For businesses operating within New Jersey, adhering to the highest standards of fire safety is not just about compliance; it's a critical aspect of ensuring the well-being of both the employees and customers. This commitment to safety is where the Fire Safety Registration Form, issued by the New Jersey Department of Community Affairs Division of Fire Safety, comes into play. Aimed at businesses that are identified as possible Life Hazard Uses, this form is a mandatory step as laid out by the Uniform Fire Safety Act. The act’s purpose is clear: to prevent fire hazards by making sure businesses maintain a standard of safety that can significantly mitigate the risk of fire incidents. Completing and filing this form is not only a legal requirement but a preventive measure that could potentially save lives and property. With sections that cover everything from business ownership details, the physical location of the business, to comprehensive contact information, the form acts as a critical tool for the Division of Fire Safety to maintain records and ensure compliance. Penalties for non-compliance can reach up to $1,000.00, emphasizing the importance of the form as part of New Jersey's broader fire safety ecosystem. Whether the business is a corporation, partnership, government agency, or operates under a different structure, this form serves as a key component of New Jersey’s proactive approach to fire safety management.
| Question | Answer |
|---|---|
| Form Name | Fire Registration Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | fire registration online, new jersey fire registration, nj safety registration, fire safety registration form online |
New Jersey Department of Community Affairs
DIVISION OF FIRE SAFETY
PO Box 809
Trenton, New Jersey
Telephone: (609) |
FAX: (609) |
FIRE SAFETY REGISTRATION FORM
Owners of possible Life Hazard Use businesses must complete and file this form in accordance with the Uniform
Fire Safety Act (N.J.A.C.
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Part A – Business Registration |
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1. Business Ownership (mark the correct box): |
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(0) |
____ Corporation |
(1) ____ Private / Individual |
(2) ____ Partnership |
(3) ____ Condominium |
(4) |
____ Cooperative |
(5) ____ Government Agency |
(6) ____ LLC Corporation |
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2. Business/Corporation Mailing Address:
If Private / Individual: Name: __________________________________________________________________________
LastFirstMiddle Initial
If Other: ___________________________________________________________________________________________
Give FULL Legal Name of Ownership, Including Corporation, Incorporated, Partnership, T/A etc.
Address: __________________________________________________________________________________________
PO Box Number or Street Number and Name |
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City: _________________________ |
State: __________ |
Zip Code: ___ ___ ___ ___ ___ - ___ ___ ___ ___ |
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Federal Employer (Tax ID) Number |
Social Security Number (For Private / Individual Only) |
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In accordance with N.J.S.A. 52:27D |
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your social security number will ensure the efficiency of its program’s notification system. |
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Telephone: (____ ____ ____) ____ ____ ____ - ____ ____ ____ ____ |
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Continued on Reverse Side |
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FOR FIRE OFFICIAL / DFS USE ONLY |
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USE CODE (S): ___ ___ ___ ___ |
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LEA Number: ____ ____ ____ ____ - ____ ____ ____ |
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Assigned Owner Number: ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ |
____ New Application |
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Alternate Owner Number: ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ |
____ Transfer |
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3.Person To Receive Certified Mail Or Other Notices. If Same As Owner, Write “Same.” (Address must not be a PO Box)
Name: ___________________________________________________________________________________________
Address: __________________________________________________________________________________________
Number |
Street Name |
City: _________________________ |
State: ________ Zip Code: ___ ___ ___ ___ ___ - ___ ___ ___ ___ |
Telephone: (____ ____ ____) ____ ____ ____ - ____ ____ ____ ____
4. Briefly describe the building types and / or uses or businesses you own.
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___________________________________________________________________________________________________
___________________________________________________________________________________________________
(Physical location and name of the business)
5.Name of Building or Business: ________________________________________________________________________
Building Location: _________________________________________________________________________________
(Number and Street)
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Suite or Room Number: ___________ Municipality: __________________________ |
County: ________________ |
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6. |
___________________________ |
____________________________ |
_________________________________ |
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Block Number |
Lot Number |
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Municipal Tax Account Number |
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7. |
_______________________ |
________________ |
___________________ |
_____________________ |
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Height of Building (in feet) |
Number of Stories |
Square Footage |
Occupant Load |
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8.I certify that all statements made by me on this registration application are true. I am aware that if any of the foregoing statements made me are willfully false, I am subject to punishment.
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Signature of Owner or Agent Completing This Form |
Date |
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________________________________ |
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Printed Name of Owner or Agent Completing this Form |
Title |
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_______________________________________________________ |
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Street Address of Owner or Agent Completing This Form |
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_______________________________________________________ |
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City |
State |
Zip Code |
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Telephone Number of Owner or Agent Completing This Form: (__ __ __) ___ ___ ___ - ___ ___ ___ ___