Town of Amherst NH

Alram Permit Application

BURGLARY/ROBBERY/FIRE ALARM SYSTEM PERMIT

APPLICATION

This application must be completed in full before a permit can be issued.  All information must be current, and it will be the responsibility of the permit holder to ensure that this information remains current at all times.

Type of Alarm   (Circle Appropriate Descriptions):

RESIDENTIAL             BUSINESS

FIRE                INTRUSION                ROBBERY                   PANIC

PERMIT FEES:  Original           $25.00              RENEWAL       $10.00

Exemptions: Principal occupant age 65 or older _______ Government Facility_______

A permit fee must accompany all permit applications. Checks should be made payable to:

TOWN OF AMHERST, N.H.
Residence / Business Name: __________________________________DOB: _____________

Address: ______________________________________________Telephone no. ____________

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Type of Alarm (Circle Appropriate One):

Dial Alarm                               Direct Alarm                             Local Alarm

Alarm Monitoring Company ______________________________ Telephone no. ____________

Does the alarm system automatically reset?  Yes _____ No ____ How soon? ________________

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Persons(s) to be contacted when alarm activates:

Name:  __________________________________________________________________

Address:  ________________________________________ Phone: __________________

Name: __________________________________________________________________

Address:  ________________________________________ Phone: __________________

Questions concerning this Ordinance or Permit Application should be brought to the Amherst Police Department, 673-4900.

We, the undersigned, by virtue of our signature to this application, hereby acknowledge that we have read the Town of Amherst intrusion alarm system ordinance regulating the conduct of the maintenance of an intrusion alarm, and we agree to abide by the same.  We further agree and consent to the imposition of the charges and penalties set forth in said ordinance in the event that the maintenance and/or operation of the system which is the subject matter of this application occasion the necessity for same.  We expressly request that all records with respect to this application be kept confidential.

___________________________________

Signature

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