PST PIBI AND TECH SURVEY FORM - ( Simon R )

CONTACT DETAILS

• PROPERTY ADDRESS

• SURVEY DATE

  Date

• Customer in

  YES

  NO

  N/A

• PROPERTY TYPE

  Select HOUSE BUNGALOW FLAT MAISONETTE DETACHED SEMI DETACHED MID TERRACED END TERRACED 1 BED 2 BED 3 BED 4 BED 5 BED pre 1930's 2012 onwards 2007- 2011 2003 - 2006 1996 - 2002 1991 - 1995 1983 - 1990 1983-1990 1976 - 1982 1967 - 1975 1960 - 1966 1950 - 1965 1930 - 1949 1900 - 1929 before 1900

  • HOUSE
  • BUNGALOW
  • FLAT
  • MAISONETTE
  • DETACHED
  • SEMI DETACHED
  • MID TERRACED
  • END TERRACED
  • 1 BED
  • 2 BED
  • 3 BED
  • 4 BED
  • 5 BED
  • pre 1930's
  • 2012 onwards
  • 2007- 2011
  • 2003 - 2006
  • 1996 - 2002
  • 1991 - 1995
  • 1983 - 1990
  • 1983-1990
  • 1976 - 1982
  • 1967 - 1975
  • 1960 - 1966
  • 1950 - 1965
  • 1930 - 1949
  • 1900 - 1929
  • before 1900

SURVEYOR DETAILS

• SURVEYOR NAME

• CONTACT DETAILS

PROPERTY DETAILS

• PROPERTY IN AN EXPOSED AREA

  YES

  NO

  N/A

DESIGN INFO

• DESIGN AND FLOOR PLANS UPLOADED

  Yes

  No

  NA

• MTRP READ AND UNDERSTOOD

  Yes

  No

  NA

• ASBESTOS REPORT UPLOADED

  Yes

  No

  NA

• SOLAR PV DESIGN UPLOADED

  Yes

  No

  NA

RECOMMENDED MEASURES

• DESIGN TEAM RECOMMENDED MEASURES

  Select CAVITY WALL INSULATION CAVITY WALL EXTRACT LOFT INSULATION EXTERNAL WALL INSULATION INTERNAL WALL INSULATION SOLAR PV SOLAR BATTERY DMEV DMVHR DOOR UNDERCUTS TRICKLE VENTS WINDOWS DOORS FULL HEATING AND ASHP INSTALL HRSH HOT WATER CYLINDER EDDIE ( SOLAR DIVERTER ) REPLACEMENT ROOF REMEDIALS low energy lighting decommission existing heating system Airex Aerogel REPLACE ROOF FELT PATCH HOLES IN FELT REPLACE ROOF TILES SEE NOTES DRAUGHT PROOF LOFT HATCH DRAUGHT PROOF AND INSULATE LOFT HATCH REPLACE LOFT HATCH

  • CAVITY WALL INSULATION
  • CAVITY WALL EXTRACT
  • LOFT INSULATION
  • EXTERNAL WALL INSULATION
  • INTERNAL WALL INSULATION
  • SOLAR PV
  • SOLAR BATTERY
  • DMEV
  • DMVHR
  • DOOR UNDERCUTS
  • TRICKLE VENTS
  • WINDOWS
  • DOORS
  • FULL HEATING AND ASHP INSTALL
  • HRSH
  • HOT WATER CYLINDER
  • EDDIE ( SOLAR DIVERTER )
  • REPLACEMENT ROOF
  • REMEDIALS
  • low energy lighting
  • decommission existing heating system
  • Airex
  • Aerogel
  • REPLACE ROOF FELT
  • PATCH HOLES IN FELT
  • REPLACE ROOF TILES
  • SEE NOTES
  • DRAUGHT PROOF LOFT HATCH
  • DRAUGHT PROOF AND INSULATE LOFT HATCH
  • REPLACE LOFT HATCH

• ADDITIONAL MEASURES IDENTIFIED AT PIBI STAGE

  Select Not Applicable SEE NOTES Cavity wall extract Cavity wall refill cavity wall insulation loft insulation window replacement door replacement DMEV DMVHR Door undercuts Solar PV Battery Roof replacement EWI EWI EXTRACT low Energy Lighting Airex Aerogel Trickle vents Replace roof felt Repair damaged roof felt Replace broken roof tiles

