Permit # ____________________
I herby certify the following to be true:
I, _________________________________, have inspected the chimney located at
and have found it to be operable and free and clear of any obstructions. The chimney is constructed:
________with __________without a flue liner.
Flue Liner Certification
I also certify that, if applicable, the flue liner conforms with USBC Section M1801.1.1 equipment changes
which reads: Upon the replacement of new installation of any fuel burning appliances or equipment in
existing buildings, an inspection or inspections shall be conducted to ensure that the connected vent or
chimney systems comply with the following: 1) vent for chimney systems are sized in accordance with this
code 2) vent or chimney systems are clean, free of any obstruction or blockages, defects or deterioration
and are in operable condition.
Where not inspected by the local building department, persons performing such changes or installations
shall certify to the building official that the requirements of Items 1 and 2 of this section are met.
Company Name __________________________________________________________
Phone # _________________ State Registration # _________________________
Company Designee Name (Print) _____________________________________________
*Note: This certification must be completed before the final on this permit can be released by the City of