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CITY OF ALBANY DEPARTMENT OF BUILDINGS & REGULATORY COMPLIANCE 200 Henry Johnson Boulevard Albany, NY 12210 Phone (518) 434-5165 Fax (518) 434-6015 FIRE ALARM PERMIT APPLICATION This form is meant for applicants seeking a permit to install a fire alarm. If we can assist you at all in completing this form, do not hesitate to ask. This form is available on our website as a fillable .pdf. GENERAL INFORMATION JOB SITE ADDRESS: TOTAL COST OF WORK (INCLUDING COST OF MATERIALS): 1% OF TOTAL WORK COST: WHEN DO YOU NEED YOUR PERMIT? WE MAY EXPEDITE AN APPLICATION IF POSSIBLE AND APPROPRIATE. APPLICANT: LICENSE NO.: EMAIL: PHONE: HOW WOULD YOU LIKE TO RECEIVE YOUR PERMIT (PLEASE CHOOSE ONE): PICK UP OR BY MAIL IF YOU WOULD LIKE TO RECEIVE YOUR PERMIT BY MAIL, PLEASE INCLUDE A STAMPED SELF-ADDRESSED ENVELOPE WITH THIS APPLICATION. OWNER: EMAIL: PHONE: PROJECT INFORMATION COMMERCIAL OR RESIDENTIAL WITH THREE OR MORE UNITS OR RESIDENTIAL $100 PER FLOOR FEE WITH A 1% SURCHARGE ON TOTAL COST OF WORK & MATERIALS $50 FLAT FEE NUMBER OF FLOORS ON WHICH ALARM IS TO BE INSTALLED: DESCRIBE THE WORK TO BE DONE: TOTAL FEE FOR COMMERCIAL PROJECTS, $100 PER FLOOR PLUS A 1% SURCHARGE ON THE TOTAL COST OF WORK FOR RESIDENTIAL PROJECTS, A FLAT FEE OF $50 INSURANCE: HAVE YOU SUBMITTED PROOF OF THE NECESSARY INSURANCE TO BRC? YES NO WORKER’S COMPENSATION: HAVE YOU SUBMITTED PROOF OF WORKER’S COMP COVERAGE? YES NO STAFF USE ONLY PERMIT NO.: APP. FEE: REC’D BY: DATE REC’D: DATE ISSUED: ASSIGNED TO: SCANNED BY: BRC Form 012 Rev’d: 3/2016 Page 1 of 1