SECTION ONE – GENERAL INFORMATION

1. 

How long have you lived in/owned the property?

................... year(s)   ............. months

2. 

How old is the original building?

It was constructed in ………….../ or

It is about ………………….. years old

3. 

Is it a listed building?

Yes

No

Not Sure

4. 

Is it in a conservation area?

Yes

No

Not Sure

5. 

Do you have a cellar?

Yes

No

Not Sure

6. 

If ‘yes’ how and where is it accessed?

7. 

Is there access to loft space?

Yes

No

Not Sure

8. 

If ‘yes’ how and where is it accessed?

9. 

Which services are connected to the property?

Electricity:

Mains

Other

Gas:

Mains

Other

LPG:

Oil:

Other – if so please give details

10.    

Do you have a Central Heating boiler?

Yes

No

11.    

If so, do you know how old it is?

                                    Years

12.    

Where is the boiler located?

(If the manufacturers manual available, please leave it out by the boiler or show it to the Domestic Energy Assessor)

13.    

Where are the following located?

Electricity meter

Electricity Fuse box

Gas meter

LPG store or Oil store

Hot water cylinder

SECTION TWO – CHANGES TO THE PROPERTY

14.    

Has it ever been extended? or

Have significant changes been made? Or

Have building works been undertaken?

Yes

No

Not Sure

If so, did you do the works?

Yes

No

15.    

If you answered YES to Q14, please provide more information.

Types of building works undertaken:

Approximate date of the works:

Attic conversion

Extensions/conversions

Other:

16.    

Has there been Window replacement or Double glazing Installed?

Yes

No

If so, what was the date of installation

Do you have a FENSA certificate?

Yes

No