FIRE PERMIT APPLICATION



|FIRE PERMIT APPLICATION |

|INSTRUCTIONS |

|Application Type: |Indicate whether a new application or a renewal on drop down menu. |

|Name of Business: |Name of business to be permitted or parent company if applicable. (Example; Cranberry, Inc. dba Juice of|

| |America. |

|Street/P. O. Box: |Mailing address if different than premise to be permitted. Also, billing address. |

|City/State/Zip Code: |City, State and Zip Code of mailing address |

|Print Name of Person Responsible: |Print name of person as it should appear on permit. |

|Business Phone No.: |Telephone number for the permitted location |

|Emergency Phone No.: |Telephone number for the parent company. |

|Permit Address (or HFD Number): |Permit Address if different from mailing address. (Must be a physical address not a P. O. Box.) HFD |

| |Number applicable to Tank Vehicle permit request. |

|Permit Needed for: |Reason for applying for permit; whether, inspector requested or complying with fire code. |

|Permit Start Date: |Applicable to specials, tank installations and abandonment. |

|Estimated Job Completion Date: |Applicable to specials, tank installations and abandonment. |

|List Identification Number(s) and capacity: |Applicable to underground tank installation and tank vehicles. |

|Type of Permit: |Refer to list below instructions. |

|Permit Fee: |Refer to list below instructions. |

|Special Handling: |If applicable follow instruction on application. |

|Weekend or night inspections: |If applicable follow instruction on application. | |

|“Fees Paid with This Application are not Refundable”: |Please note this disclosure. |

|Signature/Application Date: |Person Responsible must sign and date application |

|Deed Restrictions and Law Compliance Affidavit: |Responsible Person must complete and have notarized the aforementioned affidavit. |

Table no. 106-A FEE SCHEDULE FOR FIRE PERMITS

| | | |

|PERMIT |PERMIT DESCRIPTION |FEE FOR ORIGINIAL |

|REFERENCE | |PERMIT AND EACH |

|NUMBER | |RENEWAL |

| | |THERE OF |

|a.1 |Aerosol products |$326 |

|a.2 |Aircraft refueling vehicles |See 1 below |

|a.3 |Aircraft repair hanger |$350 |

|a.4 |Appartatus access road access-control gates |See 2 below |

|a.6 |Reserved | |

|b.1 |Battery system |No Fee |

|b.2 |Bowling pin or alley refinishing |$290 |

|c.1 |Candles and open flames in assembly areas |$102 |

|c.2 |Carnivals, festivals, exhibitions and fairs |See 3 below |

|c.3 |Cellulose nitrate film use or storage |$250 |

|c.4 |Cellulose nitrate storage |$250 |

|c.5 |Combustible fiber storage |$326 |

|c.6 |Combustible waste storage |See 2 below |

|c.7 |Compressed gases |$250 |

|c.8 |Reserved | |

|c.9 |Cryogens |$250 |

|d.1 |Dry cleaning plants |$350 |

|d.2 |Dust – producing operations |$326 |

|e.1 |Explosives or blasting agents |$350 |

|f.1 |Reserved | |

|f.2 |Fireworks |$350 |

|f.3 |Flammable or combustible liquids |$290 |

|F.4 |Fruits ripening |$250 |

|f.5 |Fumigation or thermal insecticidal fogging |$102 |

|h.1 |Hazardous materials |$350 |

|h.2 |High-piled combustible storage |$250 |

|h.3 |Hot-work operations |$150 |

|k.1 |Key boxes or fire depository boxes |See 2 below |

|l.1 |Liquefied petroleum gases |$250 |

|l.2 |Liquid-or gas-fueled vehicles in assembly buildings |See 4 below |

|1.3 |Reserved | |

|m.1 |Magnesium working |$350 |

|m.2 |Mall, covered |$500 |

|m.3 |Motor vehicle fuel-dispensing |$225 |

|o.1 |Open burning |$250 |

|o.2 |Organic coatings |$326 |

|o.3 |Ovens, industrial baking or drying |$250 |

|p.1 |Reserved | |

|p.2 |Places of Assembly: | |

| |50 – 100 |$150 |

| |101 – 299 |$250 |

| |300 + occupants |$350 |

|p.3 |Pyrotechnical special effects materials |$350 |

|r.1 |Radioactive materials |$350 |

|r.2 |Roofing operations: | |

| |Asphalt kettles – |See 5 below |

| |Ignited torches – (annual repair permit) |See 6 below |

| |Site specific Permit - |$150 |

|r.3 |Reserved | |

|s.1 |Spraying or dipping |$290 |

|t.1 |Temporary membrane structures, tents and canopies |$176 |

|t.2 |Tire storage |$250 |

|t.3 |Tank removal, abandonment |See 7 below |

| | | |

1. $102 first unit, $76 each for additional units; not to exceed $350 per site

2. $75 for one unit, $150 for two or more units per site

3. $326 for carnivals and fairs; no fee for festivals and exhibitions

4. $110 for first unit, $75 each for additional units; not to exceed $260 per site

5. $110 for first kettle; $70 for each additional kettle; not to exceed $320 per owner

6. $102 for first torch; $76 for each additional torch; not to exceed $500 per owner

7. $175 for one tank; $250 for two tanks; $290 for three or more tanks per site

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