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2002, 02-06 Notice of Unsatisfactory ConditionBUILDING AND CODE ENFORCEMENT James L. Manson, C.B.O., Director Beverly Derr E 12017 Mansfield Spokane, WA 99206 A DIVISION OF THE PUBLIC WORKS DEPARTMENT February 6, 2002 RE: Notice of Unsatisfactory Condition — Boiler Dear Mrs Derr: Our office has been informed that an unsatisfactory condition may exist with regard to the boiler 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 8:30 a.m. and 5:00 p.m. Our phone number is: (509) 477-3675. det cerely, Diane Truax Office Assistant IV 1026 W. BROADWAY • SPOKANE, WASHINGTON 99260-0220 PHONE: (509) 477-7200 • FAX: (509) 477-2243 • TDD: (509) 477-7133 qui vLSTA Utilities Customer Name Address r_ TYPE OF NOTIFICATION: Equipment Type: CONDITIONS FOUND: NOTICE OF UNSATISFACTORY CONDITIONS S-0308 (1-99) ! �� Phone Number .J J yl ' y e G 7 n t '' 7;z/iv -7- : / 7_4,1 City 7-.P 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, 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. ❑ 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. 011_6.. ❑ Apparent cracked or restricted heat exchanger ❑ 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 I have read, understood and acknowledge receipt of this notice. Location. ❑ Owner ❑ Inoperative safety system ❑ Insufficient combustion/ventilation air ❑ Gas leak at gas equipment ❑ Other • i CFH /Via 3T' ❑ Tenant ❑ Agent Customer Signature Service Representative Date lG •/) Z - 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 ❑ Yes ❑ No ❑ No Authority Notification Required? Pink Copy— Authority Having Jurisdiction HardCopy— Appliance