South Orange, MT · Essex County
Chimney Verification for Replacement of Fuel-Fired Equipment
This form records chimney and vent verification for fuel-fired equipment work and is completed by the verifying individual for a permit application or inspection.
What this form is
This form records verification of the chimney or vent for replacement or installation of fuel-fired equipment. For minor and emergency work, it must accompany the permit application; for other work, it must be presented to the code official before final inspection. It asks for replacement and appliance details, chimney and liner information, work-site and owner details, and a signed verification statement.
Who needs it
The verifying individual for fuel-fired equipment work must complete the applicable sections and provide the form with the permit application or before final inspection.
How to submit it
For minor and emergency work, provide this form with the permit application. For other work, present it to the code official before final inspection; the document gives no submission address.
About notarization
This document is signed without a notary; the signer just signs and dates the applicable verification statement.
How to submit this form
- 1
Download The Form
Download the Chimney Verification for Replacement of Fuel-Fired Equipment PDF.
- 2
Complete The Applicable Sections
Provide the requested work-site, owner, appliance, chimney, and vent details, and select the applicable replacement type.
- 3
Gather Liner Documentation
If installing a chimney liner, gather all documentation on the liner to accompany the permit application.
- 4
Sign And Submit
Sign and date the applicable verification statement. Provide the form with a minor or emergency work permit application, or present it before final inspection for other work.
Frequently asked questions
- Do I need a notary for the Chimney Verification form?
- No. The form has signature and date lines but no notary block. The signer just signs and dates the applicable verification statement.
- How do I submit the Chimney Verification form?
- For minor and emergency work, provide it with the permit application. For other work, present it to the code official before final inspection.
- What information does the Chimney Verification form ask for?
- It asks for replacement type, appliance and vent details, chimney and liner information, work-site and owner details, and a signed verification statement.
- Are liner documents required with this form?
- If a chimney liner is being installed, the form says all documentation on the liner must accompany the permit application.
Need something notarized?
This Chimney Verification for Replacement of Fuel-Fired Equipment doesn’t need a notary — but if you have another South Orange form that does, a commissioned online notary can help.