Form Fss - Claim For Property Tax Exemption For Automatic Fire Suppression Systems

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FSS (Rev. 7/2014)
CLAIM FOR PROPERTY TAX EXEMPTION FOR
AUTOMATIC FIRE SUPPRESSION SYSTEMS
Chapter 309, Laws of 1983 (N.J.S.A. 54:4-3.130 et seq.)
MUNICIPALITY: __________________________________
COUNTY: ______________________________
Section A: OWNER
Section E: TECHNICAL SITE DATA
Water Supply Source: _______________________
Owner’s Name: _______________________________________________________
Mailing Address: ______________________________________________________
Method of Alarm/Suppression System Supervision:
__________________________________________
City: ___________________________________ State: _____ Zip: ____________
Number
Block: ______ Lot: ______ Qual.: ______
Alarm Systems
Section B: LOCATION OF PROPERTY
[ ] System [ ] 110v Interconnected
[ ] CO Detectors/110v
If location of property is different than above, complete this section
Alarm Devices
Street Address: ________________________________________________________
(i.e., smoke, heat, pulls, water/flow)
____
City: ___________________________________ State: _____ Zip: ____________
Supervisory Devices
Block: ______ Lot: _______ Qual.: _______
(i.e., tampers, low/high air)
____
Signaling Devices
Section C: GENERAL CONTRACTOR
(i.e., horns/strobes, bells)
____
Name: _____________________________ Telephone Number: _______________
Other Devices: __________________
____
Suppression Systems
Mailing Address: ______________________________________________________
Fire Pump ___ GPM Type ___
____
City: ___________________________________ State: _____ Zip: ____________
Dry Pipe/Alarm Valves
____
Fire Protection Equipment, NJ Uniform Construction Code Permit No.: ___________
Pre-Action Valves
____
Fire Protection Equipment, NJ Div. of Fire Safety Installer No.: _________________
Sprinkler Heads (Wet & Dry)
____
Fire Alarm Contractor No.: _______________________ Exp. Date: ____________
Standpipes
____
Pre-Engineered Systems
Home Improvement Contractor Registration No. or Exemption Reason (if applicable):
_____________________________________________________________________
Wet Chemical
____
Dry Chemical
____
Federal Emp. ID No.: _______________________ Fax: ______________________
CO
Suppression
____
2
Section D: FIRE PROTECTION CHARACTERISTICS
Foam Suppression
____
FM200 Suppression
____
Use Group: Present ______ Proposed ______
Other: _______________________
____
Construction Class: Present ______ Proposed ______
Other Systems
Fire Alarm System: [ ] New [ ] Existing [ ] Addition [ ] Alteration
Kitchen Hood Exhaust System
____
Location of Panel: ______________________________________________
Smoke Control System
____
Fire Suppression/Standpipe System: [ ] New [ ] Existing [ ] Addition [ ] Alteration
Fireplace Venting/Metal Chimney
____
Location of Main Control Valve: ___________________________
Other: _______________________
____
COST OF ELIGIBLE AUTOMATIC FIRE SUPPRESSION SYSTEM:
$________________________________________
NOTE: Detailed cost breakdown of the proposed automatic fire suppression installation must be attached to this form.
Section F: Certification
The following declaration is submitted in accordance with the provisions of N.J.S.A. 54:4-3.130 et seq., and I certify it is true to the best of my knowledge and belief
and fully understand that such declaration will be considered as if made under oath, and, as to a false declaration shall be subject to the penalties as provided by law
for perjury.
_________________________
_________
Contractor/Installer Signature:
Print Name: ___________________________
Date:
Owner Signature: ______________________________________
Print Name: ___________________________
Date: __________
To the Tax Assessor: I hereby certify this application has been
approved/
disapproved.
Municipal Construction Official: ________________________________
Date: ________________
I have reviewed this application/certification and I
accept/
reject this claim for exemption.
Municipal Assessor: ______________________________________
Date: ________________

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