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Certification

Lot *

State *

Fee Schedule

Fee Due

The Compliance Certificate must be filled out, notarized and attached with this application.

City *

Qualifier

Realtor Information

Address *

Complete Name

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Email *

Agent Information

Seller / Owner Information

Address *

ZIP *

Email

Phone #

Address *

Application Type *

The Compliance Certificate must be filled out, notarized and attached with this application.

City, State, ZIP *

Complete Name *

Property Details

Complete Name *

Project Closing Date *

Phone # *

N.J.A.C 5:70-2.3(a) provides that, “Before any one and two-family or attached single family structure is sold, leased or otherwise made subject to a change of occupancy for residential purposes, the owner shall obtain a Certificate of Smoke Alarm, Carbon Monoxide Alarm, Portable Fire Extinguisher Compliance (CSACMAPFEC), evidencing compliance with N.J.A.C. 5:70-4.19, from the appropriate enforcing agency.”

N.J.S.A. 52:27D-198.3 provides that an owner who violates these provisions is subject to a fine of not more than $500.00.

A (CSACMAPFEC) shall not be transferable. If the change of occupancy specified in the (CSACMAPFEC) does not occur within 90 days, a new application and fee shall be required.

By signing below, I certify that all of the information provided in this application is true and accurate. I hereby certify that I am the Owner/Authorized Agent for the above described dwelling unit and request that an inspection be conducted for the issuance of a (CSDCMAPFEC).

Attachments *

Unit #

Phone # *

Block *

Email *