PISCATAWAY FIREPREVENTION BUREAU

555 SIDNEY ROADPISCATAWAY, NEW JERSEY 08854

(732)562-2315

INSTRUCTIONS FOR SMOKE DETECTOR/CARBON MONOXIDEALARM AND FIRE EXTINGUISHER COMPLIANCE APPLICATION

1. FORM MUST BE FILLED OUT COMPLETELY OR FORM CANNOT BE PROCESSEDOR RECEIVED BY THE FIRE PREVENTION OFFICE.

2. YOU MUST CHECK ALL ( 5 ) BOXES ON TOP OF THE FORM STATING YOU HAVEWORKING SMOKE DETECTORS, CARBON MONOXIDE DETECTORS AND A FIREEXTINGUISHER. PLEASE PROVIDE A RECEIPT FOR A NEW FIRE EXTINGUISHER.

3. YOU MUST HAVE AT LEAST ONE WORKING CARBON MONOXIDE DETECTOR INYOUR HOUSE OUTSIDE ALL SLEEPING AREAS.

4. FORM MUST BE FILLED OUT LEGIBLE.

5. FORM MUST BE SIGNED AND NOTORIZED.

6. FORM MUST HAVE YOUR BLOCK AND LOT NUMBERS

7. THE OWNER MUST LEAVE A DAYTIME PHONE NUMBER WHERE THEY CANBE REACHED.

8. THE CLOSING DATE WILL DETERMINE THE COST OF THE CERTIFICATION.

9. THE FEE SHOULD BE MADE OUT TO PISCATAWAY FIRE PREVENTIONBUREAU.

10. THE OWNER CAN AUTHORIZED A REPRESENTATIVE , A LETTER DATEDAND SIGNED BY THE OWNER STATING THEY GIVE PERMISSION TO THEREPRESENTATIVE (NAME OF PERSON) TO FILLED OUT THE APPLICATIONFORM. RECEIPT FOR THE FIRE EXTINGUISHER MUST BE ATTACHED.THE LETTER MUST BE ATTACHED WITH THE APPLICATION.

1 1 . FEE SCHEDULE IS AS FOLLOWS:

A. $35.00 IF NEEDED AFTER TEN (10) BUSINESS DAYS.B. S70.00 IF NEEDED FOUR (4) TO TEN (10) BUSINESS DAYS.C. S125.00 IF NEEDED BEFORE FOUR (4) BUSINESS DAYS.D. S25.00 IS REQUIRED IF MORE THAN TWO (2) INSPECTIONS ARE

NEEDED. S25.00 PER EACH INSPECTION.

AS PER ORDINANCE 06-01

**NOTICE **APPLICATION PROCESSING FEE .YOU MUST HAVEEXACT CASH, CERTIFIED BANK CHECK OR MONEYORDER WILL BE ACCEPTED. NO PERSONAL CHECKS

PAGE ONE OF THREE

PISCATAWAY TOWNSHIPFire Prevention Bureau

555 Sidney RoadPiscataway, N . J . 08854

Phone: ( 7 3 2 ) 562-2315

APPLICATION FOR ONE and TWO FAMILYCERTIFICATION OF SMOKE DETECTOR COMPLIANCE/CARBON MONOXIDE ALARM

AND FIRE EXTINGUISHER COMPLIANCE

Dwel l ing Locat ion: Block: Lot:

Street :

Municipali ty: , New Jersey Z I P :

I ( ~ , .. cert ify that the dwelling at the above referencedlocation has smoke detectors, carbon monoxide d e t e c t o r ( s ) and f i re ext inguisher (s) instal led and anin working order as listed below:

[ ] On each level of the dwel l ing, inc luding basements ; excluding a t t i c or crawl space; and

[ ] Outside each separate sleeping area ; and

[ ] All smoke detectors are in working order.

1 ] Carbon monoxide a l a r m ( s ) are in working order and outside each sleepingArea .

[ ] Fire ext inguisher installed within (10) feet of the ki tchen and not morethan (5 ) fee t above the floor level.The size must be no smaller than2:A 10BC and weigh no more than ( l O ) p o u n d s .

