True North — House energy rating application

A — Contact Details

Business name

Contact person

Address

Postcode

Contact Phone Number

Mobile Phone

Fax

Member

MBA
Wesbuilder

Please provide your member #

Remember the above details for future asessments?

B — Rating required for:

If Applicable

Job Number

Purchase Order

Select the closest option

A new house design
An existing house
Addition or extension

C — Design details:

To be constructed at

Postcode

Local Council

Is the house located within 1km of the coast or on a cliff top?

Type of Floors

Ground Floor

Slab on ground
Timber
Suspended slab

Will it have in floor heating?

Upper Floor

Timber
Suspended slab

Floor Coverings

Please indicate area and location on your plan

Attach Files

Please include if available; Site plans, Floor plans, Elevations, Section details, Cross section detail, Electrical, etc.

Please ensure your drawings show a north pointer, dimensions, window sizes, ceiling heights and electrical illumination detail.

Additional Notes

Completing this application form is deemed your acceptance of a contract between you and True North Building Thermal Assessors and payment in full prior to your collection of the documentation. All information provided in this application is true and correct. I understand that should any of the features in this application form, the attached plans and specifications be omitted or altered, certificates awarded may be withdrawn. Homes may be inspected to ensure specified features are carried out.

Name of Applicant

	Insulation type	Sisalation	Thermal Break
Ceiling	Ceiling Insulation Ceiling Insulation Other
Roof	Roof Insulation Roof Insulation Other	Yes No	20mm timber batten 12mm EPS batten Air-Cell Insulbreak R1.5 Anticon Other Other Input None
Walls	Walls Insulation Walls Insulation Other	Yes No	20mm timber batten 12mm EPS batten Air-Cell Insulbreak Other Other Input None
Floor	Floor Insulation Floor Insulation Other	Yes No

Pergolas, patios or verandas	Yes No
Flyscreens	Yes No
Security screens	Yes No
Cyclonic screens	Yes No
Does the house have skylights?	Yes No
How many skylights?
Skylight manufacturer

		N
	NE		NW
E		All		W
	SE		SW
		S