  • Not Applicable
  • SEE NOTES
  • Cavity wall extract
  • Cavity wall refill
  • cavity wall insulation
  • loft insulation
  • window replacement
  • door replacement
  • DMEV
  • DMVHR
  • Door undercuts
  • Solar PV
  • Battery
  • Roof replacement
  • EWI
  • EWI EXTRACT
  • low Energy Lighting
  • Airex
  • Aerogel
  • Trickle vents
  • Replace roof felt
  • Repair damaged roof felt
  • Replace broken roof tiles

• Measures That Need Amended

  Select Not applicable SEE NOTES ASHP outdoor unit location Hot water Cylinder location Solar array location Inverter location Battery location Radiator selection Cavity wall extract Cavity wall insulation Loft insulation EWI Windows External doors Ventilation DMEV DMVHR Solar Array design Change DOOR UNDERCUTS TRICKLE VENTS ROOF

  • Not applicable
  • SEE NOTES
  • ASHP outdoor unit location
  • Hot water Cylinder location
  • Solar array location
  • Inverter location
  • Battery location
  • Radiator selection
  • Cavity wall extract
  • Cavity wall insulation
  • Loft insulation
  • EWI
  • Windows
  • External doors
  • Ventilation DMEV
  • DMVHR
  • Solar Array design Change
  • DOOR UNDERCUTS
  • TRICKLE VENTS
  • ROOF

PRODUCT SPECIFICATIONS UPLOADED

• VENTILATION

  Yes

  No

  NA

• SOLAR PV

  Yes

  No

  NA

• CAVITY WALL INSULATION

  Yes

  No

  NA

• EXTERNAL WALL INSULATION

  Yes

  No

  NA

• LOFT INSULATION

  Yes

  No

  NA

• HHRSH

  Yes

  No

  NA

EXTERNAL ELEVATION PHOTOS

• ALL EXTERNAL ELEVATION PHOTOS TAKEN

  Yes

  No

  NA

EXTERNAL DEFECTS / AIR INGRESS

• NOTES : Condition of roof , facias , soffits , etc

• NOTES : Condition of external walls ( cracks , holes, etc )

ROOF TYPE

• ROOF STYLE

  STANDARD

  HIPPED

  OTHER

• ROOF TILE TYPE

  DOUBLE ROMAN

  FLAT

  OTHER

• ROOF COVERING MATERIAL

  CLAY

  CONCRETE

  SLATE

SCAFFOLD SURVEY

• Scaffold required

  YES

  NO

  N/A

• ELEVATIONS

  Select FRONT BACK LEFT RIGHT

  • FRONT
  • BACK
  • LEFT
  • RIGHT

• Scaffold for what measures

  Select Solar PV EWI Window replacement Roof replacement Remedials

  • Solar PV
  • EWI
  • Window replacement
  • Roof replacement
  • Remedials

• GROUND TO GUTTER HEIGHT in meters

• GROUND CONDITION

• EDGE PROTECTION REQUIRED

  Yes

  No

  NA

• ACCESS ISSUES TO ERECT SCAFFOLDNG

• ANY OBSTRUCTIONS ( CONSERVATORY , LEAN TO etc )

• PAVEMENT PERMIT REQUIRED ( 1.5M CLEARANCE REQUIRED )

  YES

  NO

  N/A

SOLAR PV ARRAY

• INSTALLING SOLAR PV

  YES

  NO

  NA

• NUMBER OF PANELS

  Select AS PER DESIGN SHEET Not applicable NONE 1 2 3 4 5 6 7 8 9 10 11 12

  • AS PER DESIGN SHEET
  • Not applicable
  • NONE
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12

