BUILDING PRE ENERGY AUDIT FORM

Building Manager (Name, Surname, Phone, e-mail) Date of Pre-audit

Name of the Building

Date of Construction (Building)

Address

Original Architects(if known) Contact Info: Direction of Facade [ ] East [ ] West [ ] North [ ] South [ ] North-West [ ] North-East [ ] South-West [ ] South-East Type of Structure [ ] Wood [ ] Brickwork [ ] Masonry [ ] Concrete [ ] Other(specify): Building Status [ ] Public [ ] Private Number of Floors [ ]1 [ ] 2-5 [ ] 6-10 [ ] more than 10 Anticipated Building Modification or Changes in the Near Future? (If Yes, Please Specify) [ ] Yes [ ] No Specify: Previous Architectural/Engineering Studies Undertaken? [ ] Yes [ ] No Specify: Is This Building on the National Historic Preservation Register? [ ] Yes [ ] No Specify:

Original Engineers(if known) Contact Info: Direction of Front Having Widest Window Area [ ] East [ ] West [ ] North [ ] South [ ] North-West [ ] North-East [ ] South-West [ ] South-East Type of Building [ ] House/Apartment [ ] Hospital [ ] School [ ] Commercial [ ] Industrial [ ] Other(specify): Building Use [ ] Living Space [ ] Office [ ] Storage [ ] Manufacturing [ ] Public Services [ ] Other(specify): Does the Building Have an Ongoing Energy Management Program? [ ] Yes [ ] No Specify: Previous Energy Audits Completed? [ ] Yes [ ] No Specify:

Does Heat Insulation Exist? (If Yes, Give Insulation Date) Does Cooling System Exist? [ ] Yes [ ] No [ ] Yes [ ] No Insulation Date: Specify: Is there any potential area on the facade of the bulding to be covered with insulation [ ] Yes (%....) material?(If Yes, give approximate percentage of the surface) Is there any potential area on the interior walls of the building to be insulated?(If Yes, [ ] Yes (%....) give approximate percentage of the surface)

[ [

] No ] No

Is there any potential area in / under the roof to be insulated?(If Yes, give approximate [ ] Yes (%....) [ ] No percentage of the surface) Heating System of Building Properties of Equipment (Age, Type, Capacity) [ ] Stove Boiler: [ ] Combi Boiler Pump: [ ] Central Heating System Radiator: [ ] Local Heating System Fan-Coil: [ ] Other(specify): Other(specify): Hot Water System of Building Does Cooling System Exist? [ ] Solid Fuel-Burning Heater [ ] Yes [ ] No [ ] Water Heater (Electrical) Specify: Average Daily Lightening Usage Period [ ] Water Heater (LPG, Naturel Gas) [ ] Combi Boiler [ ] 8 Hours [ ] Central Heating System [ ] 12 Hours [ ] Solar Energy System [ ] 16 Hours [ ] Other(specify): [ ] 24 Hours

NOTES:

Is there a possibility to renovate the external transparent enclosure (windows)? (If yes [ indicate material : glass or glass+structure )
Is there the possibility to use annexes, outbuildings, attics or any other space (with no historical and artistic value) to locate new conditioning system and plants?

] Yes. [ ] Yes [

] No ] No

Is there the possibility to locate RES (Renewable Energy Sources) in some parts of the [ building or in some annexes/outbuildings or in external areas?(if yes describe which kind of RES and approximately how much surface can be used)

] Yes

] No

PLEASE ATTACH THE PICTURES OF BUILDING FROM EACH SIDE FRONT SIDE

BACK SIDE

LEFT SIDE

RIGHT SIDE

NOTES:

PLEASE ATTACH THE PICTURES OF BUILDING's SURROUNDINGS FRONT

BACK

LEFT

RIGHT

NOTES:

Room-1

Intended Use: Area: .m2

PLEASE ATTACH THE PICTURES OF THE ROOMS in THE BUILDING

[ Location:floor ] Middle [ [ ] East ] North

[ ]West [ ] South

Room-2

Intended Use: Area: .m2

Location:floor ] Middle

[ [

] East ] North

[ ]West [ ] South

Room-3

Intended Use: Area: .m2

Location:floor ] Middle

[ [

] East ] North

[ ]West [ ] South

Room-4

Intended Use: Area: .m2

Location:floor ] Middle

[ [

] East ] North

[ ]West [ ] South

NOTES:

Footnote-1 Please attach all rooms increasing the room numbers Footnote-2 Take areas like kitchen, bathroom etc. Footnote-3 Indicate floor and direction of the room's facade for location, if the room has 2 direction indicate both, if there is no facade of the room indicate middle