Blue Hills Community Services
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Authorization and Agreement for
Multifamily Building Energy Assessment

Please complete the online application below or download a printable version and submit it by mail to:
BHCSMO, 5008 Prospect Avenue, Kansas City, MO 64139
 
* required information
1 - Building Contact Information
First / Last Name *
Title ( Owner, Property Manager, etc ) *
>> Mailing Address
Address *
City / ST / Zip *

Phone *
Alt Phone  
Fax  
Email *
2 - Building Information
>> Building (Physical) Address
Building Name (if applicable)  
Title Holder *
Address *
City / ST / Zip *

Building Type *
  Cooperative   Homeless Shelter
  Condominium   Senior
  Rental   Other

Does your building receive any financial
assistance (such as Section 8)?
 
Yes No
What year was the building built? *
Year(s) of Major Renovation?  
3 - Rental Units

Number of Heated Floors *
Total Number of Occupants *
Number of Bathrooms (including half-baths) *
Total Number of Units *
List number of each type of unit >> *
  Studio   3 Bedroom
  1 Bedroom   4 Bedroom
  2 Bedroom Other
4 - HVAC Systems
Primary Heating Fuel *
Natural Gas Electric Other

Type of Heating System *
Central Steam Boiler
Central Forced Air
Central Hot Water Boiler
Electric Baseboards
Electric Ceiling Heat
Electric Heat Pumps
Individual Forced Air Furnace

Air Conditioning *
Central AC
Window Units
Other
None

5 - Utilities
Natural Gas *
MGE Other
Natural Gas Account Number(s).
Please enter multiple account numbers with a comma.
*
Electricity *
KCP&L Other
Electric Account Number(s).
Please enter multiple account numbers with a comma.
*
Water *
City of Kansas City Other
Water Account Number(s).
Please enter multiple account numbers with a comma.
*
6 - Utility Bills
Please indicate which party pays for which utility. It is assumed that owners pay for all common area utilities.
Living Unit Space Heat *
Tenant Owner
Hot Water *
Tenant Owner
Electricity *
Tenant Owner
Cooking Gas *
Tenant Owner Not Applicable
Do you have a 2nd unit
you would like to submit for an energy audit?
*
Yes No

Additional Comments  


Form Validation >> *
Enter this information >>
 
 

 
Blue Hills Community Services | 5008 Prospect Avenue | Kansas City, MO 64130 | 816.333.7870 Equal Housing Opportunity logo