Download pdf - Smoke Questionaire and Application Questionaire...QUESTIONAIRE FOR CERTIFICATE OF COMPLIANCE SMOKE AND CARBON MONOXIDE DETECTOR Street address of property: Seller or Landlord of property:

PREVENTION THROUGH EDUCATION

P:(856)234-1222F:(856)234-4248E:[email protected]:225NorthLenolaRoadMoorestown,NJ08057Division of Fire Prevention Bureau of Fire Prevention www.FirePrevention31.org

QUESTIONAIREFORCERTIFICATEOFCOMPLIANCESMOKEANDCARBONMONOXIDEDETECTOR

Streetaddressofproperty: SellerorLandlordofproperty: Yearofconstruction: BuyerorTenantofproperty: Dateofpropertytransfer: Pleasereadthefollowingitemscarefullyandacknowledgebyinitialingeachitem. IunderstandthatanychangeofownershiporoccupancymaynotoccurpriortoasuccessfulinspectionandpossessionofaCertificateofInitialhere SmokeDetectorandCarbonMonoxide.Furthermore,Iunderstandthatifthereisanychangeofownershiporoccupancywithoutthe

requiredinspection,thepropertyownershallbesubjecttoapenaltyofnotlessthan$100.00ormorethan$2,500.00peroccurrence(N.J.A.C.5:70-2.3).

IunderstandthataFireInspectorfromMoorestownFirePreventionwillinspectthedwellingduringthescheduledtimeslot.IftheInitialhere assignedtimeslotismissedbytheapplicantortheapplicant’sagent,anothernon-refundableapplicationfeemustbepaid.Ialso

understandifIdonotpasstheinspection,ImustreturntoMoorestownFirePreventionofficesandpayare-inspectionfee.

IunderstandthatallsmokedetectorswithinthedwellingmustbeinstalledandmaintainedinaccordancewithNFPA72.IunderstandthatInitialhere allACpoweredsmokedetectorsmustbeelectronicallyinterconnected.Iunderstandthatthateachlevelofthedwellingunitisrequired

tohaveeitheranAC(electric)orDC(batterypowered)smokedetectorinstalled.IunderstandthatthetablebelowprovidesmewiththerequirementsoftheConstructionCoderegardingthenumberandtypeofsmokedetectorsthatarerequiredbasedontheyearthedwellingwasbuiltorCO(CertificateofOccupancy)wasissued.

Pre19751975–19771977–19831983–19911991-Present

DCpoweredsmokedetectoroneachlevel,includingbasementifapplicableACpoweredsmokedetectoronuppermostlevel(DCsmokedetectoronallotherlevels)ACpoweredsmokedetectoronuppermostandbasementlevel/DCsmokedetectorsonallotherlevelsACpoweredsmokedetectorsoneverylevelACpoweredsmokedetectorwithbatterybackuponeachlevelandineachsleepingarea(bedroom)

Iunderstandthatifthedwellingisequippedwithalowvoltagefirealarmsystem,installedbyanalarmcompany,thefirealarmsystemInitialhere mustbetestedandapprovedbyaNJlicensedfirealarmcontractorpriortotheinspection.Acopyofthealarmcertificationprovidedby

thealarmcontractormustbepresentedtothefireinspectoratthetimeofinspection.

Iunderstandthataneworrecentlyservicedwithanunexpiredtag,fullychargedandworkingfireextinguisherwithaminimumweightInitialhere of2½poundsandamaximumweightof10pounds,andwithanABCrating,mustbeinstalledwithin10feetofthekitchen,inthevicinity

ofanexit,notbehindacloseddoor.Iunderstandthatthefireextinguishershallbemounted,nohigherthan5feetfromthefloortothetopoftheextinguisher,andshallbevisibleandreadilyaccessibleforoccupantuse.

IunderstandthattheFireInspectorwillneedaccesstotheelectricalpanelandthatthecircuitforthesmokedetectors,ifapplicable,shallInitialhere belocatedandlabeledfortestingpurposespriortohis/herarrival.Thehomeowneroragentwillberesponsibleforturningthecircuitoff

andon.

Iunderstandthatifthedwellinghasatleastonefuelburningappliance,fireplaceorgarage,aCO(CarbonMonoxide)detectorshallbeInitialhere Installedoutsideofbutwithinthevicinityofallsleepingareas.COdetectorsinbedroomsonlywillnotpassperNFPA720.



IunderstandtheFireInspectorwillalsocheckthevisibilityandreadabilityofthehousenumbersonthedwellingtoverifytheyarevisibleInitialhere andreadablefromthestreetintheeventofanemergency.ThehousenumbersmustbepermanentlyaffixedtothehouseinArabic

numbers,approximately3incheshighand1inchwide.Iunderstandthathousenumbersmayneedtobelargerthan3-inchx1-inchinordertobevisiblefromthestreet.Brassandotherbrightmetallicnumeralsmustbeplacedonadarkorcontrastingbackground.Thenumbersshallnotbehiddenbytrees,shrubsordecorativetrim.

IunderstandthattheabovelisteditemsaretobecompletedBEFOREtheFireInspectorarrives,asher/shecannotinstallorrepairitems.InInitialhere theeventthatafailureoccurs,anewappointmentmustbemadeandpaidforpriortore-inspection.Ialsounderstandthepersonmeeting theinspectormustbe18yearsofage,orolder. PrintName:

Date:

Sign:

Pointofcontactforinspection: Phone:

AppointmentDate: AppointmentTime:



SmokeDetectors:Smokedetectorsaretobelocatedoneverylevelofadwelling.Inhomeswithonlyonesleepingareaoronefloor,adetectorshallbeinstalledinthehallwayoutsidethebedrooms.Inonestorydwellingswithseparatesleepingareas,asmokedetectorisrequiredoutsideeachsleepingarea.Inmulti-leveldwellings,smokeddetectorsshallbelocatedoutsidethesleepingareasandateverylevelofthedwelling.Asmokedetectorisrequiredtobeinstalledatthebottomofbasementstairwellsandtopofwalk-upatticstairwells,ifapplicable.

FireExtinguisher:

• ABCType• Minimumweight2½pounds/Maximumweight10pounds



APPLICATIONFORCERTIFICATEOFCOMPLIANCESMOKEANDCARBONMONOXIDEDETECTOR

ThefeeforissuanceofaCertificateofComplianceis$25.00.Thefeeincreasesto$35.00iftheapplicationissubmittedwithin5daysofinspection.Thefeemustaccompanythisapplication.Checkshouldbemadepayableto:MoorestownFirePrevention.Pleasesubmitacopyofthecontractofsaleorleaseagreementwiththisapplication.DateofApplication: DateofSettlement: AddressforInspection: RequestorName: Address: City: State: Zip: DaytimePhone: Emailaddress: Youarethe: ☐Owner☐Buyer/Lessee☐Agent BuyerorLesseeName: Address: City: State: Zip: PreferredmethodofdeliveryfortheCertificateofCompliance:☐Mail ☐Fax ☐EmailEmailAddress: Fax: IherebyacknowledgethatIhavereadthisapplication,thattheinformationgiveniscorrect,AndthatIamtheownerordulyauthorizedtoactintheowner’sbehalf.Signature: PrintedName: