BUREAU OF FIRE PREVENTION
PINE HILL FIRE DISTRICT
1109 ERIAL ROAD
PINE HILL,NEW JERSEY 08021
PHONE (856) 784-3994 FAX (856) 784-1195
INSPECTION REQUEST FORM
SMOKE DETECTOR & CARBON MONOXIDE DETECTOR & FIRE EXTINGUISHER
ADDRESS OF PROPERTY____________________________________________________________________
BLOCK_____________________________________ LOT__________________________________________
DATE OF CONSTRUCTION____________________________________________________________________
SELLER'S NAME____________________________________________________________________________
BUYER'S NAME_____________________________________________________________________________
REALTOR___________________________________________________________________________________
REALTOR ADDRESS_________________________________________________________________________
CONTACT PERSON__________________________________________PHONE #________________________
SETTLEMENT DATE__________________________________________________________________________
ALL THE ABOVE INFORMATION IS REQUIRED TO PROCESS THE REQUEST
OFFICE USE ONLY
SMOKE DETECTOR CO DETECTOR FIRE EXTINGUISHER
PASSED_________ PASSED______________ PASSED _____________
FAILED__________ FAILED_______________ FAILED ______________
DATE PASSED_________________ DATE PASSED_______________ DATE PASSED_________________
NOTE: THE FEE FOR THIS INSPECTION IS $35.00
PAYABLE TO THE PINE HILL FIRE DISTRICT.
TEN DAYS NOTICE IS REQUIRED FOR ALL INSPECTIONS.
INSPECTION REQUEST WITHIN 4-9 DAYS = $70.00
INSPECTION REQUEST WITHIN 3-1 DAYS = $125.00
