HomeMy WebLinkAboutAPPLICATION - 05-00070 - 3-D Fire Protection - Fire Safety CertificationY
~~
o~
~~
~~
Z
m
r
v
0
C
v
A
m
w~
'r' m
N
O
O
;1
n
0
1V ~
O
OO
Vl Vl
0
0
0
W
I
x ~ ~
o ~ ~
~ ~ ~
~
~ ~
r ~
r C O
~ ~
~ ~
1l
. ~
"""
~ ~ 0
,
~ z
v
~ ~ z
N C1
n
m
-~
n
1
O
Z
'0
m
3
-~
-n
m
-~
-c
N
-C
N
-i
m
~~'~'~~~ CITY OF
~~~~~~~
~ AMERICA'S FAMILY COMMUNrrY 19 E. Main St. Phone. 208 359 3020 x3261
~~'~$t~sx~ ~ Rexburg, Idaho 83440 Fax: 208-359-3024
www.rexburg.org cdd@rexburg.org
"SAFETY SYSTEM PERMIT#:
CERTIFICATION PERMIT" $100 Fee Paid: Yes/No Permit Approved: Yes/No
APPLICATION
BY: Date:
"A safety system certification permit is required to insfall, modify, maintain, or service all new and
exisfing fire extinguishers, fire suppression systems, fire alarm systems, and other life safety
systems within the City of Rexburg"
BUSINESS NAME: 3-D Fire Protection, Inc.
P 0 Box 50845
Idaho Falls, ID 83405
OFFICE ADDRESS: 6312 S Burggraf Way Idaho E3alls, ID 83402
OFFICE PHONE NUMBER: (2 0 8) 5 2 5- 8 3 7 7
CONTACT PERSON: L a M a r
CELL PHONE #:
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
vAny Additional Certifications
•Proof of Liability Insurance
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, LIABILITY INSURANCE, ETC.
FOR ALL DISIPLINES.***
BUSINESS NAME: 3-D Fire Protection, Inc.
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME: PHONE #:
COMPANY NAME: 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 corr ct and complete. I agree to comply with
all city ordinances, adopted codes, and state laws relating to the installation, modification, service, and maintenance o ew and existing life safety systems. I
hereby authorize representatives of this city to inspect any work for compliance purposes. I am either the contracto sponsible for the work, or I represent the
owner as signified above and am acting with the owner's (contractor's full knowledge or consent.
LaMar Hayward
PRINT NAME OF APPLICANT APPLICANT'S SIGN TORE
02/23/05
DATE PERMIT VALID FOR ONE YEAR FROM DATE
OF APPROVAL.