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Kinston Department of Fire and Rescue
P. O. Drawer 339, 401 E Vernon Avenue Kinston, North Carolina 28502 Office Phone: 252-939-3164 Fax Phone : 252-939-3157
Mandatory Permits Application for Combustible Dust Producing Operations
Business Name (if applicable)
Date of Application*
Date of Application
Location of Business:
City
State
Zip Code
Phone Number of Business
Business Website
Information of Applicant
Name of Applicant*
Middle Name
Last Name*
Address of Applicant*
City*
State*
Zip Code*
Contact Phone Number*
Email Address*
Information of Business Owner (if not applicant)
Name of Business Owner
Last Name
Address of Owner
City
State
Zip Code
Phone Number of Owner
Email Address of Owner
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Application Contact Information

Application Details Information
Location of the Use of Permit (if different than business)
City
State
Zip Code
Phone Number of Location
NFPA Code Information Section*
Please list in entirety what NFPA Codes are required and how the applicant will be meeting these codes.
No Smoking and NFPA 704 Signs*
Are the proper "No Smoking" and NFPA 704 Signs in place?
1. Yes
2. No
Fire Protection Equipment*
Please list the Type, Size, Quantity and Location of the Fire Protection Equipment that will be in place.
Cleaning System *
Please list the Type and Size of the vacuum cleaning system or other means that will collect and not allow combustible dust suspension into the air.
Housekeeping Methods*
Please list what type of housekeeping methods that will be used during hours of operations.
Sketches, Maps, Site Plans and Drawings*
Please upload any and all pertinent files of Sketches, Maps, Site Plans, Evacuation Routes and Drawings showing the location of equipment and/or the operation in its entirety.
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Application Details Information

Application Agreement
Permit Fee: $50.00
Payment
Payments are required to be paid in full prior to the issuance of the Permits, and can be made by Check, Cashier's/Banker's Check, Money Order or Credit/Debit Card Payment** at the Kinston Department of Fire and Rescue (Headquarters) Station 1, 401 E Vernon Avenue, Kinston, North Carolina 28501, during business hours, or by mailing or delivering a Check, Cashier's/Banker's Check or Money Order made out to the City of Kinston in care of the Kinston Department of Fire and Rescue at P. O. Drawer 339, Kinston, North Carolina 28502. ** (Conditions of Credit/Debit Card Payment can be made over the phone with the Administration Assistant of the Kinston Department of Fire and Rescue by calling 252-939-3164)
Date and Time of Payment Instructions*
Date and Time of Payment Instructions
Date and Time of Payment Instructions
By marking the date and time that the instructions have been read, Applicant is agreeing to contacting the Administration Assistant to schedule and make the payment prior to issuance of the Permit.
The Undersigned hereby makes application for a permit and the inspection of all work described above and hereby agrees to comply with all regulations and other Laws applicable to the use and type of work being performed.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
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Application Agreement

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Mandatory Operational Permit Application for Combustible Dust Producing Operations

Steps

Step One

Application Contact Information

Application Details Information

Application Agreement

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