Stafford Township, MT · Ocean County
Chimney Verification for Replacement of Fuel-Fired Equipment
This form records chimney and vent verification for fuel-fired equipment replacement and is completed by the verifying individual for a permit or inspection.
What this form is
Use this form to report details about replacement fuel-fired appliances and verify that the chimney or vent is in good repair, clear, and appropriately lined and sized. For minor and emergency work, provide it with the permit application; for other work, present it to the code official before final inspection. It requests work-site, owner, verifier, appliance, vent, liner, and signature information.
Who needs it
The verifying individual for fuel-fired equipment replacement completes this form, and the permit applicant provides it when required for the work.
How to submit it
For minor and emergency work, provide the form with the permit application. For all other work, present it to the code official before final inspection.
About notarization
This form is signed and dated without a notary; if a chimney liner is being installed, include all liner documentation with the permit application.
How to submit this form
- 1
Download the Form
Download the Chimney Verification for Replacement of Fuel-Fired Equipment PDF.
- 2
Complete the Form
Supply the requested information and select the applicable replacement, vent, and verification options.
- 3
Gather Liner Documentation
If installing a chimney liner, include all documentation on the liner with the permit application.
- 4
Provide the Form
For minor and emergency work, provide it with the permit application; otherwise present it to the code official before final inspection.
Frequently asked questions
- Do I need a notary for the Chimney Verification form?
- No. The document has signature and date fields but no notary block. If installing a chimney liner, include all liner documentation with the permit application.
- How do I submit the Chimney Verification form?
- For minor and emergency work, provide it with the permit application. For all other work, present it to the code official before final inspection.
- What information does the form ask for?
- It asks for work-site, owner, verifier, appliance, fuel, vent, and liner details, along with the applicable verification statement and signature.
- Can a homeowner use this instead of an inspection?
- No. The form states that it may not be submitted by a homeowner in lieu of the required inspection.
Need something notarized?
This Chimney Verification for Replacement of Fuel-Fired Equipment doesn’t need a notary — but if you have another Stafford Township form that does, a commissioned online notary can help.