Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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INTERIOR
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Fireplace
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None
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Location(s):
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Type
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Gas
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Wood
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Solid fuel burning stove
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Electric
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Ventless
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Material
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Masonry
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Metal (pre-fabricated)
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Metal insert
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Cast Iron
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Miscellaneous
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Blower built-in
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Operable:
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Yes
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No
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Damper operable:
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Yes
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No
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Open joints or cracks in firebrick/panels should be sealed
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Fireplace doors need repair
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Damper Modified for Gas Operation
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N/A
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Yes
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No
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Damper missing
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Hearth Extension Adequate
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Yes
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No
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Mantel
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N/A
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Secure
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Loose
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Recommend repair/replace
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Physical Condition
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Satisfactory
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Marginal
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Poor
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Recommend having flue cleaned and re-examined
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Not evaluated
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Stairs/Steps/Balconies
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None
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Satisfactory
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Marginal
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Poor
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Loose/Missing
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Handrail
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Satisfactory
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Marginal
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Poor
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Safety hazard
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Hand Rail/Railing/Balusters recommended
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Risers/Treads
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Satisfactory
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Marginal
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Poor
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Risers/Treads uneven
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Trip hazard
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Smoke/Carbon Monoxide Detectors
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Present
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Smoke detector
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Operable:
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Yes
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No
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Not tested
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Recommend additional
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CO Detector
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Operable:
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Yes
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No
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Not tested
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Recommend additional
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Attic/Structure/Framing/Insulation
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N/A
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Access
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Stairs
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Pulldown
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Scuttlehole/Hatch
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No Access
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Inspected From
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Access panel
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In the attic
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Other
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Location
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Hallway
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Bedroom Closet
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Garage
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Other
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Access Limited By:
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Flooring
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Complete
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Partial
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None
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Insulation
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Fiberglass
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Batts
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Loose
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Cellulose
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Foam
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Other
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Vermiculite
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Rock Wool
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Depth
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Recommend baffles at eaves
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Damaged
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Displaced
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Missing
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Compressed
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Installed In
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Rafters/Trusses
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Walls
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Between ceiling joists
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Underside of roof deck
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Not Visible
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Recommend additional ventilation
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Vapor Barriers
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Kraft/foiled faced
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Plastic sheeting
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Not Visible
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Improperly installed
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Ventilation
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Ventilation appears adequate
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Recommend additional ventilation
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Fans Exhausted To
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Attic:
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Yes
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No
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Recommend repair
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Outside:
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Yes
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No
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Not Visible
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HVAC Duct
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N/A
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Satisfactory
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Damaged
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Split
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Disconnected
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Leaking
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Repair/Replace
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Recommend Insulation
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Chimney Chase
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N/A
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Satisfactory
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Needs repair
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Not Visible
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Structural Problems Observed
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Yes
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No
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Recommend repair
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Recommend structural engineer
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Roof Structure
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Rafters
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Trusses
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Wood
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Metal
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Collar ties
