Home Energy Inspection

• Document No.

• Audit

  Home Inspection

  Pool Inspection

  AC Inspection

  Green Energy

• Conducted on

  Date

• Mr.

• Mrs.

• Last Name

• Client Email

• Prepared by

• Location
  Address

HOME SURVEY

• HOME BUILT

  Select 1955 1966 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1067 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

  • 1955
  • 1966
  • 1957
  • 1958
  • 1959
  • 1960
  • 1961
  • 1962
  • 1963
  • 1964
  • 1965
  • 1966
  • 1067
  • 1968
  • 1969
  • 1970
  • 1971
  • 1972
  • 1973
  • 1974
  • 1975
  • 1976
  • 1977
  • 1978
  • 1979
  • 1980
  • 1981
  • 1982
  • 1983
  • 1984
  • 1985
  • 1986
  • 1987
  • 1988
  • 1989
  • 1990
  • 1991
  • 1992
  • 1993
  • 1994
  • 1995
  • 1996
  • 1997
  • 1998
  • 1999
  • 2000
  • 2001
  • 2002
  • 2003
  • 2004
  • 2005
  • 2006
  • 2007
  • 2008
  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014
  • 2015
  • 2016
  • 2017
  • 2018
  • 2019
  • 2020

• MOVED IN

  Select 1955 1966 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1067 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

  • 1955
  • 1966
  • 1957
  • 1958
  • 1959
  • 1960
  • 1961
  • 1962
  • 1963
  • 1964
  • 1965
  • 1966
  • 1067
  • 1968
  • 1969
  • 1970
  • 1971
  • 1972
  • 1973
  • 1974
  • 1975
  • 1976
  • 1977
  • 1978
  • 1979
  • 1980
  • 1981
  • 1982
  • 1983
  • 1984
  • 1985
  • 1986
  • 1987
  • 1988
  • 1989
  • 1990
  • 1991
  • 1992
  • 1993
  • 1994
  • 1995
  • 1996
  • 1997
  • 1998
  • 1999
  • 2000
  • 2001
  • 2002
  • 2003
  • 2004
  • 2005
  • 2006
  • 2007
  • 2008
  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014
  • 2015
  • 2016
  • 2017
  • 2018
  • 2019
  • 2020

• Concern with rising ENERGY COST

  Yes

  No

  N/A

• PLANNING TO MOVE

  Never

  No

  Yes

  Maybe in the Future

• How many square FT is your home

  Select 1000-1500"SqFt 1500-2000 SqFt 2000-2500 SqFt 2500-3000 SqFt 3000-3500 SqFt 4000+ SqFt

  • 1000-1500"SqFt
  • 1500-2000 SqFt
  • 2000-2500 SqFt
  • 2500-3000 SqFt
  • 3000-3500 SqFt
  • 4000+ SqFt

• Do you use Electric or Gas

  Electric

  Gas

• Do you consider your HOME ENERGY EFFICIENT?

  Somewhat

  Yes

  No

• Is your Hot Water Heater Electric or Gas

  Electric

  Gas

• How old is it?

  Select Old New 1 2 3 4 5 6 7 8 9 10 11 12

  • Old
  • New
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• AVERAGE MONTHLY ELECTRIC. BILL

  Select $100 $150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700

  • $100
  • $150
  • $200
  • $250
  • $300
  • $350
  • $400
  • $450
  • $500
  • $550
  • $600
  • $650
  • $700

• ADD ANY ADDITIONAL INSULATION

  Select No Yes

  • No
  • Yes

• Is there an area in your home , chilly, drafty, warmer...etc

  Yes

  No

  N/A

• Specify......Where

  Select Front Living Room Living Room Dining Room 1 Dining Room 2 Kitchen Master Bedroom Bedroom 1 Bedroom 2 Bedroom 3 Kid Room 1 Kids Room 2 Garage Office Others

  • Front Living Room
  • Living Room
  • Dining Room 1
  • Dining Room 2
  • Kitchen
  • Master Bedroom
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Kid Room 1
  • Kids Room 2
  • Garage
  • Office
  • Others

• Any Specific Areas of concern

HOME ENERGY INSPECTION. DOE SUGGESTED. SAVINGS

• Refrigerator Energy Star/Adjust Temp. 1%

  Pass

  Fail

• Outlet Covers. Insulation. 1%

  Pass

  Fail

• Front Door. Energy Star/Storm Door/Weather Stripping. 1%

  Pass

  Fail

• Windows. Double Pane/Energy Film. 1%

  Pass

  Fail

• Sliding Glass Doors. Energy Film. 1%

  Pass

  Fail

• AC Thermostat Programmable. 3%

  Pass

  Fail

• Light Bulbs. CFL/LED. 3%

  Pass

  Fail

• Pool Circulation. Variable Speed. $40-$60 per mth..

