2000, 08-04 Notice of Unsatisfactory ConditionsAIP4 TSTA NOTICE OF UNSATISFACTORY CONDITIONS
S-0308 (1-99)
Utilities
Customer Name
Address
Phone Number
City
TYPE OF ❑ HAZARD The conditions noted below constitute an immediate hazard and may result in property damage, personal injury, or loss
NOTIFICATION: of life. The equipment has been turned off pending further inspection and repairs, and 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.
Equipment Type:
CONDITIONS
FOUND:
❑ 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.
rAr,Location:
❑ Apparent cracked or restriCtgd heat�xchanger
❑ Spillage of exhaust at the draft hood after a
reasonable warm-up time
❑ Damaged appliance connector
❑ Damaged or disconnected vent
❑ Defective limit control
❑ A gas leak in your house piping in the amount of
with all known appliances off
❑ Inoperative safety system
❑ Insufficient combustion/ventilation air
❑ Gas leak at gas equipment
❑ Other
I have read, understood and acknowledge receipt of this notice. ❑ Owner ❑ Tenant ❑ Agent
Customer Signature
Service Representative—
Equipment Disconnected?
Equipment Left ❑ On
❑ Yes /rb No Equipment Tag Left? ❑ Yes ❑ No
❑ Off Meter Left ❑ Off ❑ On
Date
❑ Refused to Sign
V_05� 0 Xi Timeam/pm
f F1
Authority Notification Required? ❑ Yes ❑ No
WhiteCopy- Customer YellowCopy-AttachtoServiceOrder Pink Copy -Authority Having Jurisdiction Hard Copy -Appliance
S P O K A N E
BUILDING AND CODE ENFORCEMENT
James L. Manson, C.B.O., Director
August 17, 2000
Mary Ann Linger
N 702 Dick Road
Spokane, WA 99212
C O U N T Y
A DIVISION OF THE PUBLIC WORKS DEPARTMENT
Gary Oberg, Director
RE: Notice of Unsatisfactory Condition - Basement Furnace
Dear Mary Ann Linger:
Our office has been informed that an unsatisfactory condition may exist with regard to the basement furnace
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
erely,
Diane Riordan
Office Assistant IV
1026 W. BROADWAY • SPOKANE, WASHINGTON 99260-0050
PHONE: (509) 477-3675 9 FAX: (509) 477-4703 • TDD: (509) 477-7133