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Purlins
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Knee wall
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Not Visible
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Ceiling Joists
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Wood
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Metal
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Not Visible
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Sheathing
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Plywood
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OSB
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Planking
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Rotted
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Stained
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Delaminated
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Evidence of Condensation
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Yes
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No
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Evidence of Moisture
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Yes
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No
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Evidence of Leaking
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Yes
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No
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Firewall Between Units
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N/A
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Yes
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No
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Needs repair/sealing
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Electrical
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Open junction box(es)
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Handyman wiring
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Visible knob-and-tube
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BASEMENT
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Stairs
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Condition
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Satisfactory
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Marginal
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Poor
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Typical wear and tear
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Needs repair
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Handrail
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Yes
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No
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Condition
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Satisfactory
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Loose
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Handrail/Railing/Balusters recommended
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Headway Over Stairs
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Satisfactory
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Low clearance
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Safety hazard
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Foundation
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Condition
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Satisfactory
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Marginal
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Have evaluated
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Monitor
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Material
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ICF
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Brick
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Concrete block
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Fieldstone
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Poured concrete
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Horizontal Cracks
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North
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South
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East
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West
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Step Cracks
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North
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South
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East
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West
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Vertical Cracks
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North
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South
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East
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West
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Covered Walls
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North
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South
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East
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West
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Movement Apparent
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North
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South
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East
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West
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Indication of Moisture
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Yes
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No
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Fresh
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Old stains
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Walls
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Floor
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Material
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Concrete
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Dirt/Gravel
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Not Visible
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Condition
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Satisfactory
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Marginal
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Poor
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Typical cracks
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Not Visible
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Seismic Bolts
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N/A
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None visible
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Appear satisfactory
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Recommend evaluation
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Drainage
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Sump Pump
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Yes
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No
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Working
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Not working
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Needs cleaning
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Pump not tested
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Floor Drains
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Yes
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Not Visible
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Drains not tested
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Girders/Beams
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Not Visible
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Condition
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Satisfactory
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Marginal
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Poor
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Stained/Rusted
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Material
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Steel
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Wood
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Concrete
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LVL
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Not Visible
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Columns
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Not Visible
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Condition
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Satisfactory
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Marginal
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Poor
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Stained/Rusted
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Material
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Steel
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Wood
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Concrete
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Block
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Not Visible
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Joists
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Not Visible
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Condition
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Satisfactory
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Marginal
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Poor
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Material
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Wood
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Steel
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Truss
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Not Visible
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2 x 8
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2 x 10
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2 x 12
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Engineered I-Type
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Sagging/altered joists
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Subfloor
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Not Visible
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Indication of moisture stains/rotting
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PLUMBING
