Evolve Potential Measures Survey V4 + Special Measures

• Are there any special requirements / restrictions to mention in the property?

  Yes

  No

  N/A

• Please state

• Site conducted

  Select

• First Line of Address and Postcode

• Conducted on

  Date

• Prepared by

• Job Type

  ECO

  ATP

  CONTRACTING

  OTHER

• Are there any special measure to this assessment?

  Yes

  No

Gas Works

• Does the property require GAS isolation for the commencement of works?

  Yes

  No

Cavity Wall Works

• Are there any access issues?

  Yes

  No

• Identified:

  Extension

  Conservatory

  Other

• Is the use of a Thermoscopic Lance required?

  Yes

  No

• Is internal drilling required and agreed by client?

  Yes

  No

• Is scaffolding required and being arranged by client/homeowner?

  Yes

  No

• Is "machine off" required?

  Yes

  No

• Is combustion ventilation required and agreed with the client?

  Yes

  No

Ventilation

• Is mechanical ventilation required?

  Yes

  No

• Type of fan(s) required:

  PIV

  DMEV

• Located in:

  Select Kitchen Bathroom 1 Bathroom 2 Ensuite Utility Room Other

  • Kitchen
  • Bathroom 1
  • Bathroom 2
  • Ensuite
  • Utility Room
  • Other

• Is trickle ventilation required?

  Yes

  No

  N/A

• Trickle Ventilation Required in:

  Select Living Room Dining Room Kitchen WC Office Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 UtilityRoom Bathroom 1 Bathroom 2 Ensuite Other

  • Living Room
  • Dining Room
  • Kitchen
  • WC
  • Office
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • UtilityRoom
  • Bathroom 1
  • Bathroom 2
  • Ensuite
  • Other

• Is the use of an Airbox trickle vent required?

  Yes

  No

• Located in:

  Select Living Room Dining Room Kitchen WC Office Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 UtilityRoom Bathroom 1 Bathroom 2 Ensuite Other

  • Living Room
  • Dining Room
  • Kitchen
  • WC
  • Office
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • UtilityRoom
  • Bathroom 1
  • Bathroom 2
  • Ensuite
  • Other

• Are door undercuts required?

  Yes

  No

  N/A

• Door Undercut required in

  Select Living Room Dining Room Kitchen WC Office Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 UtilityRoom Bathroom 1 Bathroom 2 Ensuite Other

  • Living Room
  • Dining Room
  • Kitchen
  • WC
  • Office
  • Bedroom 1
  • Bedroom 2
  • Bedroom 3
  • Bedroom 4
  • UtilityRoom
  • Bathroom 1
  • Bathroom 2
  • Ensuite
  • Other

Loft Works

• Is the loft clear of goods?

  Yes

  No

• Will the client be clearing goods in preparation for installation?

  Yes

  No

• Is there any boarding situated within the loft space?

  Yes

  No

• Installation method:

  Select Omit Overlay (insulation beneath flush to underside) Client Removal

  • Omit
  • Overlay (insulation beneath flush to underside)
  • Client Removal

Assessor Notes

• Please add specific notes & evidence to support your finding

Declaration & Consent

• I the Assessor can confirm that all of the special measures have been identified and listed within this report and have made the client/homeowner aware of the requirements to enable the installation take place successfully

  Sign

• I the homeowner/occupier can confirm the Assessor has made me aware of the all required Special Measures above within this form and I agree to the enabling measures for a successful installation

  Sign

• Clients Name

• Address
  Address

• County

• Clients Date of Birth

  Date

• Landline Number

• Mobile Number

• Email Address

• Is Client Main Contact?

  Yes

  No

• Main Contact Name

• Relationship

  Parent

  Son

  Daughter

  Other

• Contact Number

  Left

  Right

• Preferred Contact

  Select Landline Mobile Email Letter

  • Landline
  • Mobile
  • Email
  • Letter

CLIENT/LANDLORD DETAILS

• Name

• Contact Number

• Property Type

  Select House Bungalow Flat Maisonette Park Home Commercial

  • House
  • Bungalow
  • Flat
  • Maisonette
  • Park Home
  • Commercial

• Sub Property Type

  Detached

  Semi Detached

  End Terrace

  Mid Terrace

• Front Elevation

  Media

• Rear Elevation

  Media

• Right Elevation

  Media

• Left Elevation

  Media

• Orientation

  Left

  Right

• Front Elevation

  Media

• Rear Elevation

  Media

• Left Elevation

  Media

• Right Elevation

  Media

• Front Elevation

  Media

• Rear Elevation

  Media

• Right Elevation

  Media

• Orientation

  Left

  Right

• Front Elevation

  Media

• Rear Elevation

  Media

• Left Elevation

  Media

• Front Elevation

  Media

• Rear Elevation

  Media

• Right Elevation

  Media

• Front Elevation

  Media

• Rear Elevation

  Media

• Number of Storeys

  Select 1 2 3 4 5 5+

  • 1
  • 2
  • 3
  • 4
  • 5
  • 5+

• State number of storeys

• Number of extensions

  Select None 1 2 3 4 5

  • None
  • 1
  • 2
  • 3
  • 4
  • 5

• Number of Conservatories

  Select None 1 2 3 4 5

  • None
  • 1
  • 2
  • 3
  • 4
  • 5

• Tenure

  Private owner

  Private Rental

  Social Housing

  Other

• State tenure type

• Number Of Bedrooms

  Select 1 2 3 4 5 5+

  • 1
  • 2
  • 3
  • 4
  • 5
  • 5+

• State number of bedrooms

• Main Heating Type

  Gas

  Electric

  Oil

  Solid Fuel

  Other

• Please State Heating Type

• Appliance Type

  Select Gas Boiler Electric Storage Heaters Oil Boiler LPG Boiler Solid Fuel Boiler Electric Boiler Gas room Heaters Solid Fuel Room Heaters Electric Room Heaters Gas Fire with Back Boiler Gas Back Boiler to Radiators

  • Gas Boiler
  • Electric Storage Heaters
  • Oil Boiler
  • LPG Boiler
  • Solid Fuel Boiler
  • Electric Boiler
  • Gas room Heaters
  • Solid Fuel Room Heaters
  • Electric Room Heaters
  • Gas Fire with Back Boiler
  • Gas Back Boiler to Radiators

