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
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Utilities
Customer Name
Address
r_
TYPE OF
NOTIFICATION:
Equipment Type:
CONDITIONS
FOUND:
NOTICE OF UNSATISFACTORY CONDITIONS
S-0308 (1-99)
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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