Blank Fee Ordinance Acknowledgment Fillable Form
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| Pages | 1 |
|---|---|
| File Size | 0.2 MB |
| Folder | Departments/Fire Department |
| OCR Status | Searchable (OCR processed) |
| Source URL | Original |
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Waterford Fire Services 204 Boston Post Road Waterford, CT 06385 860-440-0544 Fire Marshal/Forms/Ordinance Acknowledgement 1/9/2024 Fire Marshal’s Office Fee Per Waterford Town Ordinance Chapter 2.36.075 - Fire Service Date request received at Fire Marshal’s Office: _______________________ Date Completed Fee Acknowledgment Form Received: _________________________ I confirm that I have received, read and understand the Waterford Ordinance 2.36.075 - Fire Marshal fee schedule and enforcement. I understand that it is my responsibility to comply with the terms stated in the Ordinance that “No permit or required certificate shall be issued to any party until the fee for such permit or certificate has been submitted with the appropriate application”. The undersigned acknowledges ordinance fee listed below and agrees to payment of such fee. Company Representative Name (Printed): ___________________________________________________ Title: _________________________________________________________________________________ Company Representative Name (Signature): __________________________________________________ Date: ________________________________________________________________________________ Company Contact Name: _________________________________________________________________ Contact Phone Number:__________________________Contact Email: ____________________________ Property Name and Location: Name: ____________________________________________________________________________ Street: ____________________________________________________________________________ City: _________________________________ State: _________ Zip Code: _____________________ Property Billing / Accounts Payable Contact Information: Name: ____________________________________________________________________________ Street: ____________________________________________________________________________ City: _________________________________ State: _________ Zip Code: _____________________ Fee Type: Inspection - Type of Occupancy: _______________________________________________________ Building Review - Square Feet: ________________________________________________________ Fire Alarm System Plan Review - Square Feet of Area Protected: _____________________________ Sprinkler System Plan - Square Feet of Area Protected: _____________________________________ Activity Fee: _______________________________________________________________________ Fee Amount $: _______________ Fee will be invoiced by the Town of Waterford Finance Department, 15 Rope Ferry Road, Waterford, CT 06385 Remit completed form to Waterford Fire Services, 204 Boston Post Rd., Waterford, CT 06385 or email: sdubicki@waterfordct.org or kpeterson@waterfordct.org