APPLICATION FOR ALARM PERMIT
Notice: Per the Wethersfield False Alarm Ordinance Chapter 50, every owner or operator must apply for a permit to operate an alarm unit in the town.
This information is CONFIDENTIAL
and will not be released outside this agency except per court order. Please Print Clearly.
I. APPLICANT:
II. ALARM PREMISES:
III. ALARM SYSTEM, MONITORING AND INSTALLATION COMPANY:
IV. AUTHORIZED KEY HOLDERS:
Upon receipt of completed application and registration fee, a registration number shall be assigned to the Alarm System. Failure to register an Alarm
System will result in a $250.00 fine. Once a registration number has been issued, any changes to permit information should be submitted in writing to the Police
Department within 10 days.
I hereby certify that, to the best of my knowledge, the above information is correct. I also agree to accept full responsibility for the alarm device within the terms
of the ordinance.
Signature ____________________________________________ Date _______________
(over)
TOWN OF WETHERSFIELD
Police Department Office of the Fire Marshal
250 Silas Deane Highway 505 Silas Deane Highway
Wethersfield, CT 06109 Wethersfield, CT 06109
NAME: DAYTIME NUMBER: EVENING NUMBER:
CELL PHONE:
MAILING ADDRESS:
DRIVER’S LICENSE NUMBER:
SPOUSE CELL:
CITY, STATE, ZIP:
KINDS OF ALARMS AT PREMISES (CHECK ALL THAT APPLY):
BURGLAR ALARM
□ FIRE □ PANIC □ IS IT AUDIBLE OUTSIDE? □ OR SILENT? □ OTHER TYPE □ ___________
ALARM MONITORING COMPANY : ALARM INSTALLATION/MAINTENANCE COMPANY :
ALARM MONITORING COMPANY ADDRESS: ALARM INSTALLATION /MAINTENANCE COMPANY ADDRESS
TELEPHONE NUMBER: TELEPHONE NUMBER:
FAX NUMBER: FAX NUMBER:
E-MAIL ADDRESS: E-MAIL ADDRESS:
A KEY HOLDER is someone you trust who, in your absence and within 20 minutes of being notified, will arrive at your premises after an alarm activation in order to secure
the property and/or assist the Police Department in determining the cause of the alarm.
NAME, FIRST KEYHOLDER: NAME, SECOND KEYHOLDER:
DAY TELEPHONE: DAY TELEPHONE:
EVENING TELEPHONE: EVENING TELEPHONE:
CELL PHONE: CELL PHONE:
ALARM PERMIT NO:________________
(Office use only)
ADDRESS, IF DIFFERENT THAN MAILING ADDRESS: TELEPHONE NUMBER AT ALARMED LOCATION:
CITY, STATE, ZIP: NON-RESIDENTIAL, BUSINESS OR ENTITY NAME:
NATURE OF PREMISES: □ RESIDENTIAL □ NON-RESIDENTIAL □ GOVERNMENT □ OTHER_____________________
□ PRE—EXISTING ALARM □ NEW INSTALLATION - IF SO, PLEASE PROVIDE PERMIT #________________
