Whippany Fire District No. 2
Bureau of Fire Prevention
440 Route 10
Tel:
Fax:
Application for Fire Safety Permit
LOCATION INFORMATION
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MUNICIPAL CODE: |
REGISTRATION #: |
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NAME: |
STREET ADDRESS: |
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MUNICIPALITY: |
COUNTY: |
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STATE: |
ZIP CODE: |
AREA CODE & PHONE#: |
APPLICANT INFORMATION
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APPLICANT NAME: |
APPLICANT STREET ADDRESS: |
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MUNICIPALITY: |
COUNTY: |
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STATE: |
ZIP CODE: |
AREA CODE & PHONE #: |
[ ] Permit requested for following
date(s):__________________________________________________________
[ ] Permit requested for one year –
Expiration Date:_________________________________________________
NOTE: Attach additional signed sheet if space is insufficient.
The above named
applicant hereby requests permission to conduct the following activity at the
above location:
______________________________________________________________________________________________
And/Or for the
storage, occupancy, use, sale, handling or manufacturing of the following:
______________________________________________________________________________________________
State quantities and
method for each category or material to be stored or used:
______________________________________________________________________________________________
I hereby acknowledge that the information given is correct, and agree
to comply with the applicable requirements of the New Jersey Uniform Fire Code
as well as any specific conditions imposed, and, if not, this permit may be
revoked and I will be subject to penalties as provided by law.
______________________________________________________________________________________________
Applicant’s Signature Title Date
See attached sheet for information concerning your administrative
appeal rights.
MAKE CHECK PAYABLE TO “WHIPPANY FIRE DISTRICT No. 2” AND MAIL TO:
The above address.
FOR OFFICIAL USE ONLY
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Permit
Type:________ [ ] Conditions Imposed [ ]
Denied [ ]
Approved pending payment of $_______ Fee** |
** Call the Bureau of Fire Prevention to determine permit fee amount.
Inspector:______________________
Appeal Rights
YOU MAY CONTEST THESE ORDERS AT AN ADMINISTRATIVE HEARING.
The request for a hearing must be in writing within 15 days of the
receipt of this order addressed to:
Office located at
In accordance with
the rules promulgated under the Administrative Procedure Act (N.J.S.A. 52:14B-1
et seq. and 52:14f-1 et seq.), an appeal request must sufficiently identify the
decision or action you wish to appeal and the specific reasons forming the
basis for your dispute, in order that a decision may be made as to whether your
appeal constitutes a contested case.
You are advised that
only matters deemed to be contested cases, as defined by the Administrative
Procedures Act, will be scheduled for a hearing. If a hearing is scheduled, you will be
notified of the time and place.
At a hearing, a Corporation
may be represented by a licensed attorney, unless approval is given by the
Construction Board of Appeals.