• Position of Flue

  Select External Internal Front Elevation Rear Elevation Side Elevation Other

  • External
  • Internal
  • Front Elevation
  • Rear Elevation
  • Side Elevation
  • Other

• Please state Location

• Photo of Gas meter

  Media

• Position of Flue

  Select External Internal Front Elevation Rear Elevation Side Elevation Other

  • External
  • Internal
  • Front Elevation
  • Rear Elevation
  • Side Elevation
  • Other

• Position of Flue

  Select External Internal Front Elevation Rear Elevation Side Elevation Other

  • External
  • Internal
  • Front Elevation
  • Rear Elevation
  • Side Elevation
  • Other

• Building Finish

  Select Exposed Brick White Magnolia Pebble Dash Other

  • Exposed Brick
  • White
  • Magnolia
  • Pebble Dash
  • Other

• Mortar Colour

  Grey

  Buff

  Red

  Brown

  Other

• Mortar Colour

• Render Finish

  Exposed Brick

  White

  Magnolia

  Pebble Dash

  Other

• Render Finish

• Mortar Colour

  Grey

  Buff

  Red

  Brown

  Other

• Structural Condition

  Safe

  At Risk

  N/A

• Photos

  Media

• External Wall Condition

  Sound

  Un-Sound

  N/A

• Photos

  Yes

  No

• Building Defects

  Yes

  No

• List Building Defects

• Photos of Defects

  Media

ACCESS

• On site Parking

• Client Instructions

• Neighbour Access Required

  Yes

  No

• Is Neighbour Aware

  Yes

  No

• Access Issues

  Yes

  No

• Please list Access Issues

• Photos Of Access Issues

  Media

• Access Equipment Required

  Select Ladders Scaffolding Conservatory Ladder Extraction Lance Installation Lance Other

  • Ladders
  • Scaffolding
  • Conservatory Ladder
  • Extraction Lance
  • Installation Lance
  • Other

• Please State Additional Equipment

• Image of basic Floor Plan

  Media

• Survey Type

  Select Cavity Loft Ventilation Party Wall Underfloor External Wall Insulation Extraction Damp Air Source Heat Pump Solar PV HHRSH Other

  • Cavity
  • Loft
  • Ventilation
  • Party Wall
  • Underfloor
  • External Wall Insulation
  • Extraction
  • Damp
  • Air Source Heat Pump
  • Solar PV
  • HHRSH
  • Other

EXTRACTION

• Reason for Extraction

  Select Low Density fill resulting in voids creating cold spots Building debris evidenced Building defects resulting in contaminated insulation Water penetration Other

  • Low Density fill resulting in voids creating cold spots
  • Building debris evidenced
  • Building defects resulting in contaminated insulation
  • Water penetration
  • Other

• Additional Reason

• Boroscope Evidence

  Media

• Total Area to be Extracted

• Has Client been advised on extent of Drilling and extraction points?

  Yes

  No

  N/A

• Are all potential ingress points been sealed internally?

  Yes

  No

  N/A

• Recommended cavity drying Time

  1 Week

  2 Weeks

  N/A

  Other

• If other please state

• Material being Extracted

  Select White Fibre Yellow Fibre Rockwool Bead Foam Building Debris

  • White Fibre
  • Yellow Fibre
  • Rockwool
  • Bead
  • Foam
  • Building Debris

FOAM EXTRACTION

• Cavity Vents, Underfloor Vents, Bedroom Vents & Combustion Vents

• Have all vents been Identified?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Reason vents have not been identified

• Have all Internal vents been Identified?

  Yes

  No

  N/A

• Please select rooms where vents to be sealed internally

  Select Living Room Dining Room Kitchen Bathroom Bedrooms Other

  • Living Room
  • Dining Room
  • Kitchen
  • Bathroom
  • Bedrooms
  • Other

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Additional Room

• Photo

  Media

• Reason vents have not been identified

• Has Main Heating appliance been Identified?

  Yes

  No

  N/A

• Has main heating have a Flue?

  Yes

  No

• Is flue directed through an External wall?

  Yes

  No

• Photo of Appliance

  Media

• Photo of Flue

  Media

• Position of Flue

• Photo of Flue

  Media

• Reason for Main Heating not being Identified

• Have all windows throughout the property been checked for possible areas of ingress?

  Yes

  No

  N/A

• Please select rooms for possible areas of Ingress around Windows

  Select Living Room Dining Room Kitchen Bathroom Bedrooms Other

  • Living Room
  • Dining Room
  • Kitchen
  • Bathroom
  • Bedrooms
  • Other

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Additional Rooms

• Photo

  Media

• Reason for checks not carried out?

• Have all Internal leaf walls been checked for hairline cracks and defects?

  Yes

  No

  N/A

• Please select rooms where defects have been detected

  Select Living Room Dining Room Kitchen Bathroom Bedrooms Other

  • Living Room
  • Dining Room
  • Kitchen
  • Bathroom
  • Bedrooms
  • Other

• Living Room Photo

  Media

• Dining Room Photo

  Media

• Kitchen Photo

  Media

• Bathroom Photo

  Media

• Bedroom Photo

  Media

• Additional Rooms

• Additional Photo

  Media

• Reason checks have not been completed

• Have all areas behind appliances on external walls been checks for possible areas of Ingress?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Photos behind appliances

  Media

• Reasons for checks not completed

• Are there any Built-In wardrobes on external walls?

  Yes

  No

• Photo of Built-In wardrobes

  Media

• Has the client been made aware of the requirement for technicians to complete internal checks and to seal up the property before extraction works can commence?

  Yes

  No

• Has the client been made aware of the potential issues that may arise from extracting foam Insulation including the potential risk of dust ingress?

  Yes

  No

• I have assessed the overall condition of the property ensuring its suitability for extraction. Whilst every possible precaution is taken to seal up prior to any extraction works commencing, it is not possible to ensure that dust and debris will not ingress into your property where previous trades have completed works on your property. Unless listed below, there are no additional significant hazards observed that are not addressed in the generic risk assessment for the works to be undertaken.

