Form 81 986 – Fill Out and Use This PDF

	APPLICATION FOR
	FIRE ALARM SYSTEMS INSPECTOR	CITY OF PHILADELPHIA
	LICENSE	DEPARTMENT OF LICENSES AND INSPECTIONS
		MUNICIPAL SERVICES BUILDING – CONCOURSE
		1401 JOHN F. KENNEDY BOULEVARD
	APPLICATION # ____________________________________________	PHILADELPHIA, PA 19102
		For more information visit us at www.phila.gov
	(Please complete all information below and print clearly)
	NAME OF APPLICANT :

ADDRESS: _________________________________________________________________________________________________________________

CITY:_____________________________________________________________STATE:_________________ ZIP :_____________________________

PHONE # (________) __________________________________E-MAIL: ________________________________________

NAME OF COMPANY OR EMPLOYER (IF ANY): __________________________________________________________________________________________

ADDRESS: _________________________________________________________________________________________________________________________

CITY: _____________________________________ STATE: _______ ZIP: ___________________		E-MAIL:_________________________________________
PHONE #: (________) __________________________________	FAX # (________)________________________________
FIRE ALARM SYSTEMS INSPECTOR LICENSES ARE ISSUED TO QUALIFIED PERSONS. THEY ARE NOT ISSUED TO COMPANIES.
YOU OR YOUR EMPLOYER ARE REQUIRED TO HAVE A COMMERCIAL ACTIVITY LICENSE TO CONDUCT BUSINESS IN PHILADELPHIA
DO YOU HAVE A COMMERCIAL ACTIVITY LICENSE?  YES		NUMBER _________  NO

SUBMIT PROOF OF QUALIFICATIONS (BASED UPON ONE OF THE FOLLOWING) WITH THIS APPLICATION

1.NICET Alternative. Submit a National Institute for Certification in Engineering Technologies (NICET) certificate at Level II or higher in the Fire Alarms subfield of Fire Protection Engineering Technology.

2.Underwriters’ Laboratory (UL) Alternative. The company for which the applicant is principal or designee is

listed with UL in one of two categories of Protective Signaling Services. The first acceptable category is for

Central Station Service (UUFX) as a “Full Service Company” or “Fire Alarm Service — Local Company.” The second acceptable category is for Local, Auxiliary, Remote Station and Proprietary Service (UUJS).

3.Professional Engineer Alternative. A professional engineer registered in the Commonwealth of Pennsylvania. You must provide the Department with a signed and sealed statement of qualifications in the field of fire alarm systems.

FEES

APPLICATION REQUIRES SUBMITTAL OF A NON-REFUNDABLE APPLICATION FEE		REVENUE	OFFICE USE ONLY
CHECK OR MONEY ORDER PAYABLE TO “CITY OF PHILADELPHIA”	FEE	CODE	CHECK #
FIRE ALARM SYSTEMS INSPECTOR	$200.00	3707

COMMERCIAL ACTIVITY LICENSE (IF REQUIRED)	$300.00	3702
TAX I.D. NUMBER ISSUED BY THE REVENUE DEPARTMENT IS	TAX I.D. NUMBER:
REQUIREDTO OBTAIN A BUSINESS PRIVILEGE LICENSE

THIS APPLICATION MUST BE ACCOMPANIED BY PAYMENT OF THE APPLICATION FEE AND PROOF OF QUALIFICATIONS

I hereby certify that the statements contained herein are true and correct to the best of my knowledge and belief. I understand that if I knowingly make any false statement herein I am subject to such penalties as may be prescribed by law or ordinance.

APPLICANT’S SIGNATURE:		DATE: _______/_______/_______
81-986 (Rev 2/13)