| NAME: |
| LOCATION ADDRESS: |
| DATE: | |
| |
| Table A | |
| Enter 1 for each unit (ie. three bedrooms=3) listed below: | |
| Living Room | |
| Unfinished Attic | |
| Bedrooms | |
| Unfinished Basement (see note below) | |
| Bathrooms (3 or more fixtures) | |
| Stone exterior Walls | |
| Kitchen | |
| Clay Tile or Slate Roof | |
| Dining Room | |
| Two-Car Attached or Built-in Garage | |
| Family or Recreation Room | |
| Three-Car Carport | |
| Den, Study, Office, or Misc. Rooms | |
| Den, Study, Office, or Misc. Rooms (Over 300 Sq. Ft.) | |
| |
| Table B | |
| Enter 1 for each unit listed below: | |
| Dinette or Breakfast Nook | |
| Enclosed Porch | |
| Half Baths (2 or less fixtures) | |
| One-Car Attached or Built-in Garage | |
| Laundry Room with adjacent Half Bath | |
| One- or Two-Car Carport | |
| Brick Exterior Walls | |
| Large Rooms (200 to 300 Sq. Ft.) | |
| Central Air Conditioning | |
| |
| Table C | |
| Enter 1 for each unit listed below: | |
| Foyer or Entrance Hall | |
| Large Deck (over 300 Sq. Ft.) | |
| Walk-in Closet or Dressing Room | |
| Concrete Tile Roof | |
| Work, Storage, or Laundry Room | |
| Fireplace | |
| Breezeway or Open Porch | |
| Additional Cars per Garage (over two) | |
| |
| Note: | |
| For Finished & Partially Finished Basements: | |
| 1. Finished basements: count only the finished rooms. | |
| 2. Partially finished basements: if the total unit count of the finished area in the basement exceeds | |
| |
| Additional Information: | |
| Year House Built | |
| Square Footage: | |
| Year of last updating on: | |
| Roof | |
| Wiring | |
| Plumbing | |
| Heating | |
| Heat Type: | |
| Woodstove (if yes, is it used often?) | |
| Large Detached Building | |
| Smoke Alarm | |
| Deadbolt Locks | |
| Non-Smoker | |
| Central Station Reporting Burglar Alarm | |
| Police Station Reporting Burglar Alarm | |
| Central Station Reporting Fire Alarm | |
| Fire Department Reporting Fire Alarm | |
| Automatic Sprinkler System | |
| Central Vacuum System | |
| Domestic Solar Hot Water Heater | |
| Hot Tub | |
| Sauna | |
| Balconies (if yes, approximate size) | |
| Decks (if yes, approximate size) | |
| Swimming Pool (if yes, is it fenced in?) | |
| Electronic Garage Door Opener (how many) | |
| Wet Bar | |
| Air Conditioning (Central or through the wall unit(s) - how many) | |
| Skylights (if yes, how many) | |
| Trash Compactor | |
| Whole House Fan | |
| Countertop Range | |
| Intercom System | |
| Garbage Disposal&l
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