  None

  See Below

• Additional

• Assessors Signature

  Sign

• Clients Signature

  Sign

CAVITY WALL

• Scheme

  HHCRO

  FLEX

  ATP

  OTHER

• State type of scheme

• Total sqm to be Insulated

• % of Property to be Installed

• Required Material

  Climabead Carbon

  Climabead White

  Supafil

  Rockwool

  Other

• If other please state

• Average Cavity Width

  Select 40mm 45mm 50mm 55mm 60mm 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 100mm+

  • 40mm
  • 45mm
  • 50mm
  • 55mm
  • 60mm
  • 65mm
  • 70mm
  • 75mm
  • 80mm
  • 85mm
  • 90mm
  • 95mm
  • 100mm
  • 100mm+

• Please state correct average Cavity width

• Please select elevations to be installed

  Select Front Rear Left Right Extension

  • Front
  • Rear
  • Left
  • Right
  • Extension

• Front Boroscope Photo

  Media

• Front DPC Photo

  Media

• Cavity Depth Photo

  Media

• Rear Boroscope Photo

  Media

• Rear DPC Photo

  Media

• Left Boroscope Photo

  Media

• Left DPC Photo

  Media

• Right Boroscope Photo

  Media

• Right DPC Photo

  Media

• Extension Boroscope Photo

  Media

• Extension DPC Photo

  Media

• Floor Type

  Solid

  Suspended

  Other

• State floor Type

• Combustion vent Required?

  Yes

  No

• Photo of Appliance requiring Combustion vent

  Media

• Cavity Brush Required?

  Yes

  No

• Number of Cavity Brushes Required

  Select 1 2 3 4 5 5+

  • 1
  • 2
  • 3
  • 4
  • 5
  • 5+

• Adjoining properties insulated?

  Yes

  No

  N/A

• Reason Brushes not required

• Location of Chimneys

  Select Internal External Front Elevation Rear Elevation Side Elevation None

  • Internal
  • External
  • Front Elevation
  • Rear Elevation
  • Side Elevation
  • None

• Location of Flue

  Select Internal External Front Elevation Rear Elevation Side Elevation None

  • Internal
  • External
  • Front Elevation
  • Rear Elevation
  • Side Elevation
  • None

• Additional Notes

• Additional Photos

  Media

OTHER WORKS

• Please State Type of Works

• Details of required works

• Additional Information

• Photos

  Media

LOFT INSULATION

• Scheme

  HHCRO

  FLEX

  ATP

  OTHER

• State type of scheme

• Total Area to be Insulated

• Photo of Loft Hatch

  Media

• Photo of Loft space

  Media

• Existing Insulation

  Yes

  No

  N/A

• Existing Depth

• Ofgem Loft Doc Required

  Yes

  No

• Photo of Loft Doc Close up

  Media

• Photo of Loft Doc in Situ

  Media

• Photo of existing depth

  Media

• Depth to be Added

• Photo of Loft

  Media

• Depth to be Installed

• What is the width of the joist?

  400mm

  600mm

  Other

• What is the width?

• Down-lights present?

  Yes

  No

• Select Rooms Down-Lights Present

  Select Living Room Dining Room Kitchen Bathroom Bedrooms Other

  • Living Room
  • Dining Room
  • Kitchen
  • Bathroom
  • Bedrooms
  • Other

• Additional room

• Total number of Down-Lights

• Any water tanks need insulating?

  Yes

  No

  N/A

• Large Tank

  Select None 1 2 3 4 5

  • None
  • 1
  • 2
  • 3
  • 4
  • 5

• Medium Tank

  Select None 1 2 3 4 5

  • None
  • 1
  • 2
  • 3
  • 4
  • 5

• Small Tank

  Select None 1 2 3 4 5

  • None
  • 1
  • 2
  • 3
  • 4
  • 5

• Photo of tanks

  Media

• Any Pipework require Lagging?

  Yes

  No

  N/A

• Please state meters of pipework

• High Amp electrical cables present? (e:g; Power Shower, Cooker)

  Yes

  No

• Photo of appliance

  Media

• Photo of Power Switch

  Media

• Loft Hatch needing D/P

  Yes

  No

  N/A

• Relay Required?

  Yes

  No

• Relay Sqm

  Yes

  No

• Areas to be omitted

  Yes

  No

• Total area to be omitted

• Loft Vents required

  Yes

  No

  N/A

• Walkway required

  Yes

  No

  N/A

• Mtrs Required

• Loft Clearance

  Yes

  No

• Additional Notes

• Additional Photos

  Media

DAMP INSPECTION

• Select Damp Issue

  Select Condensation Penetrating Damp Rising Damp Water Penetration Leaking Plumbing Other

  • Condensation
  • Penetrating Damp
  • Rising Damp
  • Water Penetration
  • Leaking Plumbing
  • Other

• State Damp Issue

• Rooms Affected

  Select Living Room Dining Room Kitchen Bathroom Bedrooms Other

  • Living Room
  • Dining Room
  • Kitchen
  • Bathroom
  • Bedrooms
  • Other

• Photos of Internal Issues

  Media

• Select rooms with issues

  Select Living Room Dining Room Kitchen Bathroom Bedrooms Other

  • Living Room
  • Dining Room
  • Kitchen
  • Bathroom
  • Bedrooms
  • Other

• Photos of Internal Issues

  Media

• Has the property adequate ventilation

  Yes

  No

  N/A

• Is there an obvious cause?

  Yes

  No

  N/A

• Details

• Evidence

  Media

• Is the property in a good state of repair?

  Yes

  No

  N/A

• Listed all Defects

• Description of Issue

• Conclusion

• Actions

• Additional Information

• Additional Photos

  Media

• Have Both Parties agreed to the measure?

  Yes

  No

  N/A

• Is the Party Wall suitable to receive insulation?

  Yes

  No

• Area to be installed m2?

• Photo of Front elevation

  Media

• Photo of DPC Front

  Media

• Photo of Rear elevation

  Media

• Photo of DPC Rear

  Media

• Is there anything obstructing direct access to the Party Wall area?

  Yes

  No

• Any access issues that may require internal drill and fill of Party Wall?

  Yes

  No

• Photos of obstructions

  Media

• Has previously installed CWI migrated in to the Party Wall Void?

  Yes

  No

• Approximately how far has the Insulation migrated down the party wall void?

  1m

  2m

  3m

  4m

  5m

• Approximately how high up the void has the insulation risen?

  1m

  2m

  3m

  4m

  5m

• Photos of material migration in to party wall void

  Media

• Are there any openings in the internal gable walls?

