Woodburning or Other Solid Fuel Stove Questionnaire

Woodburning or Other Solid Fuel Stove Questionnaire

Who Installed the Unit?

It is a:

Woodburning Stove (Freestanding)

Fireplace Insert

Furnace Modification or Add On

What Type of Fuel is Used

Is the Unit UL Approved

Is this Unit The Primary Heat Source for the Dwelling?

Is This Unit Thermostatically Controlled

The following conditions are requirements:
A. Flue pipes must be kept three times the pipe diameter away from combustibles.

B. Wall: Stove must be placed at least 36" from combustible wall or furnishings or at least 18" from non- combustible shield with 1" air space to combustible wall.

C. Floor: A noncombustible surface below the stove must extend at least 24" beyond the door and 12" beyond the side and rear of the stove. If the stove has 6" high legs, this surface must consist of 2" of solid masonry with a pad of 24-gauge sheet metal on top or bottom of the masonry. If the legs are only 2" to 6" high, there must be at least 4" of hollow masonry with ends unsealed and joints matched to provide free airflow. Stoves with less than 2" legs cannot be put on combustible floors regardless of protection.

D. Ceiling: There must be at least 18" between the top of the unit or stovepipe and the ceiling.

E. A metal container with tight fitting lid must be available for ash disposal. F. The thimble collar or opening must be noncombustible and at least three times the diameter of the stovepipe. G. Installation of a minimum of one smoke detector per woodburning unit. The detector must be located on the same floor as the stove.

Are All These Requirments Met?

If not, Explain

Is the Stove, Chimney, or Stovepipe Inspected and Cleaned Each Year?

By Whom

NOTE: Our Agent May Be Asked To Verify That The Unit And Its Component Have Been Cleaned Annually.

Will You Provide This Information(Verbal Or Written) If Requested?

Please note that coverage is not bound or altered unless confirmation is received from an agent. You also agree to release us from any liability if this information is accidentally viewed by unauthorized others. We will only use this information for insurance quoting purposes.