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Valleyair.org/burncleanerFIREPLACE DECOMMISSIONING FORMAPPLICANTThis form must be completed and signed when decommissioning a wood burning fireplace and is required for new electric heat pump applications.
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How to fill out fireplace decommissioning form

01
Obtain the fireplace decommissioning form from your local building department or online.
02
Fill out the form with your personal information such as name, address, and contact details.
03
Provide details about the fireplace you wish to decommission, including its location and reason for decommissioning.
04
Follow any additional instructions on the form, such as including any required supporting documents or signatures.
05
Submit the completed form to the appropriate authority for review and approval.

Who needs fireplace decommissioning form?

01
Property owners who no longer wish to use their fireplace or are looking to permanently remove it from their home.
02
Contractors who are hired to decommission fireplaces as part of a renovation or demolition project.
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The fireplace decommissioning form is a document used to officially retire or disable a fireplace in a property.
Property owners or landlords who want to decommission a fireplace are required to file the fireplace decommissioning form.
To fill out the fireplace decommissioning form, property owners need to provide information about the property, the fireplace to be decommissioned, and the reason for decommissioning.
The purpose of the fireplace decommissioning form is to inform authorities that a fireplace in a property is no longer in use and to ensure compliance with safety regulations.
Information such as property address, fireplace location, date of decommissioning, reason for decommissioning, and signature of the property owner must be reported on the fireplace decommissioning form.
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