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Insurance Company First Time Inspection Request

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Date of Request

Request Made By

Inspector Phone

Insurance Company of Record

OWNER INFORMATION

Owner Name

Owner Address

Owner County

Owner City

Owner Zip

JO Location Number

OBJECT LOCATION

Object Location Name

Object Location Address

Object Location County

Object Location City

Object Location Zip

LOCATION CONTACT

Location Contact Name

Overwrite default value if Name is known

Location Contact Phone

Overwrite default value if Phone is known

Location Contact Email

Overwrite default value if Email is known

Manufacturer

Type or Use

NB Number

Serial Number

Specific Location of New Object

Installation Date

Contact Information

Office of the State Fire Marshal

1035 Stevenson Drive

Springfield, IL 62703

Phone: (217) 785-0969

TTY: (866) 324-3841

Website Content Issues

Useful Links

Illinois.gov Home

State Phone Directory

State Employment Site

Illinois Fire Service Institute