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PERKASIE BOROUGH
EMERGENCY ALARM APPLICATION
**To Submit: Highlight and Print form and mail or fax to Perkasie Police Perkasie Borough Ordinance 688 requires registration of existing emergency alarms, and requires permits for new installations of emergency alarms. Application must be completed in full before a permit can be issued. Permit fee of $10.00 is required. All information furnished pursuant to this application shall be kept confidential and shall be for the authorized use of the Police Department only.
Type of Alarm Burglar _____ Fire _____ Other _____ Type of Property Residential _____ Commercial _____ Name of Alarm User: __________________________________________________ Telephone No.: __________________________________________________ Address Where Device is Installed: __________________________________________________ __________________________________________________ Address of Owner if Different: __________________________________________________ __________________________________________________ Persons other than owner/lessee authorized to respond to an emergency and gain access to address where device is installed: 1) Name: ______________________________________ Telephone No. __________________ Address:________________________________________________________________________ 2) Name: ______________________________________ Telephone No. __________________ Address: _______________________________________________________________________ 3) Name: _______________________________________ Telephone No. __________________ Address: _______________________________________________________________________ ALARM COMPANY Name, address & phone number(s) of installing alarm supplier: ______________________________________________________________________________ ______________________________________________________________________________ Alarm Manufacturer: ___________________________________ Date of Installation: ___________________________________ DATA FOR FIRE ALARMS: Type of Sensors Used: Smoke _______ Heat _______ Water Flow _______ Other _______ List any known hazardous materials present on the premises and their location: ______________________________________________________________________________ ______________________________________________________________________________ Are there any person(s) who due to medical, mental or physical condition who would be hampered in evacuating the premises in case of a fire? Yes __________ No __________ If yes, please list all names, ages, where in the property such person(s) would normally be found and nature of infirmity: ______________________________________________________________________________ ______________________________________________________________________________ Date: ____________ Fee: $10.00 ______________________________ Applicant Signature _______________________________ Chief of Police |
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