Scheduled For
Fire Prevention Bureau
Monroe Township Fire District One
Date: ____/____/____
24 Harrison Avenue  Monroe Township  NJ  08831
(732)251-0900 Ext. 3  fax (732)251-3279  E mail – Monroebofc@aol.com
Time: _____________
Application for Residential Certification of Smoke Detectors, Carbon Monoxide Detectors & Fire
Extinguisher Compliance
In accordance with N.J.A.C. 5:70-2.3 & N.J.S.A. 52:27D-198.1
Owner:
________________________________________________
Address:
________________________________________________
City, State, Zip:
________________________________________________
Phone Number:
________________________________________________
Cell Phone Number:
_____________________________________________________
Realtor Company:
________________________________________________
Realtor Name:
________________________________________________
Office Phone Number:
__________________Cell phone number: _______________
Address:
________________________________________________
City:
________________________________________________
State:
________________________________________________
Zip:
________________________________________________
Inspections based on N.F.P.A. 74 & N.F.P.A. 720
I hereby certify that I am the OWNER, REALTOR or REPRESENTATIVE for the above-described dwelling unit and request
an inspection be conducted for the issuance of a CERTIFICATION OF SMOKE DETECTOR, CARBON MONOXIDE
DETECTOR and FIRE EXTINGUISHER COMPLIANCE.
Signature: _______________________________
Date: ___ /___ /___
Payment may be made (Check, Cash or Money Order) in advance or on the day of the inspection.
(Pursuant to N.J.A.C. 5:70-2.9).
Inspectors
Initials:
Make Check Payable to: MTBFP Dist. #1
BUREAU USE ONLY
Request for Smoke, Carbon Monoxide & Fire Extinguisher certification received:
____More than 10 Business days
$35.00
Inspector filing Application
____ Between 4 – 10 Business days (no exceptions) $70.00
____ Less than 4 Business days (no exceptions)
$125.00
_____________________
____ Re-inspections due to inoperable, improperly
$30.00
located or the absence of required smoke detectors and/or carbon monoxide detectors, fire extinguisher,
or missed appointments. (no exceptions)
Payment: ____Cash (or) ____Check # ____________
Date Received _____/_____/_____
Initial:_________