Firewise Old Oak Way Sign-Up and Safety Form Name * First Name Last Name Email * Phone * (###) ### #### Address 1 * Street Number & Name Address 2 If needed for more address details City City State State Zip Code Zip Code Number of residents in household * Approximate # of acres * Property Assessment Approximate Value of your Home What type of materials is your roof? * Roofing Composite Shingles Metal Cement Tile Clay Wood Other Is your roof fireproof? Yes No Soffit Vent: A screened vent in a house that allows air to flow to the attic or the space below roof sheathing. * Do you have a soffit vent? Yes No Don't know What house siding do you have? Stucco Masonry products Plaster Cement Wood Don't know Other Skirting Material Do you have skirting material used around the bottom of homes and sometimes decks to protect the underside from exposure? Yes No Don't know House Attachments Are the attachments to your house (deck, fencing touching house) wood vs. non-combustible materials? Yes No Don't know Are most of your windows multi-paned? Yes No Don't know Are your gutters clear of needles/leaves? Yes No Don't know Are your gutters metal (or something non-flammable) or wood? Metal (or non-flammable) Wood Don't know Is the first 5 feet around your house relatively clear of combustible materials? Yes No Five to thirty feet from your house: Are there landscape & breaks to help decrease fire behavior? Yes No Fire's Path Answer Thirty to 100 feet from your house: do you have treated vegetation to interrupt fire's path, keep flames smaller and on the ground? Yes No For the current year, how many hours have you and your family members invested in vegetation management for wildfire risk reduction? For the current year, how much money have you spent on home hardening (ex: replacing attic vents) and/or vegetation management for wildfire risk reduction? Thank you for taking the time to fill out the Old Oak Way Home Assessment Form. If you have further questions about the Old Oak Way Firewise Neighborhood, please contact info@oldoakway.info
