Stroud District Council - Heating Survey Form V1

• Site conducted

• Conducted on

  Date

• Prepared by

• Property Type

  Select Detached House Semi Detached House Terrace End of Terrace Bungalow Flat

  • Detached House
  • Semi Detached House
  • Terrace
  • End of Terrace
  • Bungalow
  • Flat

• Is There A Key Lock Box

  Yes

  No

• Key Lock Box Code

• Number of Bedrooms

• Number of Bathrooms/Shower rooms

• Is there an existing Gas Supply

  Yes

  No

• Is the Gas Supply Live

  Yes

  No

• Image of meter

  Media

Existing Heating system Details

• Make and model of existing boiler

• Boiler output

• Existing flue type

  Vertical

  Horizontal

• Image of existing boiler and flue

  Media

Proposed New Boiler Details

• Make & Model

  Select WB 4000 25kw Combi WB 4000 30kw Combi WB Life 30kw Combi WB Life 35Kw Combi WB 18Ri System WB 18ri Heat Only WB Oil Boiler Other

  • WB 4000 25kw Combi
  • WB 4000 30kw Combi
  • WB Life 30kw Combi
  • WB Life 35Kw Combi
  • WB 18Ri System
  • WB 18ri Heat Only
  • WB Oil Boiler
  • Other

• Flue Type

  Vertical

  Horizontal

• Is Scaffold Required For Safe Access

  Yes

  No

• Is a Condense Pump Required

  Yes

  No

• Is The Boiler Remaining in The Existing Location

  Yes

  No

  N/A

• Details of New Boiler Location Required Including Image of Proposed Location

Radiators

• How Many New Radiators Are Required In Total

• Room 1 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 2 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 3 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 4 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 5 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 6 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 7 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 8 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 9 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

• Room 10 Details - Description of room and heat loss requirement in btu's - Image of existing radiators

• Radiator Size Required

• Proposed Location of New Radiator

Heating/Hot Water Controls

• What type of programmer is required

  Select Single channel programmer - WIRED Single channel programmer - WIRELESS Twin channel programmer - WIRED Twin channel programmer - WIRELESS

  • Single channel programmer - WIRED
  • Single channel programmer - WIRELESS
  • Twin channel programmer - WIRED
  • Twin channel programmer - WIRELESS

• Location of Proposed Programmer and Image of Site

• What type of room stat is required

  WIRED

  WIRELESS

• Location of Proposed Programmer and Image of Site

• Is an Electrician Required

  Yes

  No

Radiators Valves

• How many Thermostatic Valves are Required

• Valve size

  15mm

  22mm

  10mm

• How many Lock Shields are Required

• Valve size

  15mm

  22mm

  10mm

• How many Lock Shields with Drain Off are Required

• Valve size

  15mm

  22mm

  10mm

Pipe Work

• Is The Gas Pipe work Adequately Sized

  Yes

  No

  N/A

• Does the Heating System Require a Full Re pipe

  Yes

  No

  N/A

• Is There An Existing & SUITABLE Condense Pipe

  Yes

  No

  N/A

• Description of Proposed Condense Pipe Routing

• Boiler required

  Select WB 4000 25kw Combi WB 4000 30kw Combi WB Life 30kw Combi WB Life 35Kw Combi WB 18Ri System WB 18ri Heat Only WB Oil Boiler Other

  • WB 4000 25kw Combi
  • WB 4000 30kw Combi
  • WB Life 30kw Combi
  • WB Life 35Kw Combi
  • WB 18Ri System
  • WB 18ri Heat Only
  • WB Oil Boiler
  • Other

• Flue Terminal

  Vertical

  Horizontal

• 0.5m Flue Extensions

• 1m Flue Extensions

• 2m Flue Extensions

• Roof Flashing Kit

• Flue Support Brackets

Copper Pipe

• 15mm Copper Pipe - Meters Required

• 22mm Copper Pipe - Meters Required

• 28mm Copper Pipe - Meters Required

Plastic Pipe

• 15mm Hep2o Pipe - Meters Required

• 22mm Hep2o Pipe - Meters Required

• 21mm Overflow Pipe - Meters Required

• 32mm ABS Plastic Pipe - Meters Required

• 40mm ABS Plastic Pipe - Meters Required

Filters & Chemicals

• Magna Clean Pro Filter Required

  Yes

  No

  N/A

• Filter Size

  15mm

  22mm

  28mm

• Scale Reducer Required

  Yes

  No

  N/A

• Scale Reducer Size

  15mm

  22mm

  28mm

• Inhibitor Requirement (Litres)

  0.5L

  1L

  1.5L

  2L

• System Cleaner Requirement (Litres)

  0.5L

  1L

  1.5L

  2L

• Describe The Scaffold Requirements (Incl Location, Type, How High, Access Details Etc)

• Image of Area to be Scaffold

  Media

• List all potential hazards or issues and take pictures (i.e Difficult residents, Difficult access, No parking etc)

• Is there any Notable & Existing Property Damage to Record (Incl Damaged Carpets, Marked walls, Holes in walls or ceilings etc) IMAGES MUST BE TAKEN