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pdfAttachment A
FORM SOC-QI/SF.1
(11-2-2011)
OMB No. 0607-0110: Approval Expires 10/31/2014
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
SURVEY OF CONSTRUCTION
SINGLE-FAMILY BUILDINGS
TO BE COMPLETED BY CENSUS FIELD REPRESENTATIVE
Address or location of building
Builder/Owner
PSU
SAMPLE FORM
Project Name
Permit Month
Issued:
Building permit number
Day
Year Block Lot
BPOID
Serving post office, State, ZIP Code
RO
TO BE COMPLETED BY RESPONDENT
Month
START_DATE
Year
When did excavation start for the footings or
foundation of this house?
What primary material is being used for the framing of this
house?
EXCOMP_DATE
Month
Year
Month
COMP_DATE
Year
SALE_CATEGORY
4
Wood
Steel
Concrete/masonry other than insulated concrete forms
Insulated concrete forms OR SIP
Other – Specify
FOUNDATION
What type of foundation will this house have?
Is this house being built –
for sale or is it already sold?
for the owner by a contractor on
the owner’s land?
4
on owner’s land entirely by owner?
for rent?
5
as part of Habitat for Humanity?
3
3
5
When was this house completed or occupied?
2
1
2
When do you expect to complete this house?
1
FRAMING
1
}
Full or partial basement
Will part or all of this basement be finished?
Skip to
ASSOCIATION
2
3
DEPOSIT
4
1
Yes – Skip to BASEMENTSQFOOT
2
No – Skip to
TOTAL SQ FOOT
TOTALSQFOOT
Crawl space
Slab
Raised supports (pilings, piers, etc.)
Was a deposit taken or a sales agreement signed for this house?
5
Yes
No
This a model home
1
2
3
}
Skip to
BASEMENTSQFOOT
Month
When was a deposit taken or a sales
agreement signed?
No
ASSOCIATION
DIMENSQFOOT
Will this house be part of a community or
homeowner’s association?
Yes
1
Is the square footage based on interior or exterior dimensions?
No
2
1
DEVELOPMENT
Will this house be in a development that is age-restricted?
1
Yes
2
No
What will be the square foot area of the finished part of
the basement?
What will be the square foot area of completely finished
floor space, including finished areas of the basement
and attic?
Will this house be part of a condominium project?
2
Year
TOTALSQFOOT
CONDO
Yes
Skip to
TOTAL SQ FOOT
TOTALSQFOOT
CONDO
DEPOSIT_DATE
1
Other – Specify
}
Interior
2
Exterior
LOT_MEASUREMENT
What is the size of the individual lot
on which the house is being built?
DETACHED
Will this house be –
1
Detached?
STORIES
2
Attached?
MANUFACTURE
How many stories, not including the basement, will be
in this house?
Will this house be –
1
Modular?
3
Precut?
2
Panelized?
4
Site-built?
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FOYER
PRIMARYSOURCE
What fuel will be used most for heating this house?
Will this house have a two-story foyer?
1
Yes
No
2
How many of the following will be in this house?
5
Half Bathrooms
HALFBATHS
7
FIREPLACES
8
4
5
6
Will this house have central air conditioning?
1
In the basement
On the first floor
On the second or higher floor
In the garage or carport
4
5
No connection planned
Multiple locations
Wood or wood products
8
Stone, rock, or other stone materials
Poured concrete or concrete block
9
Other – Specify
5
6
Individual well
Other – Specify
What sewage disposal system will be used for this
house?
1
2
CONTRACT_PRICE
What is the current market value of
the improved lot?
Will this house have any of the following?
What type of financing was or will be arranged?
1
Conventional
2
FHA
VA
Cash
Other – Specify
Decks
1
Yes
2
No
Patios
1
Yes
2
No
PATIOS
4
No
PORCHES
5
2
$
FINANCING
DECKS
Yes
$
LOT_VALUE
A carport
Other off-street parking (driveway with no garage or carport)
None of the above
1
or
What is the sales price or contract
price for this house?
A garage for 1 car
A garage for 2 cars
A garage for 3 or more cars
Porches
Public sewers (including community or shared sewage/septic system)
Individual septic system
Other – Specify
SALE_PRICE
What type of parking will this house have?
4
Public water (including community or shared water supply/well)
3
PARKING
3
1
SEWAGE
Vinyl siding (including vinyl-covered aluminum)
Stucco
Brick or brick veneer
Fiber cement siding (such as Hardiplank or Hardiboard)
6
2
No
2
3
7
1
2
What water supply source will be used for this house?
Which wall material will cover most of the house
when it is completed?
3
Yes
WATER
PRIMARYWALL
2
Solar
Coal
Other – Specify
6
AIRCONDITIONING
Where will the washer and dryer connections be
located in this house?
3
4
FULLBATHS
LAUNDRY
2
Natural gas
Bottled or liquified petroleum gas (including propane)
Oil (including heating oil or kerosene)
Wood (including pellets)
Full Bathrooms
Fireplaces
1
Electricity
2
3
BEDROOMS
Bedrooms
1
3
PRIMARYSYSTEM
Which heating system will be used most in this house?
2
Heat pump, air source (including reverse-cycle AC)
3
Heat pump, ground source (geothermal)
4
Forced air furnace without heat pump
Hot water or steam (including hydronic systems)
Electric baseboard (including heat strips and wall panels)
Fireplace with insert
Solid fuel burning stove (including wood or coal stoves)
Liquid fuel burning stove
5
6
7
8
9
10
11
12
Passive solar system
No heat – Skip to
AIRCONDITIONING
Other – Specify
Please visit our website at: www.census.gov/mcd
NOTES:
PLEASE RETAIN THIS FORM FOR YOUR USE WHEN
CONTACTED BY YOUR CENSUS REPRESENTATIVE
FORM SOC-QI/SF.1 (11-2-2011)
SOC-QI/SF.1, Page 2, 100% BLACK INK
SOC-QI/SF.1, Page 2, Pantone Reflex Blue, 100% and 20% tone
File Type | application/pdf |
File Title | untitled |
File Modified | 2014-06-20 |
File Created | 2011-11-07 |