Smoke Cert Application-online version

Smoke Cert Application-online version
ANDOVER TOWNSHIP BUREAU OF FIRE PREVENTION
134 NEWTON-SPARTA ROAD ~ NEWTON, NJ 07860
Phone: 973-383-4280
Fax: 973-383-5039
APPLICATION FOR ONE & TWO FAMILY DWELLING CERTIFICATION OF
SMOKE DETECTOR, CARBON MONOXIDE DETECTOR AND FIRE EXTINGUISHER COMPLIANCE
PART I - To be completed and returned to above address with application fee made payable to Andover Township
Dwelling Location: Block:
Lot:
Address:
I,
, as owner or an authorized representative of the owner, hereby request an inspection of the above referenced
location for the purpose of obtaining a certification of smoke detector, carbon monoxide alarm and fire extinguisher compliance.
Date of Application:
Closing Date:
Name of Contact Person:
Phone Number:
Address where certificate is to be sent:
Phone Number:
Fax Number:
PART II – To be completed by homeowner or homeowner’s agent
This is a
story dwelling.
with a basement
with a fuel burning appliance
without a basement
without a fuel burning appliance
with an attached garage
without an attached garage
I,
, certify that the dwelling at the above referenced location has smoke detectors installed as follows:
On each level of the dwelling, including basements,
Outside each separate sleeping area (within 10 feet of each bedroom); and
All smoke detectors are in working order.
The detectors required above shall be listed in accordance with ANSU/UL-217 and located in accordance with NfiPA 74-1984.
The detectors are not required to be interconnected. Battery powered detectors are acceptable. Note: Homes constructed
after January 1977 provided with AC powered and/or connected detectors shall be maintained in working order. See diagrams
on the reverse side of this application for further information regarding the installation of smoke detectors.
I further certify that:
A carbon monoxide alarm is installed and working in the immediate vicinity of each sleeping area (within 10 feet of each
bedroom)
A carbon monoxide alarm is not required since there is no attached garage or fuel (wood, as or oil) burning appliance.
Carbon monoxide alarms shall be shall be listed and labeled in accordance with UL-2034 and installed in accordance with NFiPA
720. They may be battery-operated, hard-wired and of the plug-in type and can be mounted on the ceiling or wall at any
height except the 4 inches of dead air space where the wall meets the ceiling.
The Legislature amended and enacted P.L. 1991, c.92 (C.52.27D-198.1), requiring that all one and two family dwellings at a
change of occupancy be provided with a portable fire extinguisher, in addition to the requirements for smoke and carbon
monoxide detectors. The requirements for the type and placement of the extinguishers are as follows:
At least one portable fire extinguisher shall be installed in all one and two family dwellings (except seasonal rental
units) upon change of occupancy;
The extinguisher shall be listed, labeled, charged and operable;
The size shall be no smaller than 2A.10B.C, rated for residential use and weigh no more than 10 lbs.
The hangers or brackets supplied by the manufacturer must be used;
The extinguisher must be located within 10 fee of the kitchen;
The top of the extinguisher must not be more than 5 feet above the floor;
The extinguisher must be visible and in a readily accessible location, free from being blocked by furniture, storage or
other items;
The extinguisher must be accompanied by an owner’s manual or written information regarding the operation,
inspection, and maintenance of the extinguisher; and
Lastly, the extinguisher must be installed with the operating instruction clearly visible.
Applicant’s Signature
Print/Type Name
Date
PART III – CERTIFICATION OF COMPLIANCE
NOT VALID UNTIL APPLICATION FEE IS PAID AND SIGNED BY THE FIRE OFFICIAL/FIRE INSPECTOR.
THE ABOVE DWELLING HAS BEEN INSPECTED AND FOUND TO BE IN COMPLIANCE WITH THE SMOKE AND CARBON MONOXIDE DETECTOR
REQUIREMENTS OF THE NEW JERSEY UNIFORM FIRE CODE. AT THE TIME OF INSPECTION, THERE WERE
SMOKE DETECTORS,
CARBON MONOXIDE DETECTORS AND
FIRE EXTINGUISHERS INSTALLED.
PERMIT FEE PAID:
CASH
CHECK NO.
SIGNED:
Amount:
Received:
DATE:
FIRE OFFICIAL/FIRE INSPECTOR
(EXPIRES IN 6 MONTHS, NON-TRANSFERABLE)
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