Form Center

2. Township of Pine
   230 Pearce Mill Road
   Wexford, PA 15090
   Phone: 724-625-1591
   Fax: 724-625-1790
4. Fire Prevention Permit Application
   Notice: Any permit issued pursuant to the approval of this application may be revoked if the issuance of the permit was based upon incomplete or inaccurate information, or it violates any Township of Pine Ordinance, Pennsylvania Statute, United States Law, or Court Precedent.
6. Applicant Information
8. Applicant Name
9. Applicant Phone
11. Applicant Address
13. Applicant City
14. State
15. Zip Code
17. Property Information
19. Property Owner
20. Owner Phone
22. Street Address
23. Lot Block
25. Development Name
26. Lot Number
28. General Information
30. Installation / Modification Permits

    1. Fire Alarm System
    2. Kitchen Suppression System
    3. Other Fire Suppression System
    4. Other Activity
31. Operational Permits

    1. Flammable / Combustible Liquid
    2. Hazardous Materials
    3. Private Fire Hydrant
    4. Other Operation
33. Contractor (If Different From Applicant)
34. Estimated Start Date
    Estimated Start Date
36. Special Note: Fire Alarm Systems
    A record of completion must be submitted to the Township before a final acceptance test is conducted. A maintenance agreement must be signed between building owner and alarm company, and the agreement must be indicated on the record of completion. Failure to follow these procedures will delay issuance of building occupancy permits.
37. Items Submitted With Application

    1. Drawings
    2. Product Cut Sheets
    3. Knox Application
    4. Hydrant Maintenance Record
    5. Specific Operation Detail
39. Description of Work / Operation
41. MSDS / Chemical List
43. Flammable / Combustible Liquids List
45. The applicant certifies that the above information is complete and true and correct to the best of the applicant's knowledge and belief.
47. The applicant agrees to comply with the provisions of he Township of Pine's Ordinances, Codes and Regulations, and all other applicable laws and regulations of Allegheny County, Commonwealth of Pennsylvania and the United States, whether or not specified in this application.
49. The applicant agrees that if a permit is issued, the permit may be revoked by administrative action of the Township of Pine if compliance with the foregoing paragraphs and references are not absolute.
51. Additional Comments
53. Signature of Applicant
54. Date
    Date
56. Fee
    Fee determined by type of application
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58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

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