Fillable HOUSE CALL REQUEST FORM & PRE-AUDIT QUESTIONNAIRE (Owatonna Public Utilities)

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HOUSE CALL REQUEST FORM & PRE-AUDIT QUESTIONNAIRE (Owatonna Public Utilities)

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HOUSE CALL REQUEST FORM & PRE-AUDIT QUESTIONNAIRE
I request a: Standard House Call ($300 value for a co-pay of $50)
Performance House Call ($380 value for a co-pay of $125)
The audit takes about two hours. Our qualified energy auditor will call you to schedule your audit at a time when you can be present.
CUSTOMER & RESIDENCE INFORMATION
Name: _________________________________________________________________________________________
Street Address: ___________________________________________________________________________________
City / State / Zip: __________________________________________________________________________________
Email: _________________________________________________________________________________________
Austin or Owatonna Utilities services: Electric Natural Gas Water
Utility Account Number: _________________________________________________
Day Phone: (__________) _________________________ Evening Phone: (__________) _________________________
Best time to contact me: Morning Evening Anytime
Type of Home: Single-family Multi-family Owner-Occupied Rental (# of units: __________)
How many years have you lived at this residence? ___________
Year Residence Was Built: ____________________
Number of Stories: 1 1.5 2 Other __________
Total Sq. Ft. (including basement): ___________
SIGNATURE & RELEASE FOR ENERGY DATA
By signing this waiver, you’re allowing your utility company, Austin Utilities or Owatonna Public Utilities, to provide your utility usage
information and Home Energy Report (if applicable) to partners with whom they have data confidentiality agreements for the purpose
of completing your CONSERVE & SAVE House Call, as well as for conducting program evaluation.
Signature: _______________________________________________________ Date: ___________________________
Pre-Audit Questionnaire continued on back...
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Pre-Audit Questionnaire continued from front...
HEATING
Furnace Boiler Other (e.g. heat pump, electric resistance): ___________________________________
Age of equipment:
Less than 10 years 10 to 20 years 20 to 30 years 30+ years
Programmable Thermostat:
Yes (Is it programmed? Yes No) No, I do not have one.
Fireplace:
Yes (If yes: Wood Gas) No
Wood Stove:
Yes No
Portable Electric Heaters:
Yes (# of units: ______) No
COOLING
Central air conditioning Window air conditioners If yes, how many? _______
Age of equipment:
Less than 5 years 5 to 10 years 10 to 20 years 20+ years
WATER HEATING
Gas Electric Propane
Age of equipment:
Less than 5 years 5 to 10 years 10 to 20 years
Number of bathrooms with showers: ________
SUBMITTING YOUR REQUEST
Fill out the front and back of this form completely, sign the front, and return it to your utility:
Austin Utilities Owatonna Public Utilities
1908 14th St NE 208 S. Walnut Ave. / P.O. Box 800
Austin, MN 55912 Owatonna, MN55060
507.433.8886 507.451.2480
www.austinutilities.com ww.owatonnautilities.com
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HOUSE CALL REQUEST FORM & PRE-AUDIT QUESTIONNAIRE (Owatonna Public Utilities)

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Completed 8 June 2021

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