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Show B.· 2. Connec t10ns 3. Condition 4. Do appliances have automatic shut-offs X blac k steel ----X good ----------copper -------fair--------poor X 3 yes -~- ---no Building Interior 1. 2. 3. Heating system: ___X_Air conditioning System___________________ a. Type Force air. b. Fuel Natural Gas c. Adequate d. Condition overall good______X~___ fair __________JPoor_______ e. Last maintained 1978 f. Fuel storage describe g. Furnace location h. Model Fireplaces _yes no year type of work done -------turned and minor repairs. Ba s eme n t S. side ce nt er . Serial No . N/A a. Free from cracks, breaks, openings, and other defects___yes b. Is fireplace safe Free standing stove a. Type b. Hodel No. c. Year made d. e. 4. X Coleman. yes no ---no ~ /A ------------------------------.------------------- ---------year installed----------------------Distance from floor --------inches; walls ----------inch Fire resistance material on floor yes -----------no f. Describe type of material in e. ____________________ g. Is the stove safe to use yes ----------~. -----------no Chimney a. Is it free from cracks, breaks opeining or other defects_____yes X no ---------- describe de fee ts -------------------------------- |
