Residential Commercial Apartment

New Registration Update Registration

Burglary Holdup Duress Fire Other

Equipped Nonequipped

Burglar Alarm Fire Alarm

Key Code

Shuts off Resets in

Yes No

State

Is the Alarm Site equipped or nonequipped for duress alarm?

Please attach any necessary documents below.

Address

First Name *

Medical

Last Name *

Address

Medical Needs

Property Details

Closing Time

Opening Time

Selected Address *

Alarm automatically

Property Type *

Applicant Details

Permit holder and responsible for proper maintenance and operation of the alarm system.

Phone # *

City, State, ZIP

Block

minutes

Audible

Business Owner Information

Owner Cell #

City

Attachments

Building Owner Phone #

Applicant Signature *

Address *

Number of Animals

Owner Phone #

Any animals in residence or business?

Registration Type

Business Type

Name

ZIP

Address

Alarm Information

Emergency Contacts

Note: Alarm must shut off or reset within 15 minutes.

Company Name (if applicable)

Name

Certification

Purpose

Building Owner Cell #

Building Owner Name

Special Conditions or Hazards

Burglar or Fire Alarm? *

Date of Installation, Conversion, or Takeover

Information/hazards for police officers or fire personnel

Purpose (if other)

Lot

Phone #

Hold-Up

Carbon Monoxide

Phone #

Owner Name

Reset Code

in

Installation Company

2nd Phone # (Work or Other)

Other

Silent

Email *

City, State, ZIP

Type of Animals

Alarm Types (Check all that apply) *

Panic

System Monitoring

Provide information of the business monitoring the alarm system if different from the installing alarm company.

Name and phone number of AT LEAST ONE person who are familiar with system and have password and/or keys to be contacted in case of alarm and/or malfunction of alarm system. They should be able to respond in a reasonable amount of time. *

Reset Type *

Provide information of the alarm company performing the alarm system installation, conversion or alarm system takeover and responsible for providing repair service to the alarm system.

I hereby certify that:

• a set of written operating instructions for the alarm system, including written guidelines on how to avoid false alarms, has been left with the applicant.


• The alarm business has trained the applicant in the proper use of the alarm system, including instructions on how to avoid false alarms.


• Any false statement of a material matter made by an applicant for the purpose of obtaining an alarm permit shall be sufficient cause for refusal to issue a permit.


• An alarm permit cannot be transferred to another person.


• An alarm user shall inform the alarm administrator of any change that alters any information listed on the permit application within five business days.


• Information contained in permit applications shall be held in confidence by all employees or representatives of the municipality with access to such information.