• ARRAY DESIGN

  Select PORTRAIT LANDSCAPE LANDSCAPE AND PORTRAIT NOT APPLICABLE IN ROOF ON ROOF

  • PORTRAIT
  • LANDSCAPE
  • LANDSCAPE AND PORTRAIT
  • NOT APPLICABLE
  • IN ROOF
  • ON ROOF

• EXPOSED LOCATION

  YES

  NO

  NA

• PROPOSED ELEVATION

  front

  Back

  Left

  Right

• SOLAR ARRAY VISABLE FROM THE ROAD

  YES

  NO

  NA

• PLANNING PERMISSION REQUIRED

  YES

  NO

  N/A

SERVICE METERS

• ELECTRIC METER LOCATION

  Select INTERNAL EXTERNAL FRONT BACK LEFT RIGHT SEE NOTES UNDER STAIRS Lounge Kitchen Dining room Bathroom WC No Mains Gas Entrance Hall

  • INTERNAL
  • EXTERNAL
  • FRONT
  • BACK
  • LEFT
  • RIGHT
  • SEE NOTES
  • UNDER STAIRS
  • Lounge
  • Kitchen
  • Dining room
  • Bathroom
  • WC
  • No Mains Gas
  • Entrance Hall

• ELECTRIC METER BOX EVIDENCE

  Select DIAL SMART DIGITAL KEY METER SINGLE METER DUAL METER SEPERATE ECONOMY 7 METER MAIN ISOLATOR NOT PRESENT MAIN ISOLATOR PRESENT 60 AMP FUSE 80 AMP FUSE 100 AMP FUSE UNKNOWN FUSE AMP

  • DIAL
  • SMART
  • DIGITAL
  • KEY METER
  • SINGLE METER
  • DUAL METER
  • SEPERATE ECONOMY 7 METER
  • MAIN ISOLATOR NOT PRESENT
  • MAIN ISOLATOR PRESENT
  • 60 AMP FUSE
  • 80 AMP FUSE
  • 100 AMP FUSE
  • UNKNOWN FUSE AMP

• GAS METER LOCATION

  Select INTERNAL EXTERNAL FRONT BACK LEFT RIGHT SEE NOTES UNDER STAIRS Lounge Kitchen Dining room Bathroom WC No Mains Gas Entrance Hall

  • INTERNAL
  • EXTERNAL
  • FRONT
  • BACK
  • LEFT
  • RIGHT
  • SEE NOTES
  • UNDER STAIRS
  • Lounge
  • Kitchen
  • Dining room
  • Bathroom
  • WC
  • No Mains Gas
  • Entrance Hall

CONSUMER UNIT

• CONSUMER UNIT LOCATION

  Select INTERNAL EXTERNAL FRONT BACK LEFT RIGHT SEE NOTES UNDER STAIRS Lounge Kitchen Dining room Bathroom WC No Mains Gas Entrance Hall

  • INTERNAL
  • EXTERNAL
  • FRONT
  • BACK
  • LEFT
  • RIGHT
  • SEE NOTES
  • UNDER STAIRS
  • Lounge
  • Kitchen
  • Dining room
  • Bathroom
  • WC
  • No Mains Gas
  • Entrance Hall

• EXISTING CONSUMER UNIT SPARE WAYS ( SPD NEEDED NEEDED FOR PV )

  Select AS PER DESIGN SHEET NONE 1 2 3 4 5 6 7 8 9 10 SPD NEEDED SPD INSTALLED Not applicable YES NO

  • AS PER DESIGN SHEET
  • NONE
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • SPD NEEDED
  • SPD INSTALLED
  • Not applicable
  • YES
  • NO

• RCD PROTECTED ?

  YES

  NO

• RANGE

• MCB TYPE

• CONSUMER UNIT UPGRADE

  Select YES NO SUB BOARD ( MINIMUM 4 SPARE WAYS ) REPLACE EXISTING CONSUMER UNIT UPGRADE EXISTING CONSUMER UNIT

  • YES
  • NO
  • SUB BOARD ( MINIMUM 4 SPARE WAYS )
  • REPLACE EXISTING CONSUMER UNIT
  • UPGRADE EXISTING CONSUMER UNIT
INTERNAL DEFECTS

• INTERNAL DEFECTS

  YES

  NO

  N/A

• ROOM

  Select NOT APPLICABLE LOUNGE KITCHEN DINING ROOM W/C ENTRANCE HALL LANDING BED 1 BED 2 BED 3 BED 4 BED 5 BATHROOM EN SUITE TBC ALL WINDOWS AS PER DESIGN SHEET SEE NOTES FRONT PORCH BACK PORCH FRENCH DOORS

