Name

Email Address

Phone

Address

Eircode

Purpose of BER Request Purpose of BER RequestSaleRentUpdate After ExpiryNew Build (Provisional)New Build (Final)Grant Support (Technical Assessment for Heat Pump)Grant Support (Claim)Other (e.g. Owner Request)

Extension Extension Yes No

Attic Conversion Attic Conversion Yes No

Renewable Energy Sources Renewable Energy SourcesSolar Water Heating (Evacuated Tubes or Flat Plate)Solar PV (Electricity Production)Heat Pumps (Geothermal, Air to Water, Water to Water etc.)Other (Wind Turbine, Ice Stick etc.)None of the Above

Type of Dwelling Type of DwellingApartment Mid-FloorApartment Ground-FloorApartment Top-FloorMid-terrace HouseSemi-detached HouseEnd of Terrace HouseDetached HouseDuplexMaisonette

Approx Age/Year of House

Approx Floor Area

Units Unitsm2ft2

Number of Bedrooms Number of BedroomsOne BedroomTwo BedroomsThree BedroomsFour BedroomsFive BedroomsMore than five

Additional Notes