  Yes

  No

• Photos of openings

  Media

• Photos of both internal gable walls!

  Media

• Step 1: Internally measure from internal party wall to window/door reveal on both properties (A + B)
  Step 2: Externally measure from window/door wall edge to window/door wall edge on both properties measurement (C) minus A + B = measurement (D)
  Step 3: Deduct Plaster (12mm) or Plaster & Batten (37mm) and finally Brick/Block (100mm) from measurement (D) = Cavity width (E)
  Step 4: Chalk mark the cavity width on wall this will identify the centre of the cavity ready for cavity inspection.

• Party Wall Width ? ( Minimum of 40mm)

• Photo of Measurement

  Media

• Photo of Party Wall Condition

  Media

• What is the finish on the internal walls?

  Plastered

  Dot & Dab

  Other

• Photo of Internal walls

  Yes

  No

• If finish is Dot & Dab, is there a Parge coat present to a minimum of 8mm?

  Yes

  No

• Photo of Parge coat ( Identifiable within loft)

  Media

• State wall finish

• Are there any internal chimneys/flues present within the PW?

  Yes

  No

• Photo of Flue/Chimney on internal Party Wall

  Media

• If so distance from front & rear injection point?

  1m

  2m

  3m

  4m

  5m

• Spillage test required?

  Yes

  No

• Additional Comments

• Additional Photos

  Media

• Yes

  No

Basic Checks

• Pre Appointment Made With Occupant

  Yes

  No

  N/A

• Surveyor As Identification and Appropriate PPE

  Yes

  No

  N/A

• Surveyor up to Date COVID-19 Guidelines Instructions

  Yes

  No

  N/A

• Ask Housing Association, Local Authority, Principle Contractor Representative to Action

  Yes

  No

  N/A

Property Information

• Property Dimensions

  Media

• Access Around Property

  Good

  Fair

  Bad

• Do Any Of The Surrounding Landscape Features Impact On The Installation

  Yes

  No

  N/A

• Are There Any Delivery Restrictions?

  Yes

  No

  N/A

• Are There Any Scaffolding Access Issues?

  Yes

  No

  N/A

• Is There Space For Skips (If Required)

  Yes

  No

  N/A

Basic EWI Information

• System Used

  Soltherm

  Wetherby

  SPS Envirowall

  TBC

• New Top Coat Finish Specification

  Select Silicon Dash Brick Slip Brick Slip Detailing Winter Grade Gramamin Other

  • Silicon
  • Dash
  • Brick Slip
  • Brick Slip Detailing
  • Winter Grade Gramamin
  • Other

• Current External Finish Condition

  Good

  Fair

  Poor

  N/A

• Property Architype

  Traditional

  Non-Traditional

• Non-Traditional Description

  Select BISF Arcal Wimpey No Fines Cornish Airey TBC

  • BISF
  • Arcal
  • Wimpey No Fines
  • Cornish
  • Airey
  • TBC

• Additonal Notes (If Required)

• Additional Photos (If Required)

  Media

• Weather Conditions (At point of survey)

• Temperature

Construction Details Key

• Standard details refer to Standard Drawings

• Non standard details;- Detail will be designed & issued

• Installation notes:- needs to be discussed with site manager

• Installation team prior to work commencing

• Standard detail for Project Ref

Property Checks

• Plinths - Standard Details - Please add the m2 of the plinth area. (Depth/base rail)

• Cills - Standard Details

• Reveals - Standard Details

• Heads/ Lintels - Standard Details

• Facia/ Soffit - Standard Details

• Verge/ Eaves - Standard Details

• Window Surrounds - Standard Details

• Party Wall - Standard Details

• Party Wall Agreement in Place

  Yes

  No

  N/A

• Outbuildings E.G. Conservatories, Greenhouses - Are There Any Outbuildings?

  Yes

  No

  N/A

• Do the Outbuildings Affect The Install?

  Yes

  No

• Canopy - is there a Canopy?

  Yes

  No

• Canopy Type

  GRP

  Concrete

  Timber & Tile

  Other

• Is This Canopy Being Removed or Replaced

• Rainwater Goods - Standard Details

• Existing Rainwater Goods Type

  UPVC -Plastic

  Metal

  Asbestos

  Other

• Are Rainwater Goods Being Replaced

  Yes

  No

  N/A

• What Specification Is The New Rainwater Goods

  UPVC -Plastic

  Metal

  Asbestos

  Other

• Soil And Waste - Standard Details

• Existing Soil And Waste Type

  UPVC -Plastic

  Metal

  Asbestos

  Other

• Are the Soil Vent Pipe Being Replaced?

  Yes

  No

  N/A

• What Specification Is The New SVP?

  UPVC - Plastic

  Other

• Vents - Standard Details

• Locations of All Vents/ Extractor Fans

  Select Kitchen Bathroom En-Suite W/C Utility Other

  • Kitchen
  • Bathroom
  • En-Suite
  • W/C
  • Utility
  • Other

• Window Trickle Vents Present

  Yes

  No

  N/A

• Overflows - Standard Details

• Any Alterations Required?

  Yes

  No

• Boiler Flues - Standard Details

• Do Boiler Flues Need Alterations?

  Yes

  No

• Boiler Condensation Expansion Pipes - Standard Details

• Do Expansion Pipes Require Extension?

  Yes

  No

• Communication Installations E.G. Satellites/ TV Aerials

• Do any Communications Installations need taking off & refitting

  Yes

  No

• Greenery - Does It Require Trimming Back?

  Yes

  No

  N/A

• Gates, Fences and Walls - Do The Gates, Fences or Walls Require Alterations

  Yes

  No

  N/A

• External Electrical Equipment - Does It Need Alterations?

  Yes

  No

  N/A

• Residential Fixtures and Fittings - Does It Need Alterations?

  Yes

  No

  N/A

• Gas and Electrical Utility Fixtures - Does It Need Alterations?