  • NOT APPLICABLE
  • LOUNGE
  • KITCHEN
  • DINING ROOM
  • W/C
  • ENTRANCE HALL
  • LANDING
  • BED 1
  • BED 2
  • BED 3
  • BED 4
  • BED 5
  • BATHROOM
  • EN SUITE
  • TBC
  • ALL WINDOWS
  • AS PER DESIGN SHEET
  • SEE NOTES
  • FRONT PORCH
  • BACK PORCH
  • FRENCH DOORS

• CONDITION OF ROOM ( damp , mould cracks in wall or ceilings etc )

REPLACE LIGHTING

• REPLACE WITH LOW ENERGY LIGHTING

  YES

  NO

  NA

• Bulb x

• Batten x

• Bulk head

DOOR UNDERCUTS

• LOCATION OF UNDERCUTS

  Select NOT APPLICABLE LOUNGE KITCHEN DINING ROOM W/C ENTRANCE HALL LANDING BED 1 BED 2 BED 3 BED 4 BED 5 BATHROOM EN SUITE TBC ALL WINDOWS AS PER DESIGN SHEET SEE NOTES FRONT PORCH BACK PORCH FRENCH DOORS

  • NOT APPLICABLE
  • LOUNGE
  • KITCHEN
  • DINING ROOM
  • W/C
  • ENTRANCE HALL
  • LANDING
  • BED 1
  • BED 2
  • BED 3
  • BED 4
  • BED 5
  • BATHROOM
  • EN SUITE
  • TBC
  • ALL WINDOWS
  • AS PER DESIGN SHEET
  • SEE NOTES
  • FRONT PORCH
  • BACK PORCH
  • FRENCH DOORS

• NUMBER OF UNDERCUTS

  Select Not applicable 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 RADIATORS HRSH ESH ELECTRIC RADIATORS

  • Not applicable
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • RADIATORS
  • HRSH
  • ESH
  • ELECTRIC RADIATORS

VENTILATION

• EXISTING DMEV LOCATION

  Select KITHEN CEILING KITCHEN WALL NONE IN KITCHEN BATHROOM CEILING BATHROOM WALL NONE IN BATHROOM W/C CEILING W/C WALL NONE IN W/C ENSUITE CEILING ENSUITE WALL NOT APPLICABLE None TBC Kitchen Window Bathroom window

  • KITHEN CEILING
  • KITCHEN WALL
  • NONE IN KITCHEN
  • BATHROOM CEILING
  • BATHROOM WALL
  • NONE IN BATHROOM
  • W/C CEILING
  • W/C WALL
  • NONE IN W/C
  • ENSUITE CEILING
  • ENSUITE WALL
  • NOT APPLICABLE
  • None
  • TBC
  • Kitchen Window
  • Bathroom window

• NEW DMEV LOCATION

  Select KITHEN CEILING KITCHEN WALL NONE IN KITCHEN BATHROOM CEILING BATHROOM WALL NONE IN BATHROOM W/C CEILING W/C WALL NONE IN W/C ENSUITE CEILING ENSUITE WALL NOT APPLICABLE None TBC Kitchen Window Bathroom window

  • KITHEN CEILING
  • KITCHEN WALL
  • NONE IN KITCHEN
  • BATHROOM CEILING
  • BATHROOM WALL
  • NONE IN BATHROOM
  • W/C CEILING
  • W/C WALL
  • NONE IN W/C
  • ENSUITE CEILING
  • ENSUITE WALL
  • NOT APPLICABLE
  • None
  • TBC
  • Kitchen Window
  • Bathroom window

• RIGID DUCTING REQUIRED

  YES

  NO

  N/A

• LOCATION

  BATHROOM

  KITCHEN

  W/C

  EN SUITE

  NOT APPLICABLE

• LENGTH OF RIGID DUCTING IN METERS

• Bends Required

  Select 1 x 2 x 3 x 4 x 90 Bend 45 Bend NOT APPLICABLE

  • 1 x
  • 2 x
  • 3 x
  • 4 x
  • 90 Bend
  • 45 Bend
  • NOT APPLICABLE

• EXISTING DMVHR LOCATIONS

  Select Lounge Dining room bedroom 1 bedroom 2 bedroom 3 bedroom 4 bedroom 5 Other see notes None not applicable Lounge window dining room window bedroom 1 window bedroom 2 window bedroom 3 window bedroom 4 window

