Electrician: Consumer:
Address:
Representative:Distributor:
Telephone:
Email:
Address:
Telephone:
Email:
Return to:
Voltage: 120V 240V 208V
Regulator: Non programmable Programmable
End use: Radiant floor warming Radiant room heating
Subfloor: Plywood Concrete slab Other:
Floor covering: Stone Linoleum Ceramic
Floating wood flooring (
<
R*=1.4) Carpet (
<
R*=1.4)
Multilayer wood flooring Other:
Required Information
* R: Thermal resistance of floor covering. Example
Sketch of Room
Scale
=
Request # Received by:
Date: Time: Date required:
Plan is not readable as a result of poor fax transmission Dimensions are unreadable or inaccurate
Plan is too small to put to scale (inaccurate evaluation of floor area) Heated area is unclear
Other:
Technician: Date:
Indicate cabinets and fixtures (i.e., counter, shower, bathtub, vents, etc.) and location of the thermostat. Allow for a buffer zone where excess cable can be installed.
For Factory Use Only
Before ordering Reznor Model EFMA - Electric In-Floor Radiant Heating System, this form must be completed and faxed to: (724) 662-3957, or scanned and emailed to: ReznorHV[email protected].
A separate approval form will be returned with this one listing model number(s) and length(s).
Form I-EFMA-Layout
©2015 Nortek Global HVAC LLC
Phone: 800 695-1901 • www.ReznorHVAC.com
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