  Yes

  No

  N/A

Measurements

• Property Dimensions

  Media

• Solid Wall m² (Solid Measure Including Windows)

• Linear Meterage of Window & Door Heads, Reveals and Cills

• Total m² of External Window and Door Apertures

• Total m² Silicon Finish To Windows & Doors (Window Reveal)

• Base Rail Length (Metres)

• Base Track Nosing

• Mid Cast Bead

• Number of External Quoins On Property

• Cills Length (Metres)

• Party Wall Length (Metres)

• Expansion Joint (Metres) (If Semi and Both Properties Being Installed)

• System Stop End (Metres) (If Semi and Both Properties Being Installed)

• Verge Trim (If Applicable)

Enabling Works

• Downpipe Enable Length (Metres)

• Does a Water Tap Need To Be Removed?

  Yes

  No

  N/A

• Number of Taps

  Select 1 2 3 4 5 5+

  • 1
  • 2
  • 3
  • 4
  • 5
  • 5+

• Any Extractor Alterations?

  Yes

  No

  N/A

• Any Gas Pipe Alterations?

  Yes

  No

  N/A

• Gas Pipe Alternations Length (Metres)

• No. Of Satellite Dishes

• No. Of TV Aerials

• No. Of External Lights

• SVP Enabling

• SVP Alterations of Drains Required?

• No. Of OFF Set Bends

• No. Of Over Flows

• Length? (Metres)

• No. Of Over Flow Bends

• Meter Box Alterations Required?

  Yes

  No

  N/A

• PAS 2035 Design Achievable?

  Yes

  No

  N/A

• Replacement Required?

  Yes

  No

  N/A

• Are There Clothe Line Alterations Required?

  Yes

  No

  N/A

• Fence Post Alterations Required?

  Yes

  No

  N/A

• Can We Reuse Fence?

  Yes

  No

• No. Of New Fence Post Needed

• No. Of New Fence Panels Needed

• No. Of New Gates Needed

• Re - Instating

  Yes

  No

• Can We Refit Existing DP

  Yes

  No

• Length of New DP Needed

• No. of DP Brackets Needed

• No. of DP Swan Necks Needed

• No. of DP Toe Needed

• Do We Need To Fit Gas Extractor Vents

  Yes

  No

  N/A

• Re - Instating Others

• Clip Wires Needed?

  Yes

  No

  N/A

• How Many?

Additional Information and Evidence

• Brick Slip / Brick Render Soldier Courses

  Yes

  No

  N/A

• Photographs Non-Detail of Required

  Media

• Additional Photographs

  Media

• Any Additional Notes

• Fans Required?

  Select Yes No

  • Yes
  • No

• Which rooms?

  Select BATHROOM 1 BATHROOM 2 KITCHEN W/C UTLILITY OTHER ROOMS

  • BATHROOM 1
  • BATHROOM 2
  • KITCHEN
  • W/C
  • UTLILITY
  • OTHER ROOMS

• Types of Fan required?

  Select IEV DMEV PIV

  • IEV
  • DMEV
  • PIV

• Trickle Vent Required?

  Yes

  No

• Can all Trickle be completed?

  Yes

  No

• How many required?

• Which Rooms?

  Select LIVING ROOM KITCHEN BEDROOM 1 BEDROOM 2 BEDROOM 3 BEDROOM 4 BATHROOM 1 BATHROOM 2 OFFICE OTHER ROOMS

  • LIVING ROOM
  • KITCHEN
  • BEDROOM 1
  • BEDROOM 2
  • BEDROOM 3
  • BEDROOM 4
  • BATHROOM 1
  • BATHROOM 2
  • OFFICE
  • OTHER ROOMS

• Colour of vents (External)

• Colour of vents (Internal)

• Details of Why Trickle Vents can't be completed?

• Will an air permeability test be required?

  Yes

  No

• Customer signature to say that all fan options explained to them and they are happy for the works to go ahead

  Sign

• Total SQM being Installed

• Access to Sub-Floor Area

  Media

• Floor Plan of Sub-Floor Area

  Media

• Percentage of Floor Area to be Installed

• State other floor type

• Picture of other floor type

  Media

• Is there any Sub-Floor Ventilation Present?

  Yes

  No

  N/A

• Picture of Sub Floor Ventilation

  Media

• Is there any pre-existing damage to the areas that will be accessed by the installation operatives?

  Yes

  No

  N/A

• Please state

• Photo of Exsiting Damage

  Media

• Are there any asbestos containing materials present?

  Yes

  No

  N/A

• Please State

• Picture of Asbestos containing material

  Media

• Is there evidence of Rodents or Pests in Floor area? EG: Timbers or General Sub-Floor Area

  Yes

  No

  N/A

• Please State

• Picture of evidence of rodents/ pests

  Media

• Is the Electrical wiring is free from visible defects, e.g. damaged cables, trailing cables, exposed conductors;

  Yes

  No

  N/A

• Please State

• Photo of Faulty Electrical Wiring

  Media

• Are there any signs of Water Penetration or Water Accumulation in the underfloor area? EG: Externally or Pipework

  Yes

  No

  N/A

• Please State

• Picture of Water Penetration

  Media

• Will the proposed installation:

• Be non-compliant with any requirements stated by the designer/specifier;

  Yes

  No

  N/A

• Compromise the functionality of existing air supply/extract ventilation ducts/systems;

  Yes

  No

  N/A

• Result in the unsafe operation of a combustion appliance - (Floor, vents, etc.);

  Yes

  No

  N/A

• General

• Is there any potential for moisture build up as a result of the installation?

  Yes

  No

  N/A

• Will the functionality and/or safety of installed services (gas, electricity, water, telecommunications etc.) be affected in any way as a result of the installation?

  Yes

  No

  N/A

• Is there any potential risk in relation to the ongoing performance of installed services? (If YES liaison with measure specifiers and/or service providers will need to take place).

  Yes

  No

  N/A

• From the findings of this building inspection, is the installation able to be carried out in line with the full Design Specification?

  Yes

  No

  N/A

• From the findings of this building inspection, is the Method Statement suitable and complete?

  Yes

  No

  N/A

• Is there any evidence that any form of protected species would be disturbed by the installation process?

  Yes

  No

  N/A

• Does the customer understand the nature and extent of the work?

  Yes

  No

  N/A

• Have they been made aware of any disruption that may be caused (for example rubbish disposal and the siting of skips)

  Yes

  No

  N/A

• Does the customer have any particular requests or requirements?

  Yes

  No

  N/A

• Customer Request

• By signing the below you agree to the following statements:
  
  • We have explained and you are aware of the nature and extent of the installation and this meets your expectations
  • The Arrangements we have made for site access and installation materials storage are adequate and appropriate for the installation to be undertaken.
  