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Water Service
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Main shut-off location:
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Water Entry Piping
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Not Visible
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Copper/Galv.
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PVC Plastic
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CPVC Plastic
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Polybutylene Plastic
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PEX Plastic
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Lead
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Lead Other Than Solder Joints
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Yes
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No
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Unknown
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Service entry
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Visible Water Distribution Piping
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Copper
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Galvanized
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PVC Plastic
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CPVC Plastic
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Polybutylene Plastic
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PEX Plastic
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Condition
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Satisfactory
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Marginal
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Poor
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Flow
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Satisfactory
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Marginal
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Poor
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Water pressure over 80 psi
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Recommend plumber evaluate
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Recommend pressure regulator box
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Pipes Supply/Drain
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Corroded
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Leaking
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Valves broken/missing
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Dissimilar metal
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Cross connection:
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Yes
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No
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Safety hazard
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Drain/Waste/Vent Pipe
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Copper
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Cast iron
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Galvanized
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PVC
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ABS
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Brass
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Polyethylene
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Condition
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Satisfactory
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Marginal
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Poor
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Support/Insulation
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N/A
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Type:
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Traps Proper P-Type
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Yes
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No
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P-traps recommended
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Drainage
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Satisfactory
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Marginal
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Poor
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Interior Fuel Storage System
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N/A
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Yes
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No
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Leaking:
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Yes
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No
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Fuel Line
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N/A
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Copper
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Brass
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Black iron
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Stainless steel
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CSST
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Not Visible
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Condition
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Satisfactory
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Marginal
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Poor
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Recommend plumber evaluate
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Main Fuel Shut-Off Location
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N/A
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Well Pump
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N/A
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Submersible
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In basement
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Well house
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Well pit
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Shared well
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Pressure Gauge Operable
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Yes
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No
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Not Visible
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Sanitary/Grinder Pump
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N/A
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Sealed crock:
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Yes
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No
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Check valve:
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Yes
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No
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Shut-off valve:
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Yes
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No
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Vented
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Yes
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No
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Operable:
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Yes
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No
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Water Heater #1
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N/A
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Brand Name:
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Serial #:
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Capacity:
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Approx. age:
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Type:
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Gas
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Electric
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Oil
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LP
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Combustion Air Venting Present
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Yes
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No
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N/A
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Seismic Restraints Needed
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Yes
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No
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N/A
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Relief Valve
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Yes
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No
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Extension proper:
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Yes
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No
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Missing
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Recommend repair
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Improper material
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Vent Pipe
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N/A
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Satisfactory
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Pitch proper
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Improper
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Rusted
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Recommend repair
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Condition
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Satisfactory
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Marginal
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Poor
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Water Heater #2
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N/A
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Brand Name:
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Serial #:
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Capacity:
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Approx. age:
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Type:
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Gas
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Electric
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Oil
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LP
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Combustion Air Venting Present
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Yes
