Read Microsoft Word - Chimney Inspection Form 11-01-2009 text version

Chimney Inspection Form

Please check the correct statement and sign below. I / We do use the fireplace & the chimney inspection receipt is attached I / We do not use the fireplace. I / We have converted the fireplace to propane. Please print your name and unit number and sign below:

Homeowner Name (Please Print)

Address

Signature

Date

You may use any licensed and insured chimney sweep company of your choice. Please fill out form and send to: The Villages at Freedom Green c/o Westford Real Estate Management, LLC 50 Founders Plaza, Suite 207 East Hartford, CT 06108 Fax ­ 860-528-2989

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Microsoft Word - Chimney Inspection Form 11-01-2009

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