Your Name:

Your Company:


Your Email:


Address of Hazard:



Type of Hood:

 Filter     Water Wash


Style of Hood:

 Wall Mounted    Island


Size of Hood:


Number of Ducts for Exhaust:


Size of Exhaust Duct(s):


Size of Upper Plenum (if more than one duct) Length x Width x Height:


Appliances Left to Right in Cooking Order:
Appliance/Size/Fuel Type


Size of Gas Line (if applicable):


Total Current Draw for Electrical Appliances:


Building equipped with Fire Alarm?:

 Yes     No


Is there space to locate the cylinder close to the hood?:

 Yes     No

If No, how far away? On same floor?:


Type of Finish for Pipe and Fittings:

 Regular Black     Stainless Steel     Chrome


Do you require a drawing for approval?:

 Yes     No


Do you require a Fire Department Test?:

 Yes     No