Ellensburg, WA · Kittitas County
Heating Equipment Code Verification Affidavit (Winter Design Temperature)
This form documents heating equipment details and code compliance for a residence, and is completed by the licensed HVAC contractor.
What this form is
The form records the residence address, heating equipment type and model, manufacturer, BTU rating, and licensed HVAC contractor information. The contractor certifies that the installed system will adequately heat the residence in accordance with the requirements stated on the form. It also includes an exemption section for a mini-split heat pump installed in an existing structure when the existing heating system remains installed and functional.
Who needs it
A licensed HVAC contractor completes this form for a residence’s heating system and indicates whether the existing-system mini-split exemption applies.
How to submit it
The form lists the Community Development Department at 501 N. Anderson, Ellensburg, WA 98926, and [email protected]. It does not state a submission method.
About notarization
This document is signed without a notary; the licensed contractor signs and dates it, and the exemption section also provides signature and date fields.
How to submit this form
- 1
Download The Form
Download the Heating Equipment Code Verification Affidavit.
- 2
Complete The Equipment Details
Enter the permit number, site address, heating equipment information, and licensed HVAC contractor details.
- 3
Review The Exemption Section
For a mini-split in an existing structure, indicate whether the existing heating system will remain installed and functional.
- 4
Sign And Submit
The contractor signs and dates the form. Contact the Community Development Department using the address or email listed on the form.
Frequently asked questions
- Do I need a notary for the Heating Equipment Code Verification Affidavit?
- No. The form has signature and date fields but no notary block; the contractor signs and dates it.
- Who completes this heating equipment form?
- The form requests information about the heating equipment and a licensed HVAC installer, and includes a certification for the contractor to sign.
- How do I submit the Heating Equipment Code Verification Affidavit?
- The form lists the Community Development Department’s address and email. It does not give a specific submission method.
- When does the mini-split heat pump exemption apply?
- The form says its requirements do not apply to a mini-split heat pump installation in an existing structure if the existing heating system remains installed and functional.