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Nebraska State Fire Marshal

Jim Heine, State Fire Marshal

Forms

Unless indicated otherwise, forms that require fees, signatures and/or other documentation must be mailed to the State Fire Marshal’s Office at 246 South 14th Street, Lincoln, NE 68508-1804. If these forms are emailed it will delay processing.

 

Code Enforcement  |  Fire Department/NEFIRS  |  Fire Prevention  |  Fireworks
Fuels Safety Division  |  Plans  |  Training Division

 

 

Code Enforcement

pdf icon  Fire Alarm Inspector's Certification Application AND The Citizenship Attestation Form
Fire Alarm Inspector’s Certificate Application
The application must be completed to obtain a license to inspect fire alarms. The completed application and form must be mailed in along with the appropriate fee and a copy of your NICET certificate, if applicable.

 

 

Fire Department/NEFIRS

Fire Department Information
Fire departments should complete this form to report changes in chief, mailing address, etc. The form may be emailed to carmen.flynn@nebraska.gov as an attachment. Click on File – Save As before completing and save with a different name. After completing the form and saving your work, click on File – Send To – Mail Recipient (as attachment) and type in the email address. Then click Send.

NEFIRS Field Collection Form
This form is designed to be used at the scene to collect pertinent information necessary to complete the NEFIRS report. This form does not replace the regular NFIRS forms and should not be submitted to the State Fire Marshal’s office.

 NEFIRS 5.0 Master Forms
Master forms to be used to report incidents using NFIRS 5.0. Departments must make the necessary copies from these masters as needed, if they are not using software to report. These reports must be completed by hand and mailed to the Lincoln office.

 

 

Fire Prevention

None

 

 

Fireworks

 Fireworks Injury Report
The Fireworks Injury Report is used by the State Fire Marshal’s Office to learn of injuries and other pertinent information of the injury resulting from the use of fireworks. This information is for statistical purposes only. The form should be completed by any hospital emergency room or facility providing emergent care that treats a firework-related injury only during the study period of June 25 – July 5 each year.

Fireworks License Application Retail Stand
As of 2013, the only method to submit applications is through our online portal.

Fireworks Display Operators License Application with Citizen Attestation Form
If you want to take the test, you may download the application and mail it to our office. You must also complete the Citizen Attestation Form and mail it to the address below. The Attestation Form can NOT be emailed back to the department.

Public Fireworks Display Permit Application
As of 2013, the only method to submit applications is through our online portal.

 

 

Fuels Safety Division

Application for Contractor License
PDF  DOT
Any company that wants to install and/or close underground storage tanks must complete this form. The application must be notarized.

Application for Individual Certification
PDF  DOT
Any individual seeking certification to install and/or close underground storage tanks should complete this application. The applicant’s signature must be notarized. This will require the form to be mailed to the Lincoln office.

Application for Individual Certification – Cathodic Protection Tester
PDF  DOT
Any individual seeking certification to test cathodic protection of underground storage tanks should complete this application. Since the application must be notarized it must be mailed to the Lincoln office.

Application for Permit to Install Aboveground Petroleum Storage Tanks
PDF  DOT
This application needs to be completed whenever an aboveground storage tank that will hold petroleum substances is to be installed. The application, with original signature, must be mailed to the Lincoln office with a check or money order covering the fee.

Application for Permit to Install Underground Storage Tanks
PDF  DOT
This application needs to be completed whenever an underground storage tank that will hold either petroleum or hazardous substances is to be installed. The application, with original signature, must be mailed to the Lincoln office with a check or money order covering the fee.

Application for Permit to Permanently Close Underground Storage Tanks and/or Piping
PDF  DOT
This application must be completed and approved by this office before an underground storage tank and/or piping is closed. An original signature is required. Therefore the application must be mailed to the Lincoln office.

Notification for Underground Storage Tanks
PDF
This form must be completed when notifying the State Fire Marshal of regulated underground storage tanks that have not previously been registered. This form will normally be used for a new installation and will be signed by both the owner and the installation contractor.

Notification of Change
PDF
This form must be completed when notifying this office of a change in ownership, tank status, product stored or other facility information regarding regulated underground storage tanks. This form requires an original signature.

One Time Registration of Underground Storage Tanks
PDF  DOT
This form must be completed for: (1) Farm or Residential Motor Fuel Tanks (1,100 gallons or less), (2) Small Heating Oil Tanks (1,100 gallons or less), or (3) Tanks Permanently Abandoned as of January 1, 1974. Since an original signature is required on the registration form and a check or money order in payment of the fee this form cannot be emailed. It must be mailed to the Lincoln office.

Underground Storage Tank Registration Form for Heating Oil Tanks Over 1,100 Gallons
PDF  DOT
This form must be completed for all underground heating oil tanks over 1,100 gallons which are exempt under the requirement of the Federal Notification Program. This form requires an original signature and therefore must be mailed to the Lincoln office.

 

 

Plans

Plans Review

  Equivalency Concepts
The Equivalency Concepts form is used to allow the use of equivalent measures to those listed in a Code Review. If you feel that you have a solution to a Code issue, use the Equivalency Concepts form. It will be reviewed by State Fire Marshal administration and the State Fire Marshal will decide whether to accept or deny the equivalency. This form requires a signature and, therefore, must be mailed to the Lincoln office.

  Fire Suppression System – Plan Review Information
This form must be completed by anyone submitting plans for a water-based fire protection system in addition to the Plan Submittal Form.

  Fire Protection of Cooking Operations
Check off list of requirements to run cooking equipment without an exhaust hood or fire supression system.

  Plan Submittal Application
The Plan Submittal Application must be completed for all plans sent to the Plans Division for review and approval. The completed form, plans, and appropriate fee from the fee schedule on the application must be received before the plans can be reviewed. Use the Fee Calculator to determine the correct fee.

Water-Based Fire Protection Systems

  Contractor’s Material and Test Certificate for Aboveground Piping
This form must be completed before final approval is given for the aboveground piping installed for water-based fire protection systems.

  Contractor’s Material and Test Certificate for Underground Piping
This form must be completed before final approval is given for the underground piping installed for water-based fire protection systems.

  Fire Sprinkler Inspection
This form must be completed and submitted to the State Fire Marshal’s Office for inspections conducted on water-based fire protection systems. The completed report must be mailed to the Lincoln office. Due to signature requirements this form cannot be emailed.

  Water-Based Fire Protection Contractor’s Certificate Application
Anyone wanting to be certified as a Water-Based Fire Protection Contractor must complete this application and mail it to the office with a check or money order for $100. The Agency has added two additional forms to the Application Process. One form, the Employer Affidavit, is to be filled out by the Company and the other form, the Employee Affidavit, must be filled out by the person applying as the RME. These two forms, along with the Application Form and the Citizen Attestation Form, need to be completed and returned to the Agency at 246 S 14th St Lincoln, NE 68508-1804. The Citizen Attestation Form can NOT be emailed back to the department all others may be emailed.

 

 

Training Division

Application for Candidacy

Training Division Course Catalog