DEPARTMENT OF PUBLIC SAFETY
BENSALEM FIRE RESCUE
CONTRACTOR LICENSE APPLICATION
Total fee due with this application: $100.00 (check or money order, made payable to Bensalem Township)
TO SUBMIT YOUR APPLICATION AND/OR CONTACT US FOR INFORMATION:
BENSALEM FIRE RESCUE Phone: 215-633-3617 FAX: 215-633-3662
2400 Byberry Road Website:
Bensalem, PA 19020
All personal & employment information is strictly confidential and is not shared with any organization outside of Bensalem Township.
License #BUSINESS INFORMATION
Business Name:
Address:
City / State / ZIP
Phone #: / Fax #:
State Tax #: / Federal Tax #:
E-Mail Address:
APPLICANT INFORMATION
Name:
Address:
City / State / ZIP
Phone #: / Position/Title:
Check all services that apply:
Specific Services
Inspection / Installation / Design
Fire Alarm Systems*
Sprinkler Systems**
Alternative Extinguishing Systems***
Cooking Hood Suppression Systems
Underground Fire Main
Fire Hydrants
Fireplaces/Chimneys
Fire Extinguishers
General Services
Cooking Hood Cleaning / Tanks (Installation/Removal)
Environmental Remediation / Tents
Hot Works/Welding / Other / Please list service
See next page for requirements
QUALIFICATIONS (ATTACH SUPPORTING DOCUMENTATION)
An original certificate of insurance for public liability, property damage, products liability and complete operations, each of which must have single occurrence limit of at least $25,000 dollar must accompany this application. Bensalem Township must be listed as a certificate holder. Certificate must contain a clause stating the policy will not be cancelled until the Township of Bensalem is provided a 30 day notice prior to cancellation.
*FIRE ALARM CONTRACTORS*
All fire alarm contractors shall provide a copy of NICET II certification or higher, or submit a certificate of training from the alarm manufacturer to inspect and install systems.
All plans submitted for fire alarm systems shall be signed and sealed by a P.E. Licensed in PA or NICET III or higher.
**SPRINKLER CONTRACTORS**
All sprinkler contractors shall provide a copy of NICET II certification or higher to inspect systems.
All sprinkler contractors shall provide a copy of NICET III certification or higher to install systems.
All plans submitted for sprinkler systems shall be signed and sealed by a P.E. Licensed in PA or NICET III.
**SPECIAL HAZARD SUPPRESSION SYSTEMS**
All special hazard suppression contractors shall provide a copy of NICET III certification or higher to install systems.
All plans submitted for special hazard suppression systems shall be signed and sealed by a P.E. Licensed in PA or NICET III.
Name: / NICET II / NICET III / NICET IV / PE / (Check One)
Name: / NICET II / NICET III / NICET IV / PE / (Check One)
Name: / NICET II / NICET III / NICET IV / PE / (Check One)
Name: / NICET II / NICET III / NICET IV / PE / (Check One)
Name: / NICET II / NICET III / NICET IV / PE / (Check One)
INFORMATION OF RECORD
1. Names of Owners, Partners, etc. & Business Trade Name:
2. Statements regarding any other municipalities having refused to issue a license within the last two years:
3. If licensed in other municipalities, please list at three along with license number:
4. List all convictions within last two years:
5. List all unsatisfied civil judgments in any jurisdiction against the applicant:
6. List all personnel working within the Township as required by Bensalem Township Code:
7. List contractor jobs completed or accepted within the last two years. At least five are required. Jobs are not required to have been performed in Bensalem Township.
Pursuant to the code of the Township of Bensalem Section 65-46, I hereby apply for a license with Bensalem Township.
Applicant / Date
Page 1 of 3BTFR 06/2014