2000, 07-19 Notice of Unsatisfactory ConditionS POK A N E "T, : � C O U N T Y
BUILDING AND CODE ENFORCEMENT
James L. Manson, C.B.O., Director
Robert Ackerly
1315 N Bowdish
Spokane, WA 99206
July 19, 2000
A DIVLSION OF THE PUBLIC WORKS DEPARTMENT
Gary Oberg, Director
RE: Notice of Unsatisfactory Condition - Basement Water Heater
Dear Robert Ackerly:
Our office has been informed that an unsatisfactory condition may exist with regard to the basement water heater
located at the referenced address.
This notice is to inform you that should you install new equipment, you must obtain a permit.
Should you have any questions, please contact this office between the hours of 8:00 a.m. and 4:00 p.m. Our phone
number is: (509) 477-3675.
der
Diane Riordan
Office Assistant IV
1026 W. BROADWAY • SPOKANE, WASHINGTON 99260-0050
PHONE: (509) 477-3675 • FAX: (509) 477-4703 • TDD: (509) 477-7133
Amp_ _
Utilities
Customer Name
NOTICE OF UNSATISFACTORY CONDITIONS
Address
TYPE OF
NOTIFICATION:
S-0308 (1-99)
Phone Number
City
❑ HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss
of life. The equipment has been turned off pending further inspection and repairs, arid shall not be turned back on until such repairs have
been completed by a qualified HVAC dealer, contractor, or service agency, and the equipment has been brought up to current safety
standards. Do not attempt to use this equipment until it has been repaired.
❑ WARNING The conditions noted below constitute a potential hazard. Although the condition does not present an immediate
threat to life or property, failure to correct the condition may lead to a hazardous condition. Please contact a qualified HVAC dealer,
contractor, or service agency to perform further inspections or to bring the equipment up to current safety standards.
Equipment Type: Location•
CONDITIONS
FOUND:
❑ Apparent cracked or restricted heat exchanger ❑ Inoperative safety system
❑ Spillage of exhaust at the draft hood after a ❑ Insufficient combustion/ventilation air
reasonable warm-up time ❑ Gas leak at gas equipment
❑ Damaged appliance connector ❑ Other
❑ Damaged or disconnected vent
❑ Defective limit control
❑ A gas leak in your house piping in the amount of CFH
with all known appliances off
I have read, understood and acknowledge receipt of this notice.
❑ Owner ❑ Tenant ❑ Agent
Customer Signature
Service Representative Date
Equipment Disconnected? ❑ Yes ❑ No Equipment Tag Left?
Equipment Left ❑ On ❑ Off Meter Left ❑ Off ❑ On
White Copy—Customer Yellow Copy—Attach to Service Order
❑ Yes
Time
❑ Refused to Sign
am/pm
❑ No
❑ No Authority Notification Required? ❑ Yes
Pink Copy—Authority Having Jurisdiction Hard Copy — Appliance