Business Registration/Update

The Evesham Township Fire District No.1, Division of Fire Prevention, is the enforcing agency of State Legislation, Public Law 1983, Chapter 383 N.J.S.A. 52:27D-192 et. seq. that provides for the establishment of the Uniform Fire Safety Act.

Every owner or tenant/occupant subject to this section shall file with the local enforcing agency for a certification or registration. The application shall include but not be limited to the name, address, telephone number and valid email of the applicant, the business, the owner of the property (if different from the applicant) as well as an emergency contact person for the business. The required forms will be supplied by the Fire Prevention office.

If the owner or tenant/occupant fails to complete and return the registration within 30 days of the date on which it was mailed, the local enforcing agency shall issue a penalty equal to double the scheduled registration fee.

Fire safety registration fees are established by the Township of Evesham Local Ordinance 8-2-2006, Chapter 75, section 75-9.

Business Registration Form

Please fill out all appropriate fields in the form below. Complete every section that applies to your business to ensure accurate and comprehensive registration. If a section does not apply to you, please leave it blank or mark it as not applicable (N/A).

Business Registration Type(Required)

Business Information

Name of Business(Required)

Address(Required)

FEIN Number(Required)

Business Phone Number(Required)

Contact Person(Required)

Contact Person Email(Required)

Description of Business(Required)

Square Footage of Business(Required)

If this is an Expansion of an Existing Business at this Location, What is the Total New Square Footage?

Occupancy Load(Required)

Is Alcohol Served?(Required)

Yes

Owner Information

Owner of Business(Required)

Owner Address(Required)

Type of Ownership (LLC, LLP, Corp., Non-Profit, etc.)(Required)

Owner Phone(Required)

Owner Email(Required)

Previous Tenant (If Applicable)

Corporate Information (If Applicable)

If the business is a corporation, please fill out the following:

President

Corporate Headquarters Address

Corporate Telephone Number

Building Information

Landlord/Owner of Building

Landlord/Owner Address

Contact Person

Phone Number

Is there a Facilities Manager/Responsible Party Different From Contact Person?

Yes

Facilities Manager Name(Required)

Facilities Manager Address(Required)

Facilities Manager Phone(Required)

Facilities Manager Email(Required)

Billing Information

If the billing/business mailing address is different from the physical address:

Billing Name

Billing Address

Billing Phone

Emergency Contacts

List up to two 24/7 emergency contact persons (kept confidential):

Emergency Contact #1(Required)

Emergency Contact #1 Mobile Phone(Required)

Emergency Contact #2(Required)

Emergency Contact #2 Mobile Phone(Required)

Hazardous Materials Infromation

Describe briefly any flammable, combustible liquids or hazardous materials and chemicals handled or stored:(Required)

Certification & Signature

Signature of Owner or Representative(Required)

Name of Owner or Representative(Required)

Evesham

Fire-Rescue

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