HEATING APPLIANCE* INSTALLATION Regulation 30 COMPLIANCE CERTIFICATE (* A stove, heater or similar appliance that burns oil or solid fuel) To: Permit Authority Address Suburb/postcode Details of installation: Address: (address of installation) (X the applicable box.) flue only: new: second-hand: replacement: freestanding: built-in: Appliance type: fuel used: Make: model No.: (X the applicable box.) Manufacturer: AS 2918- tested: yes: no: Address: compliance cert. No. emission cert. No. Flue type: hearth type: Owner/installer details: Owner: Contact person: Address: Phone No: Fax No: Email address: Installer: Address: Phone No: Fax No: Registration No. Email address: (if applicable): Notification and Certification details: I certify that the installation of the heating appliance referred to above, has been carried out in accordance with the National Construction Code. Note: this notification must be supplied to the Permit Authority within 7 days of the installation. Name: [print] Signed Date (Delete one not applicable) Owner/Installer:
HEATING APPLIANCE* INSTALLATION COMPLIANCE CERTIFICATE Regulation 30 (* A stove, heater or similar appliance that burns oil or solid fuel) To: Permit Authority Address Suburb/postcode Details of installation: Address: (address of installation) (X the applicable box.) new: second-hand: replacement: freestanding: built-in: flue only: Appliance type: fuel used: Make: model No.: (X the applicable box.) Manufacturer: AS 2918- tested: yes: no: Address: compliance cert. No. emission cert. No. Flue type: hearth type: Owner/installer details: Owner: Contact person: Address: Phone No: Fax No: Email address: Installer: Address: Phone No: Fax No: Registration No. (if applicable): Email address: Notification and Certification details: I certify that the installation of the heating appliance referred to above, has been carried out in accordance with the National Construction Code. Note: this notification must be supplied to the Permit Authority within 7 days of the installation. (Delete one not applicable) Name: [print] Signed Date Owner/Installer:
Form-54-Heating-Appliance-Installation-Compliance-Certificate.DOCX