Stacy Custom Homes LIFESTYLE SURVEY

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.")

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?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

Additional provisions:

____________________________________________________________________

Stacy Custom Homes • 51716 Trail Ridge Drive • Granger, IN 46530
574.679.9433 • fax 574.674.0865 • email us