Alarm Application/Permit Form

Pursuant to City of Keene City Code, Chapter 34, Section 34-55, an alarm permit is required for every alarm system on the premises. The application form, signed and approved by the Chief of Police or designee, will serve as an approved permit. A yearly renewal is requested by January 1. This Permit cannot be transferred. Changes to the information contained herein must be filed with the Police Department within five business days. Applicants are required to familiarize themselves with the City Code.

Type of Application(Required)

Initial

Renewal

Name of Resident

First Last

Resident Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Resident Mailing Address

If different from above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number at Alarm Address

Additional Contact Number (i.e., cell/work)

Name of Business

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Mailing Address

If different from above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number at Business Address

Business Hours and Days Open

EMERGENCY CONTACT / RESPONDING PARTY INFORMATION

Name

Title

Address

Telephone Number

Classification of Alarm

Residential

Commercial

Purpose

Burglary

Robbery

Other

Name, Address, Telephone # of Alarm Company

Date of Alarm Installation

Date of last inspection by Alarm Company

Please describe the types of alarms: (i.e. motion detector, sensor) and their locations