HomeMy WebLinkAboutChimney Service - BLD Letters / Memos - 3/22/1996 11446
Contract#: NORTHCS101 CB
y, Certification#:2814
� ®
t1 O r` rD
BREMERTON PORT ORCHARD ® GIG HARBOR
373-3034 876-4748 851-3331
SHOWROOM: 510 DEKALB ST. SUITE D IN PORT ORCHARD
Customer t v Type of Fireplace: ❑ Pre-fab ❑ Masonry ❑ Modular
Address Nr- c'+ °,Nn l7e 11 a No. of Stories:Q2 3 4 m No. of Fireplaces: 1103 4
City Y ^, (—_ State Zip o Woodstove: ❑ Insert MFree Standing ❑ Pellet
r
Phone .'5 o"?57 2 o Flue Size (n t
Date J o22— (9 Time li
is ID COMMENTS:
CONDITION 0 CCZ
U U
cd —
y
REPORT `° � a _
Cn
(O C O
UD Z
CHIMNEY �
1. Height
S/B I.
2. Chimney Cap/Spark Arrestor FIRECLAY
FLUE
LINER '%r_Nr=R l E-V4111GE!;
3. Crown/Wash �(
C
4. Brickwork/Mortar DE
5. Flashing
6. Flue Tiles ----- CUSTOMER VERIFICATION
7. Moisture Resistance I have read this form and now and rstand which areas of my woodburning
o SMOKE system appear t be satisf c ry nd which areas,are not satisfactory.
FIREPLACE o SHELF
C7 DAMPER l Sig
ned) J 7,! l / Date'
8. Smoke Chamber D b i� �1,;Z�A�
9. Damper moo NEXT SERVICING RECOMMENDED
10. Firebox/Grate LINTEL o on
MONTH DAY YEAR
11.Ash Container FIREBRICK The fireplace and chimney should be inspected yearly for any structural faults.
12. Spark Screen/Doors ASH DUMP Sweep's or Mason's Signature 1
13.Tools/Gloves ,/�
RE�oEOg��T/ INVOICE
ap��9e®®I�rE _
14. Hearth Protection
DESCRIPTION PRICE
WOODSTOVE OR FIREPLACE INSERT
15..Stovepipe Condition (woodstove)
16. NFPAApproved Flue Connection (insert)
17. Installation/Thimble/Clearances
18. Fire Ext./Smoke Detectors/CO Alarms
19. Gas/Oil Furnace Flue Liner
SUBTOTAL
Note: This sheet is the result of a visual inspection done at the time of cleaning.It is in- 1
tended as a convenience to our customer,not as certification of fire worthiness or safety.
Since conditions of use and hidden construction defects are beyond our control,we DATE COMPLETED TOTAL
make no warranty of the safety or function of any appliance and none is to be implied. '
4