Hackensack, MT · Bergen County
Chimney Verification for Replacement of Fuel-Fired Equipment
This chimney verification form is completed by a verifying individual for fuel-fired equipment replacements and submitted with or presented during the permit process.
What this form is
This form records verification of the chimney or vent for fuel-fired equipment replacements, new or additional appliances, and certain other work. The form says to provide it with the permit application for minor and emergency work, or present it to the code official before final inspection for all other work requiring a full permit. It requests work-site and owner details, appliance and vent information, and a signed verification statement.
Who needs it
A verifying individual completes this form for applicable fuel-fired equipment replacement or installation work covered by a permit.
How to submit it
For minor and emergency work, provide the form with the permit application; for all other work requiring a full permit, present it to the code official before final inspection.
About notarization
This form is signed and dated without a notary; the document does not identify any notarized attachment or related step.
How to submit this form
- 1
Download the Form
Download the Chimney Verification Form.
- 2
Complete the Form
Enter the work-site, owner, verifying-individual, appliance, and vent information, then select the applicable verification statement and sign and date it.
- 3
Gather Liner Documents
If installing a chimney liner, include all documentation on the liner with the permit application.
- 4
Submit for the Permit Process
For minor and emergency work, provide the form with the permit application; for full-permit work, present it to the code official before final inspection.
Frequently asked questions
- Do I need a notary for the Chimney Verification Form?
- No. The form calls for a signature and date but has no notary block; it does not identify any notarized attachment or related step.
- How do I submit the Chimney Verification Form?
- For minor and emergency work, provide it with the permit application. For all other work requiring a full permit, present it to the code official before final inspection.
- What information does the Chimney Verification Form request?
- It requests the work-site address, owner and verifying-individual details, replacement and vent information, appliance fuel types and ratings, and a selected verification statement.
Need something notarized?
This Chimney Verification for Replacement of Fuel-Fired Equipment doesn’t need a notary — but if you have another Hackensack form that does, a commissioned online notary can help.