Report Form - Nordpeis N-24 round Installation & User Manual

Report form

CHECKLIST AND CONFIRMATION ON VERIFICATION OF FIREPLACE INNSTALLATION
Residence address
House owners name
Installers name
Fireplace model and manufacturer
Chimney type (e.g. brick, steel, prefabricated)
Controllers name
Qualifications
Checked by craftsman during installation:
Checkpoint
Is fireplace installed according to the manual?
Is minimum distance to firewall checked?
Is minimum distance to flammable materials checked?
Is minimum distance to ceiling checked?
Is there a non-flammable plate under and in front of fireplace?
Will the floor withstand the weight of the fireplace?
Do the chimneysweeper have access to soot hatch and smoke pipe?
Do the inset have access to enough combustive air through air vents into the room?
Is smoke inlet into chimney mounted as recommended by chimney manufacturer?
Is the chimney suited for this fireplace?
Do the chimney have an adequate gross-section area?
Are there access to product documents and installation manuals on the construction site?
Installed
..................................................
CONTROL DECLARATION
Installation is checked by the use of:
Supplemented checklist
Visual control
Video camera
Other: .......................................................................................................................................................
...................................................................................................................................................................
Installation is checked and approved:
Verified
..................................................
It is a benefit to have documentation of correct installation in existence. Have this form filled in and contain it as security for the
residence. The homeowner / landlord have an obligation to inform the local authorities on the installation of a new fireplace.
Land number
Address
Address
Energy efficiency
Address
...................................
City
...................................
City
You may also want to send a copy of this form to the local fire dept.
Title number
Postal code
Postal code
Fuel type
Cross-section
area, cm²
Postal code
..........................................................................
Date
......................................................................
Date
Phone
City
City
Number of fire-
places on same
chimney
City
Yes
Craftsman's signature
Controllers signature
No
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