• Customer Signature

  Sign

Planning

• Is the property listed or in a conservation area:

  Yes

  No

• Are there any other planning issues to be considered

  Yes

  No

• List detail of issues to be considered:

• Is the current roof lining under an active warranty?

  Yes

  No

• Provide details of warranty:

• Will any form of protected species be disturbed by the installation process?

  Yes

  No

• Provide details

• New Build or Retro-fit:

  New Build

  Retro-fit

Current Electrical Installation

• Location of electric meter:

• Type of electric meter

  Analogue

  Digital

• Image of electric meter

  Media

• Location of electric distribution board

• Make of electric distribution board

• Are there any spare breakers:

  Yes

  No

• Is there a form of isolation:

  Yes

  No

• General condition of the electrical installation:

  Good

  Fair

  Poor

• Image of electric distribution board

  Media

• Is main earthing and bonding in place?

  Yes

  No

• On or Off grid?

  On

  Off

• DNO

  Select Western Power Scottish and southern electricity UK power networks SP energy networks

  • Western Power
  • Scottish and southern electricity
  • UK power networks
  • SP energy networks

• Electric supplier:

• Cost of electricity per kwh:

• Image of electricity bill

  Media

Building Assessment

External

• General condition of roof:

  Good

  Fair

  Poor

  N/A

• Roof covering:

  Tiles

  Slate

  Flat

  Thatch

• Is the property in an exposed location:

  Yes

  No

• Any overhanging power cables:

  Yes

  No

• Width of building (m)

• Depth of building (m)

• Height to guttering (m)

• Height to ridge (m)

Internal

• Is there a loft present

  Yes

  No

  Loft conversion/room in roof

• Is loft accessible

  Yes

  No

• Distance from ceiling to ridge (m)

• Condition of Internal Rafters

  Good

  Fair

  Poor

  N/A

• Spacing between Rafters

• Please provide Pictures of internal Rafters

  Media

• Pitch of Roof (deg)

• Image of loft

  Media

• Image of loft 2

  Media

Property Orientation

• Orientation of front elevation

  North

  East

  West

  South

• Image of compass providing exact orientation

  Media

• Image of front elevation

  Media

• Orientation of South Elevation

  North

  East

  West

  South

• Image of compass providing exact orientation

  Media

• Image of rear elevation

  Media

• Orientation of left elevation

  North

  East

  West

  South

• Image of compass providing exact orientation

  Media

• Image of left elevation

  Media

• Orientation of right elevation

  North

  East

  West

  South

• Image of compass providing exact orientation

  Media

• Image of right elevation

  Media

Proposed PV Installation

Roof

• Roof elevation where panels will be fitted:

  Front elevation

  Rear elevation

  Left elevation

  Right elevation

• Area of roof available (m2):

• Any roof vents, flues or soil stacks present:

  Yes

  No

• Any shading concerns:

  Yes

  No

• Any future shading concerns:

  Yes

  No

• Is there a chimney present:

  Yes

  No

• Is there a Velux window:

  Yes

  No

PV Panels

• System Output (Number of Panels)

• Design and Layout of Panels

  Portrait

  Landscape

  Combination of Both

• Sketch of proposed Design

  Media

• Has the above sketch been discussed with the customer

  Yes

  No

  N/A

Inverter and DC Isolation

• Proposed location of inverter:

• If timber-frame required for inverter - attic installation

• Location of DC isolation:

• Description of cable route from PV panels to DC isolation

AC isolation and Generation Meter

• Location of AC isolation

• Location of Generation Meter

• Description of cable run from Inverter to AC isolation

Summary

• Is there a suitable location for the Inverter:

  Yes

  No

• Can electric cables be run from panels to inverter:

  Yes

  No

• Is there a suitable location for the generation meter - close to the electrical distribution board:

  Yes

  No

• Can electric cables be run from the inverter to the generation meter:

  Yes

  No

• Is there a spare breaker breaker in the electrical distribution board:

  Yes

  No

• Is there suitable isolation:

  Yes

  No

Scaffolding

• Is a scaffolding permit required

  Yes

  No

• Is there appropriate access for scaffolding?

  Yes

  No

• Can scaffolding be erected safely?

  Yes

  No

Electrical Supply

• Is property served by Economy 7?

  Yes

  No

  N/A

• Location of electric meter:

• Type of Meter:

  Analogue

  Digital

  Smart

• Image of electric meter:

  Media

• Image of Economy 7 meter if in separate location:

  Media

• Location of electrical display board:

• Are there any spare breakers:

  Yes

  No

• Is there a form of isolation:

  Yes

  No

• Image of electrical display board:

  Media

• Image of customers electricity bill:

  Media
Existing Electric Storage Heaters

• Location

• Number of existing Storage Heaters in the room

  1

  2

• Type of ESH1:

• Image of ESH1:

  Media

• Close up of Serial number / Data badge

  Media

• Image of fused spur for ESH1:

  Media

• Location of closest permanent power supply to ESH1:

• Distance from closest permanent power supply to ESH1:

• Image of closest permanent power supply to ESH1:

  Media

• Type of ESH1:

• Image of ESH1:

  Media

• Close up of Serial number / Data badge

  Media

• Image of fused spur for ESH1:

  Media

• Location of closest permanent power supply to ESH1:

• Distance from closest permanent power supply to ESH1:

• Image of closest permanent power supply to ESH1:

  Media

• Type of ESH2:

• Image of ESH2:

  Media

• Image of fused spur for ESH2:

  Media

• Location of closest permanent power supply to ESH2:

• Distance from closest permanent power supply to ESH2:

• Image of closest permanent power supply to ESH2:

  Media

• Screenshot of Dimplex Room Calc showing room dimensions and Total Input Rating (KW)

  Media

• Full Image of room from each angle

  Media

• Recommended Quantum Heater Size

  QM050

  QM070

  QM100

  QM125

  QM150
Habitable room without existing electric storage heater

• Location

• Picture of Room from each angle

  Media

• Screenshot of Dimplex Room Calc showing room dimensions and Total Input Rating (KW)

  Media

• Be aware, in order to comply with Heat Loss Regulations, we will need a max of 1400cm

• Proposed location of Storage heater

  Media

• Recommended Quantum Heater Size

  QM050

  QM070

  QM100

  QM125

  QM150

Details of Required Ventilation

• Picture of Fuseboard

  Media
Extractor Fans Required

• Location of Required Fan?

