Business License Application - North Pole - Alaska Page 3

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North Pole Fire Department
Pre-Fire Questionnaire
The purpose of this questionnaire is to help us help you during an emergency. Please fill this form out as completely as
possible. Please contact the Fire Department at 488-2232 if you need any assistance to complete this form. Let us know
immediately if any of this information changes so we can update our records. Thank you for your assistance.
Business Name
Phone
FAX
Address (physical location)
City
State
ZIP
Emergency Contact Information
Fire Protection Systems Present and Working
Primary Contact
Battery Powered Smoke Detectors
____________________________(
)_________
Name
Phone
110v Smoke Detectors
____________________________(
)_________
Sprinkler System
Address
Cell Phone
__________________________________________
Standpipe
City
State
Zip
Fire Suppression System
Secondary Contact
____________________________(
)__________
Name
Phone
Other_________________________________
_________________________________________
____________________________(
)_________
_________________________________________
Address
Cell Phone
_________________________________________
__________________________________________
_________________________________________
City
State
Zip
Hazards Specific to Type of Business
Type of Building Construction
Mixed commercial/residential occupancy
Standard Wood Frame (Protected)
Firearms, ammunition, explosives, etc…
Indicate below what type and amount.
Standard Wood Frame (Unprotected)
Hazardous Materials stored on premises
(Please include copy of MSDS for each)
Fire Resistive
Equipment generating heat, sparks or flame.
Please list______________________________
Ordinary construction
______________________________________
Activities in which injuries are likely to occur.
Non-combustible
______________________________________
Confined space activities likely.
Light Weight
Special rescue situations that might occur_____
______________________________________
Heavy Timber
What do you think the Fire Department should know about your business?
Revised 12/10

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