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2. 

4. The Portland Fire Department Corrective Action Plan (CAP) form must be submitted within 30 days of the failed fire inspection in lieu of a re-inspection conducted by the Portland Fire Department. Failure to submit and implement a corrective action plan, may result in penalties provided by law. The form submitted will be kept on file with the Portland Fire Marshal’s Office.

   
    IMPORTANT: This form must be completed by a person that has executive authority to ensure the corrections listed on this form are made. By submitting this form, you ensure that the necessary steps are being taken in a reasonable amount of time to correct the infraction(s) listed on the Company Inspection Report to ensure the safety of all occupants of the business. Unless deemed necessary, the Portland Fire Department will not be conducting immediate follow-up inspections on the violations reported.

8. Business Name*
10. Business Address*
12. City*
13. State*
14. Zip Code*
16. First Name*
17. Last Name*
19. Business Title*
20. Today's Date*
    Today's Date

    Today's Date
22. Phone Number*
23. Email Address*
25. List below all violations noted on your business's Company Inspection Report issued by the Portland Fire Department. (Violations are noted at the bottom of the report)*
27. Answer below a plan to correct the violations listed on the inspection report.*
29. Do you agree to correct all violations in a reasonable amount of time?*
    -- Select One --Yes, I agree.No, I refuse to correct the issues.
30. What is the anticipated completion date of the corrective actions listed?*
    What is the anticipated completion date of the corrective actions listed?
32. 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.
34. Electronic Signature
Leave This Blank:


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

    This field is not part of the form submission.

38. Submit

* indicates a required field