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2. Parcel Number*
3. Date*
   Date
5. Owner's Name*
6. Phone Number*
8. Email Address*
10. On what kind of foundation is your house built?

    Please indicate the portion of each (excluding the garage).

    1. SLAB 1/4
    2. SLAB 1/2
    3. SLAB 3/4
    4. SLAB FULL

    1. CRAWL 1/4
    2. CRAWL 1/2
    3. CRAWL 3/4
    4. CRAWL FULL

    1. BASEMENT 1/4
    2. BASEMENT 1/2
    3. BASEMENT 3/4
    4. BASEMENT FULL
12. What is the approximate size of any finished area in the basement?
14. FLOOR

    1. Tile/Linoleum
    2. Carpet
    3. Concrete
15. WALLS

    1. Paneling
    2. Drywall
    3. Unfinished
16. CEILING

    1. Suspended
    2. Drywall
    3. Unfinished
20. Please list the number of rooms on each floor.
    (excluding the bathrooms & laundry)
22. Basement
23. First
24. Upper Floors
26. Please list the number of bedrooms on each floor.
28. Basement
29. First
30. Upper Floors
34. Does this house have a fireplace?

    1. Yes
    2. No
35. If yes, what kind is it?

    1. Gas
    2. Woodburning
36. If yes, how many stacks (chimneys) does it have?
37. How many fireplace openings does it have?
41. Does the house have central air/geothermal?

    1. Yes
    2. No
42. Does the house have heat?

    1. Yes
    2. No
46. How many 3-fixture baths(toilets, sinks, tub and/or shower) does this house have?
47. How many 2-fixture baths (toilet and sink only) does this house have?
48. Are there any additional fixtures?
    His/her sinks, laundry room sink, wet bar sink or additional sink in kitchen?
52. What year was the house built?
53. What is the street address for this house?
54. Have you remodeled/improved this house in the last 7 years?

    1. Yes
    2. No
56. New Construction or Remodeling

    Check the kind of structure(s)/ building(s) you have built or remodeled (including unfinished projects).

    1. New House
    2. Addition(s) to House

    1. Exterior Remodeling
    2. Interior Remodeling

    1. Attached New Garage
    2. Detached New Garage

    1. New Outbuilding(s) (Sheds, Gazebos, Etc.)
    2. Other
58. Date Started
    Date Started
59. Date Finished
    Date Finished
60. If not finished as of January 1, please tell us what has yet to be completed:
62. Approximate Cost:
63. Does this include labor?

    1. Yes
    2. No
67. Owner's Comments:
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit Submit and Print

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