas Department of Insurance (TDI) collects about you. Under sections 552.021 and 552.023 of
the Texas Government Code, you have a right to review or receive copies of information about yourself, including
private information. However, TDI may withhold information for reasons other than to protect your right to privacy.
Under section 559.004 of the Texas Government Code, you entitled to request that TDI correct information that TDI
has about you that is incorrect. For more information about the procedure and costs for obtaining information from
TDI or about the procedure for correcting information kept by TDI, please contact the Agency Counsel Section of
TDI's General Counsel Division at (512) 676-6551 or visit the Corrections Procedure section of TDI's website at
www.tdi.texas.gov.
Texas Department of Insurance | www.tdi.texas.gov2/2
Location of Property to be Insured
Street:
Lot:
Block:
Tract or Addition:
City:
County:
Date of Construction:
Application ID:
Certificate Number:
Occupancy Type:
Building Type:
Certificate Type:
Certificate Detail:
Certificate Date:
Inspector Type:
Certificate Type:
Certificate Detail:
Certificate Date:
Inspector Type:
Certificate Type:
Certificate Detail:
Certificate Date:
Inspector Type:
PC350(WPI-1) | 0908
Application for Certificate of Compliance
Form WPI-1
App ID:
Physical Address of Structure to be Inspected
Tract/Addition:
Lot:
Block:
City:
ZIP:
County:
City Limits:
Structure is located in:
Is the structure located in a Coastal Barrier Resource Zone (CBRA):
Owner
Name:
Phone:
Fax:
Mailing Address:
City:
ZIP:
Contractor
Name:
Phone:
Fax:
Mailing Address:
City:
ZIP:
Engineer
Name:
Phone:
Fax:
Mailing Address:
City:
ZIP:
Email:
Texas Registration No.:
Commencement of Construction Date
Date of Application
Type of Building
Inspections
1.
2.
3.
Comments
Submitter
Name:
Phone:
Date:
Submitter Type:
For Texas Department of Insurance Inspections: mail or email to your local
field office
For inspections by engineers: mail or email to Austin office: windstorm@tdi.texas.gov
Texas Department of Insurance Windstorm Inspections Program P.O. Box 12030 Austin, TX 78711-2030
Texas Department of Insurance | www.tdi.texas.gov 1/2
PC350(WPI-1) | 0908
NOTICE ABOUT CERTAIN INFORMATION LAWS AND PRACTICESWith few exceptions, you are entitled to be informed about the
information that the Texas Department of Insurance (TDI) collects about you. Under sections 552.021 and 552.023 of
the Texas Government Code, you have a right to review or receive copies of information about yourself, including
private information. However, TDI may withhold information for reasons other than to protect your right to privacy.
Under section 559.004 of the Texas Government Code, you entitled to request that TDI correct information that TDI
has about you that is incorrect. For more information about the procedure and costs for obtaining information from
TDI or about the procedure for correcting information kept by TDI, please contact the Agency Counsel Section of
TDI's General Counsel Division at (512) 676-6551 or visit the Corrections Procedure section of TDI's website at
www.tdi.texas.gov.
Texas Department of Insurance | www.tdi.texas.gov2/2