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No
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N/A
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Seismic Restraints Needed
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Yes
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No
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N/A
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Relief Valve
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Yes
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No
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Extension proper:
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Yes
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No
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Missing
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Recommend repair
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Improper material
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Vent Pipe
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N/A
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Satisfactory
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Pitch proper
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Improper
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Rusted
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Recommend repair
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Condition
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Satisfactory
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Marginal
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Poor
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Water Softener
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N/A
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Present
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Loop Installed
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Yes
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No
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Plumbing Hooked Up
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Yes
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No
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Plumbing Leaking
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Yes
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No
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HEATING SYSTEM
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Heating System
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Unit #1
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Brand name:
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Approx. age:
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Unknown
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Model #:
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Serial #:
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Unit #2
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Brand name:
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Approx. age:
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Unknown
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Model #:
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Serial #:
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Energy Source
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Gas
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LP
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Oil
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Electric
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Solid fuel
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Warm Air System
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Belt drive
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Direct drive
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Gravity
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Central system
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Floor/wall unit
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Heat Exchanger
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N/A
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Sealed
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Not visible
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Visual w/mirror
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Flame distortion
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Rusted
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Carbon/soot buildup
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Carbon Monoxide
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N/A
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Detected at plenum
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Detected at register
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Not tested
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CO Test
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Tester:
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Combustion Air Venting Present
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N/A
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Yes
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No
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Controls
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Disconnect:
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Yes
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No
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Normal operating and safety controls observed
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Distribution
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Metal duct
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Insulated flex duct
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Cold air returns
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Duct board
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Asbestos-like wrap
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Safety hazard
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Flue Piping
-
N/A
-
Satisfactory
-
Rusted
-
Improper slope
-
Safety hazard
-
Recommend repair/replace
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Filter
-
Standard
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Electrostatic
-
Satisfactory
-
Needs cleaning/replacement
-
Missing
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Electronic (not tested)
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When Turned On By Thermostat
-
Fired
-
Did not fire
-
Proper operation:
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Yes
-
No
-
Not tested
-
Heat Pump
-
N/A
-
Supplement electric
-
Supplemental gas
-
Sub-Slab Ducts
-
N/A
-
Satisfactory
-
Marginal
-
Poor
-
Water/Sand Observed:
-
Yes
-
No
-
#1 - System Condition
-
Satisfactory
-
Marginal
-
Poor
-
Recommended HVAC technician examine
-
#2 - System Condition
-
Satisfactory
-
Marginal
-
Poor
-
Recommended HVAC technician examine
-
System Not Operated Due To
-
Exterior temperature
-
Boiler System
-
N/A
-
Brand name:
-
Approx. age:
-
Model #:
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Serial #:
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Energy Source:
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Gas
-
LP
-
Oil
-
Electric
-
Solid fuel
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Distribution
-
Hot water
-
Baseboard
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Steam
-
Radiator
-
Radiant floor
-
Circulator
-
Pump
-
Gravity
-
Multiple zones
-
Controls
-
Temp/Pressure gauge exist:
-
Yes
-
No
-
Operable:
-
Yes
-
No
-
Oil Fired Units
-
Disconnect:
-
Yes
-
No
-
Combustion Air Venting Present
-
Yes
-
No
-
N/A
-
Relief Valve
-
Yes
-
No
-
Missing
-
Extension proper:
-
Yes
-
No
-
Recommend repair/replace
-
Operated
-
When turned on by thermostat:
-
Fired
-
Did not fire
-
Operation:
-
Satisfactory:
-
Yes
-
No
-
Recommend HVAC technician examine before closing
-
Other Systems
-
N/A
-
Electric baseboard
-
Radiant ceiling cable
-
Gas space heater
-
Solid fuel burning stove
-
Proper Operation:
-
Yes
-
No
-
System Condition
-
Satisfactory
-
Marginal
-
Poor
-
Recommend HVAC technician examine
-
ELECTRIC/COOLING SYSTEM
-
Main Panel
-
Location:
-
Condition
-
Satisfactory
-
Marginal
-
Poor
-
Adequate Clearance to Panel
-
Yes
-
No
-
Amperage/Voltage
-
Unknown
-
60a
-
100a
-
150a
-
200a
-
400a
-
120v/240v
-
Breakers/Fuses
-
Breakers
-
Fuses
-
Appears Grounded
-
Yes
-
No
-
Not Visible
-
GFCI Breaker
-
Yes
-
No
-
Operable:
-
Yes
-
No
-
AFCI
-
Yes
-
No
-
Operable:
-
Yes
-
No
-
Main Wire
-
Copper
-
Aluminum
-
Solid Branch Aluminum Wiring
-
Not visible
-
Safety Hazard
-
Branch Wire Condition
-
Satisfactory
-
Poor
-
Recommend electrician evaluate/repair
-
Romex
-
BX cable
-
Conduit
-
Knob/Tube
-
Double tapping
-
Wire undersized/oversized breaker/fuse
-
Panel not accessible
-
Not evaluated
-
Reason:
-
Sub Panel(s)
-
None apparent
-
Location 1:
-
Location 2:
-
Locations 3:
-
Panel not accessible
-
Not evaluated
-
Reason:
-
Branch Wire
-
Copper
-
Aluminum
-
Safety hazard
-
Neutral/ground separated:
-
Yes
-
No
-
Neutral isolated:
-
Yes
-
No
-
Condition
-
Satisfactory
-
Marginal
-
Poor
-
Recommend separating/isolating neutrals
-
Recommend electrician repair/evaluate box
-
Heat Pump - A/C Unit #1
-
Central system
-
Wall unit
-
Brand name:
-
Location:
-
Age:
-
Serial #:
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Evaporator Coil
-
Satisfactory
-
Not visible
-
Needs cleaning
-
Damaged
-
Refrigerant Lines
-
Leak/Oil present
-
Damage
-
Insulation missing
-
Satisfactory
-
Condensate Line/Drain
-
To exterior
-
To pump
-
Floor drain
-
Secondary Condensate Line/Drain
-
Present:
-
Yes
-
No
-
Needed:
-
Yes
-
No
-
Primary pan appears clogged
-
Recommend technician evaluate
-
Operational
-
Differential
-
Condition
-
Satisfactory
-
Marginal
-
Poor
-
Recommend HVAC technician examine/clean/service
-
Not operated due to exterior temperature
-
Heat Pump - A/C Unit #2
-
Central system
-
Wall unit
-
Brand name:
-
Location:
-
Age:
-
Serial #:
-
Evaporator Coil
-
Satisfactory
-
Not visible
-
Needs cleaning
-
Damaged
-
Refrigerant Lines
-
Leak/Oil present
-
Damage
-
Insulation missing
-
Satisfactory
-
Condensate Line/Drain
-
To exterior
-
To pump
-
Floor drain
-
Secondary Condensate Line/Drain
-
Present:
-
Yes
-
No
-
Needed:
-
Yes
-
No
-
Primary pan appears clogged
-
Recommend technician evaluate
-
Operational
-
Differential
-
Condition
-
Satisfactory
-
Marginal
-
Poor
-
Recommend HVAC technician examine/clean/service
-
Not operated due to exterior temperature