LIFESTYLE SURVEY


Name:____________________________________ Phone: _____________________
Site location:____________________________________ Phone:________________
Client name:____________________________________
Budget (w/o site, W & S, taps, or mtg. Financing):____________________
Estimated time for completion of the home:________________
Family Information
Spouse's name:_____________________________________
Children (ages):_____________________________________
Others who will be living with you:_____________________________________
Future in-law needs:_________________________________________________
Handicap requirements:______________________________________________
Pets:_____________________________________



Home Style and Type

Ranch Two Story One and a Half Story Other___________________
Traditional Contemporary Spanish Modern
Square footage of living space (without basemen)t: ________________
No. of bedrooms: ____ No. of baths: ____ Full Half 3/4
Type of kitchen (large, small, country, etc.): ____________________

Rooms Required
(Rate on a scale of 1-5 with 5 being "Must Have" and 1 being "Do Not Want.")

Living Room ____ Size ____________ Location _______________________________
Dining Room ____ Size ____________ Location _______________________________
Family Room ____ Size ____________ Location _______________________________
Great Room ____ Size ____________ Location _______________________________
Recreation Room ____ Size ____________ Location _______________________________
Sun Room ____ Size ____________ Location _______________________________
Den ____ Size ____________ Location _______________________________
Master Bedroom ____ Size ____________ Location _______________________________
Bedroom #2 ____ Size ____________ Location _______________________________
Bedroom #3 ____ Size ____________ Location _______________________________
Bedroom #4 ____ Size ____________ Location _______________________________
Bedroom #5 ____ Size ____________ Location _______________________________
Bedroom #6 ____ Size ____________ Location _______________________________
Laundry Room ____ Size ____________ Location _______________________________
Hobby Room ____ Size ____________ Location _______________________________
Home Office ____ Size ____________ Location _______________________________
Theatre Room ____ Size ____________ Location _______________________________
Workshop ____ Size ____________ Location _______________________________
Garage ____ Size ____________ Location _______________________________

Features
(Rate these features on the same scale as the "Rooms Required" section.)

Basement_____ Walkout_____ Lookout _____
 
Construction:
____ 2 4 ____ 2 6 ____ High "R" sheathing ____ Tyvek ____ Custom Ceramic Shower
____ Wood siding ____ Brick or stone ____ Veneer ____ Atrium ____ Patio
____ Hip roof ____ Gable roof ____ Doors w/transom glass ____ Wet bar ____ Direct Vent Fireplace
____ Casement windows ____ Clad windows ____ Skylights ____ Double Hung Windows ____ Laminate Flooring
____ Open stairs ____ Curved stairs ____ Decks ____ Stucco ____ Built in Appliance
____ Masonry fireplace ____ Pre-fab fireplace ____ Wood stove ____ High efficiency furnace ____ Gas or Electic Appliance
____ Shake roof ____ Tile roof ____ Concrete drive ____ Asphalt drive
____ Whirlpool tub ____ Quality Bath fixtures ____ Hot tub ____ Humidifier
____ Air cleaner ____ Hot water heat ____ Track lighting ____ Ceiling fans
____ Recessed lighting ____ Surround Sound ____ Central vacuum ____ Stereo wiring
____ Gas logs ____ High "R" insulation ____ Finished garage ____ Custom cabinets
____ Corian counters ____ Ceramic tile counters ____ Pre-cast marble counters
and surrounds
____ Hardwood flooring
____ Tile flooring ____ Glass shower doors ____ Double ovens ____ Microwave
____ Compactor ____ Jenn-air type range ____ Oak trim ____ 6-panel fir doors
____ Painted trim ____ Mantles ____ Granite Counters ____ Style of Doors

Personal Preferences

How many cars do you own? ____ # of Garage Stalls needed ____________________________
Motorhome/trailer? ____ Heat or AC in Garage? ____________________________
Do you like music? ____ Any special requirements? ____________________________
Speaker wiring? ___________________________________________________________
Do you own a computer? ___________ Need a dedicated circuit? ______ Modem? _______
Do you want a computer center in your home?
How many TVs do you own? _______DVDs? _______
Any special TV requirements?_________________________Theatre Room?________________________
What hobbies or sports do you like?_____________________________________________
Do you own any furniture or art which requires special consideration? _______________________
_____________________________________________________________________
Do you entertain at home? _______ Business?_______ Personal?_______
What size, style, type of home do you currently live in? ________________________________
____________________________________________________________________
What do you like about it? __________________________________________________
What do you dislike about it? ________________________________________________
What other areas of importance need to be discussed in the design phase of your new home?
____________________________________________________________________
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Additional provisions:
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Stacy Custom Homes • 51716 Trail Ridge Drive • Granger, IN 46530
574.679.9433 • fax 574.674
.0865 email us