  Pass

  Fail

• Air Conditioning. 14 Seer. Varies

  Pass

  Fail

• Attic Rafters. Reflective insulation. Up to 25%

  Pass

  Fail

• Attic Ventilation. Solar Turbine Fan. 10-30%

  Pass

  Fail

• Attic Floor. R30 to R60. 10%

  Pass

  Fail

• Water Heater. Solar Water Heater. 20% to 40%

  Pass

  Fail

• Notes

• Audit Information

  Drawing

Mrs......HOMEOWNER REACTION REPORT

• After reviewing the Energy evaluation, I feel my electric bills are:

  Too low

  Fair

  Too High

• In the future my electric bills will:

  Stay the same

  Go up

  Go way up

• Clean, renewable energy for my family is:

  Not important

  Important

  Extremely Important

• The amount of money a solar system would save me per month is:

  $50-$100

  $100-$150

  $150+

• Would you like to have Solar power in your home in the future?

  Yes

  No

  N/A

• What features appeal to you most?

• Add signature

  Sign

Mr......HOMEOWNER REACTION REPORT

• After reviewing the Energy evaluation, I feel my electric bills are:

  Too low

  Fair

  Too High

• In the future my electric bills will:

  Stay the same

  Go up

  Go way up

• Clean, renewable energy for my family is:

  Not important

  Important

  Extremely Important

• The amount of money a solar system would save me per month is:

  $50-$100

  $100-$150

  $150+

• Would you like to have Solar power in your home in the future?

  Yes

  No

  N/A

• What features appeal to you most?

• Add signature

  Sign

Energy Inspection Sign-out

• Energy Representative Signature

  Sign

• Sign Out

  Date

GREEN SOLUTION

• Heating & Cooling Square FT= _______________x 1.30 ________________

• Garage

  Yes

  No

  N/A

• If Yes, Square FT= _______________x 1.30 ________________

Cellulose Brown Insulation

• Heating & Cooling Square FT= _______________

• Garage

  Yes

  No

  N/A

• If Yes, Square FT= _______________x 1.30 ________________

• If Yes, Square FT= _______________

• 36 Compact Florescent Bulbs

  Yes

  No

  N/A

• Electric Use Regulator

  Yes

  No

  N/A

• Green Pack

  Yes

  No

  N/A

• Estimate Time and Date for installation

  Date

• Special instructions

• I accept the terms of installation:

  Sign

• DATE

  Date

• Special instructions

NEW SOLAR WATER HEATING SYSTEM

• Closet

  Yes

  No

  N/A

• Garage

  Yes

  No

  N/A

• Floor (L) _________________x(W)_______________x(H)______________

• Closet Door Jamb x(W)_______________x(H)______________

• Distance Tank to Elec Outlet

  Select 5ft 6ft 7ft 8ft 9ft 10ft 11ft 12ft 13ft 14ft 15ft 16ft 17ft 18ft 19ft 20ft

  • 5ft
  • 6ft
  • 7ft
  • 8ft
  • 9ft
  • 10ft
  • 11ft
  • 12ft
  • 13ft
  • 14ft
  • 15ft
  • 16ft
  • 17ft
  • 18ft
  • 19ft
  • 20ft

• Free standing panel rack

  Yes

  No

  N/A

• Roof Mount The Panel

  Yes

  No

  N/A

• New 80 gal tank w/. (1) - 4' x 10' panel

  Yes

  No

  N/A

• New 120 gal tank w/. (2) 4' x 10' panel

  Yes

  No

  N/A

• # of Users

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Retro Kit for Original tank

  Yes

  No

  N/A

• Original Tank Size

  Select 40 gal 50 gal 66 gal 80 gal 120

  • 40 gal
  • 50 gal
  • 66 gal
  • 80 gal
  • 120

• Original Tank

  Electric

  Gas

• PVC PUMP OPTION

  Yes

  No

  N/A

• Roof type

  Shingle

  Barrel Tile

  Metal

• Roof Color

  Gray

  Brown

  Black

  Other

• Exterior wall Type

  Stucco

  Siding

  Brick

• Roof Height

  Single Story

  Two Story

  Three Story

• Attic Space

  Yes

  No

  N/A

• Approx. Pipe run to panel from WH___________footage

• Installation Diagram

  Drawing

• Picture of Home

  Media

• Picture of home 2

  Media