Form 1505 "Application for Certification as a Fire Protection System Component Designer" - Ohio

What Is Form 1505?

This is a legal form that was released by the Ohio Department of Commerce - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Ohio Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 1505 by clicking the link below or browse more documents and templates provided by the Ohio Department of Commerce.

ADVERTISEMENT
ADVERTISEMENT

Download Form 1505 "Application for Certification as a Fire Protection System Component Designer" - Ohio

Download PDF

Fill PDF online

Rate (4.7 / 5) 17 votes
Page background image
Board of Building Standards
6606 Tussing Road, P.O. Box 4009,
Reynoldsburg, Ohio 43068-9009
APPLICATION
(614) 644-2613 Fax: (614) 644-3147
bbs@com.state.oh.us
www.com.ohio.gov/dico/bbs/
CERTIFICATION
FOR
AS A
1.
APPLICANT:
FIRE PROTECTION SYSTEM
COMPONENT DESIGNER
Name:
Pursuant to Section 3781.105 of the Revised Code,
Address:
enclose a Letter of Approval from the National
Institute
for
Certification
in
Engineering
City:
State:
Zip:
Technologies
(NICET)
which
identifies:
a
Telephone:
County:
certification
in
the
field
of
fire
protection
engineering technology in the subfield of automatic
E-mail:
sprinkler systems, fire alarm systems, or special
hazard systems; evidence that the applicant has
Date:
Home Address:
attained Level III of Level IV work elements; and
the certification number issued by NICET.
NICET Number:
Business Address:
2. REFERENCES [In the spaces below list employers for whom systems were designed and drawings were prepared by the applicant.]
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
3.
SPECIFIC CERTIFICATION(S) BEING REQUESTED: (Please check appropriate box for certification being requested for which applicant has
received appropriate NICET Level III or Level IV Certificates.)
Automatic Sprinler Systems
Fire Alarm Systems
Special Hazards Systems
4.
FEES:
Submit a check or money order for One Hundred Dollars ($100.00) per certification made payable to : Treasurer, State of Ohio, BBS
5. CERTIFICATION: (APPLICATION WILL NOT BE ACCEPTED IF THIS SECTION IS OMMITTED.)
I solemnly swear or affirm that the answers I have made to each and all of the questions in this application are complete and true to the
best of my knowledge and belief. I hereby waive all provisions of law forbidding colleges or universities that I have attended, or past
employers, from disclosing any knowledge or information which they thereby acquired relevant to my employment and I hereby consent
that they may disclose such knowledge or information to the Board of Building Standards. Falsification is a violation of section 2921.13
of the Ohio Revised Code and is punishable as a misdemeanor of the first degree.
SIGNATURE OF APPLICANT:
Subscribed and duly sworn before me according to law, by the above named applicant this
day
of
in the year
at
, County of
and State of
.
SEAL
Notary Public
Form: 1505
AFPSD 91020230
Board of Building Standards
6606 Tussing Road, P.O. Box 4009,
Reynoldsburg, Ohio 43068-9009
APPLICATION
(614) 644-2613 Fax: (614) 644-3147
bbs@com.state.oh.us
www.com.ohio.gov/dico/bbs/
CERTIFICATION
FOR
AS A
1.
APPLICANT:
FIRE PROTECTION SYSTEM
COMPONENT DESIGNER
Name:
Pursuant to Section 3781.105 of the Revised Code,
Address:
enclose a Letter of Approval from the National
Institute
for
Certification
in
Engineering
City:
State:
Zip:
Technologies
(NICET)
which
identifies:
a
Telephone:
County:
certification
in
the
field
of
fire
protection
engineering technology in the subfield of automatic
E-mail:
sprinkler systems, fire alarm systems, or special
hazard systems; evidence that the applicant has
Date:
Home Address:
attained Level III of Level IV work elements; and
the certification number issued by NICET.
NICET Number:
Business Address:
2. REFERENCES [In the spaces below list employers for whom systems were designed and drawings were prepared by the applicant.]
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
Employed by:
Address:
Dates of Employment (mm/dd/yy)
From:
To:
3.
SPECIFIC CERTIFICATION(S) BEING REQUESTED: (Please check appropriate box for certification being requested for which applicant has
received appropriate NICET Level III or Level IV Certificates.)
Automatic Sprinler Systems
Fire Alarm Systems
Special Hazards Systems
4.
FEES:
Submit a check or money order for One Hundred Dollars ($100.00) per certification made payable to : Treasurer, State of Ohio, BBS
5. CERTIFICATION: (APPLICATION WILL NOT BE ACCEPTED IF THIS SECTION IS OMMITTED.)
I solemnly swear or affirm that the answers I have made to each and all of the questions in this application are complete and true to the
best of my knowledge and belief. I hereby waive all provisions of law forbidding colleges or universities that I have attended, or past
employers, from disclosing any knowledge or information which they thereby acquired relevant to my employment and I hereby consent
that they may disclose such knowledge or information to the Board of Building Standards. Falsification is a violation of section 2921.13
of the Ohio Revised Code and is punishable as a misdemeanor of the first degree.
SIGNATURE OF APPLICANT:
Subscribed and duly sworn before me according to law, by the above named applicant this
day
of
in the year
at
, County of
and State of
.
SEAL
Notary Public
Form: 1505
AFPSD 91020230