  • Lounge
  • Dining room
  • bedroom 1
  • bedroom 2
  • bedroom 3
  • bedroom 4
  • bedroom 5
  • Other see notes
  • None
  • not applicable
  • Lounge window
  • dining room window
  • bedroom 1 window
  • bedroom 2 window
  • bedroom 3 window
  • bedroom 4 window

• NEW DMVHR LOCATIONS

  Select Lounge Dining room bedroom 1 bedroom 2 bedroom 3 bedroom 4 bedroom 5 Other see notes None not applicable Lounge window dining room window bedroom 1 window bedroom 2 window bedroom 3 window bedroom 4 window

  • Lounge
  • Dining room
  • bedroom 1
  • bedroom 2
  • bedroom 3
  • bedroom 4
  • bedroom 5
  • Other see notes
  • None
  • not applicable
  • Lounge window
  • dining room window
  • bedroom 1 window
  • bedroom 2 window
  • bedroom 3 window
  • bedroom 4 window

WINDOW AND DOOR REPLACEMENT

• DOORS TO BE REPLACED

  YES

  NO

  NA
DOOR MEASUREMENTS

• ROOM IDENTIFIER

  Select FRONT DOOR BACK DOOR PATIO DOORS SLIDING DOORS

  • FRONT DOOR
  • BACK DOOR
  • PATIO DOORS
  • SLIDING DOORS

• WIDTH X HEIGHT

• REPLACE WINDOWS

  YES

  NO

  NA
WINDOW MEASUREMENTS

• ROOM IDENTIFIER

  Select NOT APPLICABLE LOUNGE KITCHEN DINING ROOM W/C ENTRANCE HALL LANDING BED 1 BED 2 BED 3 BED 4 BED 5 BATHROOM EN SUITE TBC ALL WINDOWS AS PER DESIGN SHEET SEE NOTES FRONT PORCH BACK PORCH FRENCH DOORS

  • NOT APPLICABLE
  • LOUNGE
  • KITCHEN
  • DINING ROOM
  • W/C
  • ENTRANCE HALL
  • LANDING
  • BED 1
  • BED 2
  • BED 3
  • BED 4
  • BED 5
  • BATHROOM
  • EN SUITE
  • TBC
  • ALL WINDOWS
  • AS PER DESIGN SHEET
  • SEE NOTES
  • FRONT PORCH
  • BACK PORCH
  • FRENCH DOORS

• WIDTH X HEIGHT

SOLAR INVERTER SURVEY

• INVERTER BEING INSTALLED

  YES

  NO

  NA

• PROPOSED INVERTER LOCATION

• SMOKE DETECTOR REQUIRED

  YES

  NO

  N/A

• INVERTER TO ROOF DISTANCE in meters

• INVERTER TO CONSUMER UNIT DISTANCE in meters

• Solar Diverter Required

  YES

  NO

  NA

• NOTES SECTION

LOFT SURVEY

• LOFT HATCH DIMENSIONS

• Are there any Bats / Rodents / Birds / Bees in the loft

  YES

  NO

  N/A

• ROOF PITCH IN METERS

• CONDITION OF EXISTING ROOF FELT

  Select GOOD CONDITION FAIR CONDITION POOR CONDITION SEE NOTES

  • GOOD CONDITION
  • FAIR CONDITION
  • POOR CONDITION
  • SEE NOTES

• RAFTER MOISTURE READINGS ( TAKE PHOTOS )

• LOFT TO BE INSULATED

  YES

  NO

  NA

• EXISTING INSULATION DEPTH

• EXISTING INSULATION TO BE REMOVED

  YES

  NO

• INSULATION TOTAL DEPTH REQUIRED

  Select NOT APPLICABLE 400mm 350mm 270mm 200mm 150mm 100mm

  • NOT APPLICABLE
  • 400mm
  • 350mm
  • 270mm
  • 200mm
  • 150mm
  • 100mm

• EXISTING LOFT VENTS

  Select YES NO 1 2 3 4 5 6 7 8 9 10

  • YES
  • NO
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• HOW MUCH BELOGINGS IN LOFT

