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.: _______________________
ADDRESS:_______________________________________________________________________________
EMAIL: __________________________________________________________ PHONE: ________________
HOW WOULD YOU LIKE TO RECEIVE YOUR PERMIT (PLEASE CHOOSE ONE): A.) PICK UP OR B.) BY MAIL
IF YOU WOULD LIKE TO RECEIVE YOUR PERMIT BY MAIL, PLEASE INCLUDE A STAMPED SELF-ADDRESSED ENVELOPE WITH THIS APPLICATION.
OWNER: ________________________________________________________________________________
ADDRESS:_______________________________________________________________________________
EMAIL: __________________________________________________________ PHONE: ________________
COMMERCIAL OR RESIDENTIAL WITH THREE OR MORE UNITS OR
$100 PER FLOOR FEE WITH A
1% SURCHARGE ON TOTAL COST OF WORK & MATERIALS
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
REC’D BY: _______________
ASSIGNED TO: ____________
BRC Form 012 Rev’d: 3/2016
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