PLEASE PROVIDE A RECEIPT FOR A NEW FIRE E X T I N G U I S H E R * *

This inspection shall be conducted by the owner or an authorized representa t ive of the owner .The detectors required above shall be located in accordance with NFiPA 7 4 . The detectors arenot required to be interconnected. Ba t t e ry powered detectors are acceptable. Note: Homesconst ructed a f t e r J anua ry , 1977 provided wi th AC powered and/or in t e rconnec ted detectorsshall be ma in ta ined in w o r k i n g order . See d iagram for f u r t h e r i n fo rma t ion rega rd ingin s t a l l a t i on on the back of this app l i ca t ion .*Carbon monoxide d e t e c t o r ( s ) shallbe l isted in accordanace with U L - 2 0 4 3 and NFPA 7 2 0 .

Address Cer t i f i ca te to be sent :

Phone number :

I do hereby c e r t i f y that the foregoing statements made by me are t r u e . I am aware t h a t if anyof the foregoing statements made by me are wi l l fu l ly fa lse , I will be subjec t to p e n a l t y .

Sworn and subscribed to before me this day of » 20

N o t a r y Si^n^Tu^F" O W N E R / A U T H O R I Z E D PARTY S I G N A T U R E

SEAL Pr inted Name

PLEASE P R O V I D E Y O U R TENATIVE CLOSING DATE:

PAGE TWO OF THREE

3"1 PAGE OF THREE FOR SMOKE/CARBON DETECTOR COMPLIANCE APPLICATION FORMLEGEND MAP FOR SMOKE/CARBON MONOXIDE DETECTOR PLACEMENT

WHERE TO LOCATED:DETECTORS ARE TO BE LOCATED ON EVERY LEVEL OF A RESIDENCE, FIRST FLOOR.SECOND FLOOREXCLUDING CRAWL SPACES AND UNFINISHED ATTICS AND IN EVERY SEPARATE SLEEPING AREA,BETWEEN SLEEPING AREAS AND LIVING AREAS SUCH AS THE KITCHEN ,GARAGE,BASEMENT OR UTILTYROOM. HOUSES WITH ONLY ONE SLEEPING AREA ON ONE FLOOR A DETECTOR IS TO BE PUT IN THEHALLWAY OUTSIDE THE BEDROOMS AS SHOWNED IN FIGURE L IN SINGLE FLOOR FAMILY HOMES WITHTWO SEPARATE SLEEPING AREA TWO DETECTORS ARE REQUIRED OUTSIDE EACH SLEEPING AREA ASSHOWN IN FIGURE 2. IN MUTl-LEVEL HOMES DETECTORS SHOULD BE LOCATED OUTSIDE SLEEPING AREASAND IN EVERY LEVEL OF THR HOMES AS SHOWN IN FIGURE 3.

WHERE NOT TO LOCATE DETECTORS:KITCHEN SMOKE FROM COOKING MAY CAUSE A NUISANCE ALARM.BATHROOMS EXCESSIVE STEAM FROM A SHOWER MAY CAUSE A NUISANCE ALARM.FORCED AIR DUCTS USED FOR HEATING OR AIR MOVEMENT MAY PREVENT SMOKE FROM REACHINGDETECTOR.AIR FURNANCES OF ANY TYPE AND DUCT MOVEMENT AND NORMAL COMBUSTION PRODUCTSMAY CAUSE A NUISANCE ALARM.DEAD AIR SPACE WHERE THE CEILING MEETS THE WALLS AS SHOWN ITS FIGURE 5. OR OF AN " A" FRAMETYPE OF CEILING , "DEAD AIR" AT THE TOP MAY PREVENT SMOKE FROM REACHING DETECTOR.OTHER INFORMATION REGARDI7MG PLACEMENT OF DETECTOR LOCATIONS.'OTHER INFORMATION ABOUT DETECTOR PLACEMENT CONSULT THE NATIONAL FIRE PROTECTIONASSOCIATION PUBLICATION UNIT BATTERY PARK , QUINCY MA.

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1 , r

Bedroom

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Bedroorn

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Bedroom

TVRoom

DiningRoom

Kjtchcn Bedroom

Living Room

Bedroom

Bedroom

CURE 1.FIGURE 2.

1 CAJR.BON MONOXIDE DETECTORS ARE TO BE LOCATED OUTSIDE OF EACH SLEEPING AREA"

icdroom

LivingRoam

HjdlBedroom

DiningRoom

FIGURE 3. FIGURE 4.

FIGURE 5.NOTE MEASUREMENT SHOWN ARE TO THE CLOSEST EDGE OF THE DETECTOR

FIGURE 5.

NEVERHERE

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