  Select BATHROOM 1 BATHROOM 2 KITCHEN W/C UTLILITY OTHER ROOMS

  • BATHROOM 1
  • BATHROOM 2
  • KITCHEN
  • W/C
  • UTLILITY
  • OTHER ROOMS

• Pictures of entire room from each angle

  Media

• Close up of internal wall where fan is intended to be installed

  Media

• Picture of external wall where fan is intended to be installed

  Media

• Example of Fan Illustration

  

• Illustration on wall of fan position (example above)

  Media

• Picture of electric outlet near the fan install location, EG: Plugs/Lights/Switches

  Media

• Will the Fan require Trucking? If so please advise the customer that this may be a requirement

  Yes

  No

• Where is the fan intended to leave the property?

  WALL

  CEILING

• Wall Width?

• Wall Construction?

• Picture of Soffit

  Media

• Roof Material

  TILE

  SLATE

  ROSEMARY

  OTHER

• State roof material

• What is the other room

PIV Unit Required

• Is PIV Unit Required?

  Yes

  No

• Picture of Loft Space from each angle

  Media

• Picture of Internal Hallway

  Media

• Floor plan of intended location of PIV unit, including doors

  Media

• Make sure Trickle vent section is filled out

Trickle Vents Required

• Location of Trickle Vent

  Select LIVING ROOM KITCHEN BEDROOM 1 BEDROOM 2 BEDROOM 3 BEDROOM 4 BATHROOM 1 BATHROOM 2 OFFICE OTHER ROOMS

  • LIVING ROOM
  • KITCHEN
  • BEDROOM 1
  • BEDROOM 2
  • BEDROOM 3
  • BEDROOM 4
  • BATHROOM 1
  • BATHROOM 2
  • OFFICE
  • OTHER ROOMS

• Window Material

• Internal Picture of Window

  Media

• External Picture of Window

  Media

• Undertake Pas 2035

• Type of Works

  Select Cavity Wall Loft

  • Cavity Wall
  • Loft

• PAS 2035 CAVITY WALL

• Will the CWI Installation Work Result in Non-compliance with Building Regulations? e.g. Workmanship, Materials

  Yes

  No

• Will the CWI Work Result in Unsafe Operation of a Combustion Appliance? e.g. Flue

  Yes

  No

• Will the CWI Insulation Work Result in Compromise to the Functionality of Existing Ventilation Ducts/ Systems?

  Yes

  No

• Will the CWI Insulation Work Result in Compromise to the Functionality and/or Safety of Existing Services?

  Yes

  No

• Will the CWI Insulation Work Result in Installation that is Non-Compliant Material Supplier Requirement?

  Yes

  No

• Have relevant checks been undertaken to determine if asbestos containing materials are present?

  Yes

  No

• Type & Condition of Building Structure Suitable for Works to Commence

  Yes

  No

• Property Drilled to Establish Clear Cavity Width

  Yes

  No

• All Areas not to be Insulated are Agreed with Customer?

  Yes

  No

• Any Areas to be Insulated via the Internal Leaf Agreed with Customer?

  Yes

  No

• Scaffold Supplied by Customer?

  Yes

  No

  N/A

• What is the Extent of the Cavity to be Filled?

• Will the Site layout or conditions impair the execution of the works?

  Yes

  No

• Is there any potential for moisture build up as a result of the insulation?

  Yes

  No

• Will the Functionality and/or safety of insulation services (Gas, Electricity, Water, Telecommunications etc.) be Affected in any way as a result of the Installation?

  Yes

  No

• Is there any Potential Risk in Relation to the Ongoing Performance of Installed Services?

  Yes

  No

• From the Findings of this Survey, Is the Installation able to be Carried out in Line with the Full Design Specification?

  Yes

  No

• From the Findings of this Survey, is the Method Statement suitable and Complete?

  Yes

  No

• Is there any Evidence that any Form of Protected Species would be Disturbed by the Installation Process?

  Yes

  No

• Does the Customer understand the Nature and Extent of the Works?

  Yes

  No

• Have they been made Aware of any Disruption that may be Caused? (e.g. Rubbish Disposal and the Siting of Skips)

  Yes

  No

• Does the Customer have any Particular Requests or Requirements?

  Yes

  No

• Are the Arrangements for Site Access and the Storage of Installation Materials adequate and Appropriate?

  Yes

  No

• Is there any other Information which would help ensure the smooth running of the Installation process?

  Yes

  No

• PAS 2035 LOFT INSULATION

• Is there any Pre-existing Damage to the Areas that will be Accessed by the Installation Operatives?

  Yes

  No

• Is the Condition of the Roof Space suitable for the Works in relation to the existence of appropriate Roof Space Ventilation arrangements?

  Yes

  No

• Is the Condition of the Roof Space suitable for the Works to Commence in relation to the Timbers being free from Rot and/or Infestation?

  Yes

  No

• Is the Condition of the Roof Space suitable for the Works to Commence in relation to the Condition of the Ceilings?

  Yes

  No

• Is the Condition of the Roof Space suitable for the Works to Commence in relation to Metal Structural roof members being Free from Visible signs of Corrosion?

  Yes

  No

• Is the Condition of the Roof Space suitable for the Works to Commence in relation to Electrical wiring being free from Visible defects? (e.g. Damaged Cables, Trailing Cables, Exposed Conductors)

  Yes

  No

• No Visible signs of Water Penetration

  Yes

  No

• No Visible signs of Leakage from Water System components? (e.g. Pipework, Cisterns, Tanks etc.)

  Yes

  No

• Following Investigation, will the proposed Installation be Non-compliant with any requirements stated by the Designer/ Specifier?

  Yes

  No

• Following Investigation, will the proposed Installation compromise the Functionality of Existing air supply/ Extract ventilation ducts/systems?

  Yes

  No

• Following Investigation, will the proposed Installation result in Unsafe operation of a Combustion Appliance?

  Yes

  No

• Following Investigation, will the proposed Installation Work Result in Non-compliance with Building Regulations? e.g. Workmanship, Materials, Fire Safety, Resistance to Moisture?

