High Rise Inspection Request Form

High-Rise Licenses Inspection Request
This form is for scheduling the annual fire safety inspection required for an active High-Rise License.

Please use this form only if you already have an issued and active High-Rise License. Inactive or expired licenses should be renewed before requesting an inspecion.
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
High Rise License Number *
This number will appear on your license under "License No." or it can be found on eCLIPSE.
Name of Owner's Representative *

First NameLast Name
Mobile Phone Number*
Email Address*
example@example.com
If you need translation services, please specify the language below:
Specify the language*
Building Details

The information below helps us to estimate the time required to complete the inspection. Please complete this section to the best of your ability.
Primary Occupancy of the Building*
Total Number of Stories*
Describe the Occupancy of the Building*
Scheduling

Please use the calendar below to select a date for your inspection.
What date and time work best for you?*
Should be Empty:

High-Rise Licenses Inspection Request