  LOFT FULL

  LOFT HAS A FEW BELONGINGS

  LOFT IS EMPTY OF BELONGINGS

  LOFT HALF FULL

• CUSTOMER AWARE LOFT WILL NEED TO BE CLEARED

  Select YES NO N/A FOR EWI ASHP SOLAR PV LOFT INSULATION

  • YES
  • NO
  • N/A
  • FOR EWI
  • ASHP
  • SOLAR PV
  • LOFT INSULATION

• NOTES SECTION

• STRUCTURAL SURVEY REQUIRED

  YES

  NO

• REASON FOR STRUCTURAL SURVEY

CAVITY WALL SURVEY

• INSTALLING CAVITY WALL INSULATION ?

  YES

  NO

  NA

• WALL TYPE

  Select EMPTY CAVITY CAVITY INSULATED FIBRE CAVITY INSULATED BEAD FAILED CAVITY INSULATION PARTIAL FILLED TIMBER FRAMED SOLID WALL

  • EMPTY CAVITY
  • CAVITY INSULATED FIBRE
  • CAVITY INSULATED BEAD
  • FAILED CAVITY INSULATION
  • PARTIAL FILLED
  • TIMBER FRAMED
  • SOLID WALL

• CAVITY DEPTH

  Select 50mm 60mm 70mm 80mm + LESS THAN 50mm

  • 50mm
  • 60mm
  • 70mm
  • 80mm +
  • LESS THAN 50mm

• BOROSCOPE PHOTOS TAKEN ( each elevations )

  YES

  NO

  N/A

• EXTRACT AND REFILL

  YES

  NO

  N/A

• INSTALL CAVITY WALL INSULATION TO EMPTY CAVITY

  YES

  NO

  N/A

• NOTES

EXTERNAL WALL INSULATION SURVEY

• External wall insulation

  YES

  NO

  NA

• PROPERTY CONSTRUCTION

  Select CAVITY WALL SOLID BRICK PRE - FAB NON TRADITIONAL OTHER ( SEE NOTES ) CAVITY WALL WITH EXISTING EWI

  • CAVITY WALL
  • SOLID BRICK
  • PRE - FAB
  • NON TRADITIONAL
  • OTHER ( SEE NOTES )
  • CAVITY WALL WITH EXISTING EWI

• Remove existing Failed EWI

  YES

  NO

  N/A

• IS THE PROPERTY SUITABLE FOR EWI

  YES

  NO

  N/A

• ELEVATIONS REQUIRING EWI

  Select FRONT BACK LEFT SIDE RIGHT SIDE FRONT PORCH BACK PORCH SINGLE STOREY EXTENSION (FRONT ) SINGLE STOREY EXTENSION ( BACK )

  • FRONT
  • BACK
  • LEFT SIDE
  • RIGHT SIDE
  • FRONT PORCH
  • BACK PORCH
  • SINGLE STOREY EXTENSION (FRONT )
  • SINGLE STOREY EXTENSION ( BACK )

• EXISTING FINISH

  Select STONE BRICK SAND AND CEMENT RENDER MASS CONCRETE DRY DASH WET DASH CONCRETE BLOCK WOOD PAINT

  • STONE
  • BRICK
  • SAND AND CEMENT RENDER
  • MASS CONCRETE
  • DRY DASH
  • WET DASH
  • CONCRETE BLOCK
  • WOOD PAINT

• IDENTIFY FRONT ELEVATION SERVICES

  Select Not applicable ROOM VENTS WASTE PIPE ARIEL SATELLITE DISH SUB FLOOR VENTS ESB METER BOX GAS METER BOX ALARM BOX BOILER FLUE EXTRACTOR VENT OUTDOOR LIGHT SOCKET CLOTHES LINE GARDEN TAP ADDITIONAL (SEE NOTES ) RAIWATER DOWN PIPES SECURITY CAMERAS FACIAS Soffits Fibre optic cables Washing line External light

