Removal of Master Box

Providence Fire Department

Office of Fire Prevention
Request for removal of Fire Alarm Municipal Connection
Code of Ordinances of the City of Providence

Sec. 9-95. - Disconnect/reconnect charge.
Any disconnects or reconnects will be done at a one hundred twenty-five dollar ($125.00) charge per request payable to the city treasurer.

(Ord. 1981, ch. 81-59, § 6, 11-27-81; Ord. 2003, ch. 03-47, § 1, 8-1-03)
Email for submission confirmation:*
example@example.com
Building Information
Master Box #:*
City Permit # (i.e RAZE,BLDG):*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Owner Information
Full Name/Business Name*
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Electrician Information
Full Name/Business Name*
Electrician License #*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Reason for removal:*
Check/Money Order Information

Name on CheckCheck/MO #
Payment Amount
By typing my name in the signature field, I understand that I am electronically signing this form. I attest and certify that the information provided is true and accurate. I understand that my electronic signature has the same legal effect and can be enforced in the same way as a handwritten signature.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Providence Fire Department