HomeMy WebLinkAboutAPPLICATION - 05-00195 - Wasatch Electric - Fire Safety Certificationa~
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~u~.15. 2005 8:47RM
1 CITY rQF
R~=~B~~~
AMERICAS FAMILY COMl1AUNITY 19 E. Main St
Rexburg, Idaho 53440
www.rpx!?~ra.ora
No. 08?0 P. 13
Phone: 205-359-3020x326
Fex: 208-35e-3024
odd~rexburg,org
"SAFETY SYSTEM PERMIT#:
CERTIFICATION PERMIT" $100 Fee Paid: Y~,/No Permit Approved: Yes/No
APFLICATION
BY: ~ Dste• ~- (_ OS
"A safefy system cerf~cafion permit is required fo insfall, modify, maintain, or service all new and
existing fire extinguishers, fire suppression systems, fire alarm sysfems, and other life safefy
sysfems wifhin the Gify of Rexburg°
BUSINESS NAME: I~10.5a'~..~ fit? ~'~'I~ Parcel:
OFFICE ADDRESS; 1 S7 ~ ~ ~-~ ~~ T~ i.c S ~I u'p'G-~ ~ ~ < < S~
OF)=1CE PHONE NUMBER; ~~ ~ r 4 ~7 - _4 ~~ ~
CONTACT PERSON; ~-'~~-Y .CELL PHONE #; ~ ~ '~ S5'7- S I ~ y
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT• CHECK ALl. THAT APPLY.
FIRE ALARM SYSTEMS -Alarm Contrlaactors shall have a minimum of NICET Level 7 Certifications
PLEASE PROVIDE CERTIFICATIONS:
NICET Certification
Panel Certification
~Proofof Liability Insurance
AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have a minimum of NICET Level III
Certifications.
PLEASE PROVIDE CERTIFICATIONS:
NICET Certification
tAny Additional Certifications
~Prnof of Liability Insurance
FIRE EXTINGUISHERS STANDPIPE SYSTEMS SMOKE CONTROL SYSTEMS
SPECIAL HAZARD SYSTEMS FIRE PUMPS
AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
"""PLEASE PROVIDEDOCUMENTATION OF TRAINING LEI/EL~ INSTALLATION CERTIFIC~iT10NS, LlABlUTYINSURANCE, ETC
FOR ALL DISIPUNES.''*''
.Jun. 15. 2005 8;47AM ~ No. 0820 P. 14
BUSINESS NAME: VJ0. S a-~t./n ~Ct' c~-~P'i Cs
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME: j~[ Wle-- o~7h e vas PHONE #:
COMPANY NAME:
PHONE #:
COMPANY NAME: `~ PHONE #;
*'*'*PLEASE LIST ADDITIONAL COMPANY AUTHORIZATIONS ON THE BACK OF THIS FORM"`
1 cerUryr khat I have mad thk appitcafion and declare under penally of pefjury chat the Iniormatlon coMalned herein Is rornct and wmplele. I agree fo compy whh
all cly ordinances, adopted oodss, and state laws relatin0 to the installation, madificaticn, service, and maintenance of naw and t life safety systems. l
hereby authorhe ~ of this city to inspect airy work for compGence purposes. I am either the conbacbr responsmk for the work, or 1 represent the
owner as s1gnlHed above and am acting wNh fhe awnefs konhactor's full knowledge or consent
Q+~ e ~s i3 , !J ~~~t h
PRINT NAME OF APPLICANT
~'vv~~ _ Z.1 ~
~~ ~- Y~~____
a
APPLICANT'S SIGNATURE
DATE PERMIT VALID FOR ONE YEAR FROM DAVE
OF APPROVAL.