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HomeMy WebLinkAboutAPPLICATION - 05-00091 - Fire & Security Systems - Fire Safety Certification~~ ~~ ~~ o~ ~~ z_ Z m a r v x 0 c v ~n m w ° .~ m N O O 0 ~o r~ 0 ~~ x o ~ r~ ~ ~ ~ ~ r ~ r o cn ~ ~ ~ ~ ~ d ~ r~ z ~ ~ ~ Q ~ ~ ~. Vl n m -~ n -~ O Z '0 m 3 1 m -~ -c N -C -~ m ~'""~~~ CITY tJF =--~ , ~~'' a rtN1ERfCA'S FAMELY COMMUi*IfTY 19 E. Main St. Phone: 208-359-3020 x326 ~$tt3HED Rexburg, Idaho 83440 Fax: 208-359-3024 www.rexburp.or4 cdd@rexburg.org "SAFETY SYSTEM PERMIT#: ~ 5 ©~ ~ CERTIFICATION PERMIT" $100 Fee Pai • Yes/ o Permit Approved: Yes/No APPLICATION BY: Date: "A safety system certification permit is required to install, modify, maintain, or service all new and existing fire extinguishers, fire suppression systems, fire alarm systems, and other life safety systems within the City of Rexburg" BUSINESS NAME: Fire & Security Systems Parcel: OFFICE ADDRESS: 1301 June Ave. , Idaho Falls, ID 83404-5335 OFFICE PHONE NUMBER: 208-524-1234 CONTACT PERSON:Mike McKnight CELL PHONE#: 208-403-5194 PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL THAT APPLY. ~~FIRE ALARM SYSTEMS -Alarm Contractors shall have a minimum of NICET Level 1 Certifications •PLEASE PROVIDE CERTIFICATIONS: •NICET Certification •Panel Certification •Proof of Liability Insurance AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have a minimum of NICET Level III Certifications. •PLEASE PROVIDE CERTIFICATIONS: •NICET Certification •Any Additional Certifications •Proof of Liability Insurance xx FIRE EXTINGUISHERS STANDPIPE SYSTEMS SMOKE CONTROL SYSTEMS SPECIAL HAZARD SYSTEMS FIRE PUMPS AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING ***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS, LIABILITYINSURANCE, ETC. FOR ALL D/SIPL/NES.*** BUSINESS NAME: Fire & Security Systems PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT: COMPANY NAME: COMPANY NAME: COMPANY NAME: PHONE #: PHONE #: PHONE #: *****PLEASE LIST ADDITIONAL COMPANY AUTHORIZATIONS ON THE BACK OF THIS FORM**** I certify that I have read this application and declare under penalty of perjury that the information contained herein is correct and complete. I agree to comply with all city ordinances, adopted codes, and state laws relating to the installation, modification, service, and maintenance of new and existing life safety systems. I hereby authorize representatives ofthis city to inspect any work for compliance purposes. I am either the contractor responsible for the work, or I represent the owner as signified above and am acting with the owner's (contractor's full knowledge or consent. Michael McKnight ~ I, ~- ~ ~ "-- PRINT NAME OF APPLICANT A LICANT'S SI .NATURE 25 March, 2005 ` DATE PERMIT VALID FOR ONE YEAR FROM DATE OF APPROVAL. **~**,~,t**~~****~*********~****,~**~*****~*,~~~************:~****,~,~,~*:~**:~*,~**~********,~~*,~***,~**~*,~*****~~***