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Blasting Permit Application Form

  1. Danville Fire Department

  2. 600 Lynn Street, Danville, VA 24541
    Phone: (434) 799-5226 Fax: (434) 797-8943

  3. APPLICATION FOR BLASTING PERMIT

  4. Fee: $125 for 30 days, $200 for 90 days
    Checks are to be made payable to City of Danville

  5. Checks should be mailed to: 600 Lynn Street, Danville, VA 24541. Permit will be issued after payment is received.

  6. Blaster will be required to provide:

  7. Copy of Valid Driver's License, Virginia Blasting Certification, Proof of Insurance and three references

  8. =================================================================================

  9. THIS SECTION TO BE COMPLETED AFTER SITE VISIT BY FIRE MARSHAL

  10. Additional Requirements:

    __________________________________________________________________________________________

  11. __________________________________________________________________________________________

  12. __________________________________________________________________________________________

  13. Certificate of Insurance:

    __________________________________________________________________________________________

  14. Blaster Certification:

    __________________________________________________________________________________________

  15. Certification Number:

    ____________________________________________________________

  16. Utility Department Approval:

    __________________________________________________________________________________________

  17. BLASTER: I certify that the information included in the above application is true to the best of my knowledge and understand that the storage and use of explosive materials shall comply with the provisions of NFPA 495, DOTn 49 CFR and the Virginia Statewide Fire Prevention Code. I also understand I must follow the additional requirements, if any, as indicated above, and further understand I must notify the Danville Fire Marshal's office--(434) 799-5226, and the Danville Water & Gas Department (434) 799-5268--each day of blasting.

  18. Blaster Signature:______________________________________________Date:________________

  19. Approved by: _________________________________________________Date:________________

  20. Permit Expiration Date:_________________

  21. (Rev. 2/2015)

  22. Leave This Blank:

  23. This field is not part of the form submission.