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Nebraska State Fire Marshal

Christopher Cantrell, 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, Suite 1, Lincoln, NE 68508-1804. If these forms are emailed it will delay processing.

 

Affidavits/Attestation  |  Amusement Rides  |  Fire Alarm Inspector  |  Fire Department/NEFIRS  |  Fire Prevention
Fireworks  |  Fuels Safety Division  |  Investigations |  Plans  |  Public Records Request
Structure Burn  |  Training Division  |  Water-Based Contractors

 

 

Affidavits/Attestation

Documents with an original notary stamp and original signature should be mailed to the State Fire Marshal's Office at 246 S 14th St, Suite 1, Lincoln, NE 68508-1804. Photocopies cannot be accepted. Please refer to the specific category for the applicatoin forms.

 

 

Amusement Rides

        Amusement Ride Inspector Checklist

        Amusement Ride Permit Application

        Amusement Ride Qualified Inspector Application

        Amusement Ride Route Listing Form

 

 

Fire Alarm Inspector

In accordance with Title 153, Chapter 6, individuals must be licensed to inspect fire alarm systems in the State of Nebraska. The license is valid for four years and costs $100. A license may be obtained by either passing a test or, if NICET certified Level II or above, sending us a copy of your NICET certificate along with the pro-rated fee of $25 per year of the certification. Example: If your NICET certification expires April 1, 2013 and you are applying for the license in March 2010, the fee would be $75. The certificate will be returned with your license.

Fire Alarm Inspector's Certification Application

United States Citizenship Attestation Form

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.

Tests are given on the third Tuesday of each month.  The test sites alternate between Lincoln and North Platte one month and Omaha the following month.  A  2021 Fire Alarm Test Schedule and list of study materials is available.  For more information regarding the test, contact Regina Shields.

For more information on NICET go to their website, http://www.nicet.org/, or call (888) 476-4238.

This agency does not license Fire Alarm Installers. For information on becoming a licensed installer, contact the State Electrical Division at (402) 471-3550.

 

 

Fire Departments/NEFIRS

Fire Department Information
Fire departments should complete this form to report changes in chief, mailing address, etc. The form may be emailed to Deb Hostetler 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.

Structure Burn Permit
The State Fire Marshal’s office has two types of burn permits – an Open Burn Permit and a Structure Burn Permit. These permits are issued by the state’s fire departments in accordance with state law. Anyone obtaining either type of burn permit should also contact the Department of Environmental Quality regarding their requirements affecting open burns and any forms they may require.

 

 

Fire Prevention

Fire and Life Safety Education Training/Event Request

 

 

Fireworks

Firework 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 Operator License Application with Citizen Attestation
The process to receive a Fireworks Display Operator License includes the completion of an Application and United States Citizenship Attestation Form. The application can be faxed or emailed to the Lincoln address on the Application. An original (not a copy) Citizen Attestation form must be mailed (not faxed or emailed) to the Lincoln address on the application.

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

2021 Fireworks Display Operators Test Schedule and list of study materials is available.  For more information regarding the test, contact Regina Shields.

 

 

Fuels Safety Division

Application for Permit to Install Aboveground Petroleum Storage Tanks

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, can be mailed to the Lincoln office with a check or money order covering the fee. Or you may email the form and pay the fee online.

Application for Permit to Install Underground Storage Tanks
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, may be mailed to the Lincoln office with a check or money order covering the fee. Or you may email the form and pay the fee online.

Application for Permit to Permanently Close Underground Storage Tanks and/or Piping
This application must be completed and approved by this office before an underground storage tank and/or piping is closed. You may email the form or mail the hard copy to the Lincoln office. There is no fee for this permit

Daily Inventory Instructions
Instructions on how to use the Daily Inventory Record for Underground Storage Tanks.

Daily Inventory Record
Daily Inventory Record for Underground Storage Tanks. Daily Invenotry should be performed at approximately the same time every day.

Notification for Underground Storage Tanks
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. You may email the form or mail the hard copy to the Lincoln office.

Notification of Change
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. You may email the form or mail the hard copy to the Lincoln office.

One Time Registration of Underground Storage Tanks
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. . The application, with original signature, may be mailed to the Lincoln office with a check or money order covering the fee. Or you may email the form and pay the fee online.

Underground Storage Tank Registration Form for Heating Oil Tanks Over 1,100 Gallons
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. You may email the form or mail the hard copy to the Lincoln office.

Application for License Underground Storage Tank Contractor
Any company that wants to install and/or close underground storage tanks must complete this form. You may email the form or mail the hard copy to the Lincoln office.

Application for Individual Certification Underground Storage Tank Contractor
Any individual seeking certification to install and/or close underground storage tanks should complete this application. You may email the form or mail the hard copy to the Lincoln office.

Application for Individual Certification – Cathodic Protection Tester
Any individual seeking certification to test cathodic protection of underground storage tanks should complete this application. You may email the form or mail the hard copy to the Lincoln office.

 

 

Investigations Division

Fire Report Request
To request a Fire Report, please use the Public Records Request form.

 

 

Plans Division

Addendum and Revision Form

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.

Electronic Plan Submission

Plans Submission 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.

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.

 

 

Public Records Request

Public Records Request Form
This form can be used to request records from a specific division or all agency records for an address.

 

 

Structure Burn Permits

Structure Burn Permit

 

 

Training Division

Application for Candidacy

Training Division Course Catalog

 

 

Water-Based Contractors

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
An Employee Affidavit, Employer Affidavit and a United States Citizenship Attestation should be mailed to the State Fire Marshal's Office at 246 S 14th St, Suite 1, Lincoln, NE 68508-1804. These documents must contain original notary stamps and original signatures. Photocopies and scans of the affidavits and attestations may delay your application.