  Yes

  No

• Will the Site Layout or Conditions impair the Execution of the works in relation to appropriate access to the property and to the roof space?

  Yes

  No

• Will the Site Layout or Conditions impair the Execution of the works in relation to the roof space being free from Stored items, Boarding etc.?

  Yes

  No

• What is the Extent of the Area and Elements to be Insulated?

• Is there any potential for moisture build up as a result of the insulation?

  Yes

  No

• Will the Functionality and/or safety of insulation services (Gas, Electricity, Water, Telecommunications etc.) be Affected in any way as a result of the Installation?

  Yes

  No

• Is there any Potential Risk in Relation to the Ongoing Performance of Installed Services?

  Yes

  No

• From the Findings of this Survey, Is the Installation able to be Carried out in Line with the Full Design Specification?

  Yes

  No

• From the Findings of this Survey, is the Method Statement suitable and Complete?

  Yes

  No

• Is there any Evidence that any Form of Protected Species would be Disturbed by the Installation Process?

  Yes

  No

• Is the Condition of the Roof Space suitable for the Works to commence in relation the under floor area being free from Rodents/ Pests?

  Yes

  No

• Does the Customer understand the Nature and Extent of the Works?

  Yes

  No

• Have they been made Aware of any Disruption that may be Caused? (e.g. Rubbish Disposal and the Siting of Skips)

  Yes

  No

• Does the Customer have any Particular Requests or Requirements?

  Yes

  No

• Are the Arrangements for Site Access and the Storage of Installation Materials adequate and Appropriate?

  Yes

  No

• Is there any other Information which would help ensure the smooth running of the Installation process?

  Yes

  No

• Undertake Risk Assessment

• Type of Works

  Select Cavity Wall Loft

  • Cavity Wall
  • Loft

• Cavity Wall Insulation Risk Assessment Questions

• Overhead Electricity Cables Present?

  Yes

  No

• Does the Property have a Garage?

  Yes

  No

• Does the Property have a Porch?

  Yes

  No

• Does the Property have an Outside Tap?

  Yes

  No

• Does the Property have Finlock Gutters?

  Yes

  No

• Does the Property suggest that Asbestos could be Present?

  Yes

  No

• Confirm you have asked the Client if there was any known Asbestos or Asbestos containing materials within the property

  Yes

  No

• Do you or the Client have any Reason to suspect Asbestos is present in the Property?

  Yes

  No

• Access from Road/ Around Property

  Good

  Fair

  Poor

  N/A

• Is there any Evidence of Vermin?

  Yes

  No

• Is there any Evidence of Protected Wildlife? (e.g. Bats)

  Yes

  No

• Use of a Mobile Tower Required?

  Yes

  No

• Working on Roof Required?

  Yes

  No

• Vibration Likely?

  Yes

  No

• High Noise Levels Likely?

  Yes

  No

• Working with Wet Cement/ Concrete/ Mortar required?

  Yes

  No

• Use of Mobile Elevation Working Platform (MEWP) required?

  Yes

  No

• If Obstructions present, can an extended Lance be used to Remedy?

  Yes

  No

• Reversing of Vehicle Required?

  Yes

  No

• Electricity Required?

  Yes

  No

• Housekeeping Required

  Yes

  No

• Distance from Works vehicle to Property

• Will Public Walkway be at Risk?

  Yes

  No

• Is neighbour access required?

  Yes

  No

• Safety Signage required?

  Yes

  No

• Loft Insulation Risk Assessment Questions

• Does the Property suggest that Asbestos could be Present?

  Yes

  No

• Confirm you have asked the Client if there was any known Asbestos or Asbestos containing materials within the property

  Yes

  No

• Do you or the Client have any Reason to suspect Asbestos is present in the Property?

  Yes

  No

• Have all checks been Undertaken to determine if Asbestos containing materials are present within the property?

  Yes

  No

• Access from Road/ Around Property

  Good

  Fair

  Poor

  N/A

• Is there any Evidence of Vermin?

  Yes

  No

• Is there any Evidence of Protected Wildlife? (e.g. Bats)

  Yes

  No

• Vulnerable Person Present?

  Yes

  No

• Use of Ladders Required?

  Yes

  No

• Manual Handling Required?

  Yes

  No

• Reversing of Vehicle Required?

  Yes

  No

• Electricity Required?

  Yes

  No

• Housekeeping Required

  Yes

  No

• Distance from Works vehicle to Property

• Will Public Walkway be at Risk?

  Yes

  No

• Is neighbour access required?

  Yes

  No

• Safety Signage required?

  Yes

  No

• Electricity Cables present in Loft

  Yes

  No

• Working in Confined Spaces required?

  Yes

  No

• Lone Working?

  Yes

  No

• Use of Scaffold required?

  Yes

  No

• I has assessed the conditions on site ensuring there is adequate ventilation. Unless listed below, there are no additional significant hazards observed that are not addresses in the generic risk assessment for the works to be undertaken

  None

  See Below

• undefined

• Assessors Name and Signature

  Sign

• Customer's name and Signature

  Sign

• Upload Compliance Doc's

• POPT

  Yes

  No

• POPT (Paper Survey up to 6 pages)

• Number of Doc's

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• Benefit Details/Letters

  Yes

  No

• Benefit Details/Letters (up to 15 Pages)

• Number of Doc's

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• DSSY with a Floor Plan

  Yes

  No

• DSSY with a Floor Plan (12 Pages)

• Number of Doc's

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  Yes

  No

• Party Wall Consent form

  Yes

  No

• Signed by Owner of the subject Property and Neighbouring property/properties. (min 2 pages)

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• EST Form

  Yes

  No

• EST Form (Signed by Owner Occupier 1 page)

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• Land Registry Form

  Yes

  No

• Land Registry Form signed by Owner Occupier (1 page)

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• LMCP

  Yes

  No

• Landlord Management Company Permission Form (only for privately rented 2 pages)

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• Recent EPC

  Yes

  No

• EPC (only for privately rented 3 pages)

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• Additional Supporting Evidence

  Yes

  No

• Additional Supporting Evidence (Title Deeds, Mortgage Statement, Tenancy Agreements (up to 20 pages)

• Number of Doc's

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  Yes

  No

• Additional Information and Photos

  Yes

  No

• Additional Information

• Additional Photos

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