Fire Prevention Permit / Permission # FP
Services Requested: (choose one)
Fire District:
Inspection Date Request: (Provide 3)
Project Name:
Project Location:
Hamlet:
Tax Map #: 0200 -
Requester Information
Company Name:
Comp
any Address:
Town: S
tate: Zip:
Point
of Contact:
Telephone #:
Email:
Zip:
Party Responsible for Payment (if same as requester check box)
Name
:
Address:
Town: State:
Point of Contact:
Telephone #:
Email:
Reason for Request:
Terms & Conditions
The individual signing below requests accelerated service, as requested, and agrees to all terms and conditions list below.
I agree to submit payment for all accelerated services requested above based on the Division of Fire Prevention fee schedule and
that: a. Payment is due regardless of outcome of inspection or plan review. b. Payment for plan review is due at the time of
paperwork pickup. c. Payment for inspection(s) is due within 10 days after the inspection. d. No permits or certificates of compliance
will be issued until all fees are paid. e. Failure to submit payment in a timely fashion may result in the revocation of any permits or
certificates of compliance issued by the Division of Fire Prevention, as well as appropriate legal action. f. It is the responsibility of the
Requester to ensure all parties / contractors are present and ready for final inspection of any and all open permits / permissions at
the time of the inspection, with the exception of progress inspections, i.e. rough piping, light bulb test, pre-backfill.
Cancellation of an accelerated inspection with less than 24 hours (business day) prior to the scheduled time of inspection will result
in a charge of 50% of the fee. Failure to cancel an accelerated inspection within two hours of the scheduled time of inspection or
failure to appear for the inspection will result in a charge of 100% of the fee. Cancellations must be made to a member of the Fire
Prevention Staff in person or via telephone. Email and /or voice mail is not acceptable.
By signing below, I understand and agree to the terms and conditions above:
Signature: Print Name:
Date:
Req
uest Approved: Date: CFM: SFM / FM: Date
Request Denied: Date: CFM: Clerical: Date
AM PM
DEPARTMENT OF PUBLIC SAFETY
DIVISION OF FIRE PREVENTION
Accelerated Service Request Form FP-05 rev. 3/18
office use only - time stamp
This form can be downloaded and form fillable. Go to www.brookhavenny.gov/fire (click the forms tab)
RESET FORM
For Inspection Requests Only- Not for Plan Review Request
office use only
click to print
Section
B
lock
Lot