  • Not applicable
  • ROOM VENTS
  • WASTE PIPE
  • ARIEL
  • SATELLITE DISH
  • SUB FLOOR VENTS
  • ESB METER BOX
  • GAS METER BOX
  • ALARM BOX
  • BOILER FLUE
  • EXTRACTOR VENT
  • OUTDOOR LIGHT SOCKET
  • CLOTHES LINE
  • GARDEN TAP
  • ADDITIONAL (SEE NOTES )
  • RAIWATER DOWN PIPES
  • SECURITY CAMERAS
  • FACIAS
  • Soffits
  • Fibre optic cables
  • Washing line
  • External light

• IDENTIFY REAR ELEVATION SERVICES

  Select Not applicable ROOM VENTS WASTE PIPE ARIEL SATELLITE DISH SUB FLOOR VENTS ESB METER BOX GAS METER BOX ALARM BOX BOILER FLUE EXTRACTOR VENT OUTDOOR LIGHT SOCKET CLOTHES LINE GARDEN TAP ADDITIONAL (SEE NOTES ) RAIWATER DOWN PIPES SECURITY CAMERAS FACIAS Soffits Fibre optic cables Washing line External light

  • Not applicable
  • ROOM VENTS
  • WASTE PIPE
  • ARIEL
  • SATELLITE DISH
  • SUB FLOOR VENTS
  • ESB METER BOX
  • GAS METER BOX
  • ALARM BOX
  • BOILER FLUE
  • EXTRACTOR VENT
  • OUTDOOR LIGHT SOCKET
  • CLOTHES LINE
  • GARDEN TAP
  • ADDITIONAL (SEE NOTES )
  • RAIWATER DOWN PIPES
  • SECURITY CAMERAS
  • FACIAS
  • Soffits
  • Fibre optic cables
  • Washing line
  • External light

• IDENTIFY LEFT SIDE ELEVATION SERVICES

  Select Not applicable ROOM VENTS WASTE PIPE ARIEL SATELLITE DISH SUB FLOOR VENTS ESB METER BOX GAS METER BOX ALARM BOX BOILER FLUE EXTRACTOR VENT OUTDOOR LIGHT SOCKET CLOTHES LINE GARDEN TAP ADDITIONAL (SEE NOTES ) RAIWATER DOWN PIPES SECURITY CAMERAS FACIAS Soffits Fibre optic cables Washing line External light

  • Not applicable
  • ROOM VENTS
  • WASTE PIPE
  • ARIEL
  • SATELLITE DISH
  • SUB FLOOR VENTS
  • ESB METER BOX
  • GAS METER BOX
  • ALARM BOX
  • BOILER FLUE
  • EXTRACTOR VENT
  • OUTDOOR LIGHT SOCKET
  • CLOTHES LINE
  • GARDEN TAP
  • ADDITIONAL (SEE NOTES )
  • RAIWATER DOWN PIPES
  • SECURITY CAMERAS
  • FACIAS
  • Soffits
  • Fibre optic cables
  • Washing line
  • External light

• IDENTIFY RIGHT SIDE ELEVATION SERVICES

  Select Not applicable ROOM VENTS WASTE PIPE ARIEL SATELLITE DISH SUB FLOOR VENTS ESB METER BOX GAS METER BOX ALARM BOX BOILER FLUE EXTRACTOR VENT OUTDOOR LIGHT SOCKET CLOTHES LINE GARDEN TAP ADDITIONAL (SEE NOTES ) RAIWATER DOWN PIPES SECURITY CAMERAS FACIAS Soffits Fibre optic cables Washing line External light

  • Not applicable
  • ROOM VENTS
  • WASTE PIPE
  • ARIEL
  • SATELLITE DISH
  • SUB FLOOR VENTS
  • ESB METER BOX
  • GAS METER BOX
  • ALARM BOX
  • BOILER FLUE
  • EXTRACTOR VENT
  • OUTDOOR LIGHT SOCKET
  • CLOTHES LINE
  • GARDEN TAP
  • ADDITIONAL (SEE NOTES )
  • RAIWATER DOWN PIPES
  • SECURITY CAMERAS
  • FACIAS
  • Soffits
  • Fibre optic cables
  • Washing line
  • External light

• ROOF OVERHANG DIMENSIONS

• ROOF TO BE EXTENDED ?

