HomeMy WebLinkAboutAPPLICATION - 06-00137 - SimplexGrinnell LP - Fire Safety Certification~c~+'urr~
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'Q$ttsxE'~^ AMERICA'S FAMILY COMMUNITY 19E. Main St. Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www.rexburg.org cdd@rexburg.org
"SAFETY SYSTEM PERMIT#: ~l(, ~ I~~'
CERTIFICATION PERMIT" $100 Fee Paid: es o Permit Approved: Yes/No
APPLICATION
BY: Date:
"A safety system certification permit is required to install, 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 NArJiE: SimplexGrinnell LP
OFFICE ADDRESS: 1272 West 2240 South, Ste A Salt Lake City, UT 84119
OFFICE PHONE NUMBER: 801-262-9406
CONTACT PERSON: Jean Court
CELL PHONE#: Idaho -Jason Williams 208-520-9680
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL THAT APPLY.
x 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
x FIRE EXTINGUISHERS x STANDPIPE SYSTEMS x SMOKE CONTROL SYSTEMS
x SPECIAL HAZARD SYSTEMS x FIRE PUMPS
x AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS
FOR ALL D/SIPL/NES.*** ~ I; ~~ _~
MAR 1 6 2006 f (~`
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BUSINESS NAME:
lexGrinnell LP
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME: Tyco Fire & Safet
COMPANY NAME: Ansul
PHONE #:
PHONE #:
•
COMPANY NAME: Pyrochem 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 ei her 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 sent.
Michael G. Brown
PRINT NAME OF APPLICANT A LICAN S NATURE ' -
03/07/08
DATE PERMIT VALID FOR ONE YEAR FROM DATE
OF APPROVAL.
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