HomeMy WebLinkAboutSAFETY PERMIT - 05-00068 - Omni Security Systems - Fire Safety Certification~~
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c~~~~, - CITY 0~
REXBLIR~
~'?q,~Er~~y~.`'~ AMERICA'S FAMIt,Y COMMI.tNFtY
"SAFETY SYSTEM
CERTIFICATION PERMIT"
APPLICATION
L~
19 E. Main St. Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www. rexbura. oro cdd@rexburg. org
PERMIT#: ~ ~. QOO
$100 Fee Paid. Ye No Permit Approved: Yes/No
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: Parcel:
OFFICE ADDRESS: ~I 3 ~ L c~0
OFFICE PHONE NUMBER: ~~~ ' 7~~ ° ~Uo~-U
CONTACT PERSON: - CELL PHONE #: ~Q' b~~~
TEASE 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 ju~s,cv~.s,r~~ ;~,ru
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
FIRE EXTINGUISHERS
SPECIAL HAZARD SYSTEMS
STANDPIPE SYSTEMS
FIRE PUMPS
SMOKE CONTROL SYSTEMS
AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS, LIAB/LITY/NSURANCE, ETC.
FOR ALL D/SIPL/NES.***
r ~
BUSINESS NAME:
PLEASE LIST ALL COM} P~ANI~EjS YOUR BUSINESS IS AUtTHORIZED TO REPRESENT: t i~
COMPANY NAME: - ~~f!I i ~i`'`1~~~~~ ~.~j-1.~5 ~'1C'PHONE #: ~C~~~~~ ~ IOZV
COMPANY NAME: ~rnmu ~l-Q,u~ ~ ( PHONE #: ~~ (~ ~~ '~ ~~
COMPANY NAME:
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 of this 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 knowled/ge~or~c yonsent.
„1, r~~{ ~ti k~
l 1bY ,,"J~I)`f"~` ,
PRINT ME OF APPLICANT APPLIC T'S SI ATURE
3--6 i-o5
DATE
PERMIT VALID FOR ONE YEAR FROM DATE
OF APPROVAL.