  YES

  NO

  N/A

• CAVITY WALL PRESENT

  YES

  NO

  NA

• DEPTH OF CAVITY

  Select 50mm 60mm 70mm 80mm + LESS THAN 50mm

  • 50mm
  • 60mm
  • 70mm
  • 80mm +
  • LESS THAN 50mm

• CONDITION OF CAVITY

  Select CLEAR RUBBLE IN CAVITY BELOW DAMP COURSE SNOTS ON WALL TIES OTHER ( SEE NOTES ) RUBBLE IN CAVITY ABOVE DAMP COURSE PATCHY INSULATION

  • CLEAR
  • RUBBLE IN CAVITY BELOW DAMP COURSE
  • SNOTS ON WALL TIES
  • OTHER ( SEE NOTES )
  • RUBBLE IN CAVITY ABOVE DAMP COURSE
  • PATCHY INSULATION

• FILL EMPTY CAVITY / EXTRACT AND REFILL

  FILL EMPTY CAVITY

  EXTRACT AND REFILL

  OTHER ( SEE NOTES )

• Boroscope photos taken ( each elevation)

  YES

  NO

  NA

• ADDITIONAL NOTES

• REQUIRES A STRUCTURAL ENGINEER

  YES

  NO

  N/A

AIREX

• AIREX REQUIRED

  YES

  NO

  NA

• How many installed

  Select Not applicable 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 RADIATORS HRSH ESH ELECTRIC RADIATORS

  • Not applicable
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • RADIATORS
  • HRSH
  • ESH
  • ELECTRIC RADIATORS

• How many required

  Select Not applicable 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 RADIATORS HRSH ESH ELECTRIC RADIATORS

  • Not applicable
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • RADIATORS
  • HRSH
  • ESH
  • ELECTRIC RADIATORS
HHRSH

• INSTALLING HHRSH

  YES

  NO

  NA

• ROOM IDENTIFIER

  Select NOT APPLICABLE LOUNGE KITCHEN DINING ROOM W/C ENTRANCE HALL LANDING BED 1 BED 2 BED 3 BED 4 BED 5 BATHROOM EN SUITE TBC ALL WINDOWS AS PER DESIGN SHEET SEE NOTES FRONT PORCH BACK PORCH FRENCH DOORS

  • NOT APPLICABLE
  • LOUNGE
  • KITCHEN
  • DINING ROOM
  • W/C
  • ENTRANCE HALL
  • LANDING
  • BED 1
  • BED 2
  • BED 3
  • BED 4
  • BED 5
  • BATHROOM
  • EN SUITE
  • TBC
  • ALL WINDOWS
  • AS PER DESIGN SHEET
  • SEE NOTES
  • FRONT PORCH
  • BACK PORCH
  • FRENCH DOORS

• EXISTING ROOM HEATER

  HHRSH

  STORAGE HEATER

  ELECTRIC WALL HEATER

  NO EXISTING HEATER

• DIMENSIONS Width x Height

HOT WATER CYLINDER

• EXISTING HOTWATER CYLINDER

  YES

  NO

  NA

• LOCATION

• TYPE

  GRAVITY

  PRESSURISED

• IMMERSION

  SINGLE

  DOUBLE

  DUAL

• REPLACE IMMERSION

  YES

  NO

  N/A

• REPLACE HOT WATER CYLINDER

  YES

  NO

  N/A

REMEDIAL WORKS

• ROOF TO BE REPLACED

  YES

  NO

  NA

• NOTES

• ADDITIONAL REMEDIAL WORKS REQUIRED

  YES

  NO

  NA

• NOTES

ADDITIONAL NOTES REGARDING TENANT

• undefined

• Our installers will need for you to provide ease of access around the external elevations , in your loft and to all the rooms in your home to allow us to install your new energy saving measures

• all belonging in the loft to be removed prior to installing loft insulation ( for loft insulation top up works )
  

• I understand that the installation works will be carried out by LivGreen in Partnership with your local Housing Association

• Name of Customer & Signature

  Sign

• Select date

  Date

• Customer Name:

• DATES UNAVAILABLE

• Are you happy to proceed to the installation stage

  Yes

  No

  NA