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SPRINKLER REGISTRATION FORM This form must be filled out completely and legibly. Email addresses are now required. Building Address Owner of Record: OFFICIAL USE ONLY Owner’s Address: Date Rec’d Owner’s Phone: Owner’s Email: Fee: $50.00 Agent’s Name: Agent’s Address: Check No. Reg. No. Agent’s Phone: (Daytime) (Alternate) Agent’s Email: ➢ If owner does not reside in the tri-county area of Albany, NY an agent within this area must be designated. ➢ If the owner is a company/partnership/corporation an individual must be designated as the agent. ➢ If you have any questions on completing the information, please contact the Department of Buildings & Regulatory Compliance - (518) 434-5995. I hereby certify that the above sprinkler is inspected and/or tested in accordance with the requirements of NFPA 25. Records of such inspection and/or testing is maintained on the property site and will be made available for review at any and all times. Please return this form along with the fee to the Department of Buildings & Regulatory Compliance - Make checks payable to "City of Albany". Credit Card Information Card Number: Exp. Date: CVV Thank you! Signed: Title: Name: Company: Date: