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Take the Survey
In order to be contacted about the results of this survey, please submit your name, email, and/or phone number and you will receive an email with the results.
Name
Email
Phone
What best describes your situation? (Select all that apply)
Home owner currently experiencing comfort issues, high energy bills or durability issues?
Home owner who is preparing your home for sale looking to increase value?
Home owner curious about taking advantage of federal tax incentives to make “green” and/or energy efficiency improvements?
Potential buyer of a pre-existing home interested in energy efficiency of the home, determining improvements, savings and cost of improvements?
Please provide the following basic information:
Location Street:
Location City:
Location State:
Approximate size of home (sq ft living space):
Year that the home was built:
Type of home:
Single family detached
Townhome
Condo
Number of bedrooms:
Type of basement:
Air conditioned/heated basement
Unconditioned basement
No basement
Number of floors above ground:
Check any energy improvements that you have already made to your home
Building:
Added insulation to attic
New windows
Total thickness of insulation (0 if N/A):
Year windows replaced (0 if N/A):
Lighting and Appliances:
New hot water heater
New dishwasher
New refrigerator
Hot water heater year replaced (0 if N/A):
Dishwasher year replaced (0 if N/A):
Refrigerator year replaced (0 if N/A):
Heating, Ventilation and Air Conditioning (HVAC):
Air conditioning system replaced
Furnace system replaced
Air conditioning system year replaced (0 if N/A):
Furnace system year replaced (0 if N/A):
Other improvements (describe):
Please provide the following information on your heating, cooling and water heating systems
Number of air conditioning systems (count the outside units):
Heating system is:
natural gas furnace
propane furnace
electric – heat pump
not sure
Type of hot water heater:
natural gas storage tank
propane gas storage tank
electric storage tank
natural gas tankless
electric tankless
not sure
Number of hot water heaters:
Known issues with the home (check all that apply):
Hot rooms in the summer
Cold rooms in the winter
Feel drafts in the winter
Moisture accumulating on a wall area
Moisture accumulating on a ceiling area
Moisture accumulating on an HVAC register
Moisture accumulating in basement or crawlspace area
Roof needing repair
Facia around roofline needing repair
Water standing near foundation – poor drainage
Paint needed on exterior
Smelling natural gas or propane near appliances
Light bulbs burning out often
Other issues that you would prefer to describe in person
Please describe any of these situations or other situations in more detail: