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HomeMy WebLinkAboutAPPLICATION - 06-00156 - Fire & Security Systems - Fire Safety Certification19E. Main St. Rexburg, Idaho 83440 www.rexburg.org I ...~1 Phone: 208-359-3020 x326 Fax: 208-359-3024 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 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" ~r BUSINESS NAME: OFFICE ADDRESS: I ~O I ~ C.Gy~~. ~ ~Z ~ ~ ~ ~ ~D ~I~`>~ I ~ ~~~©~ ~~ ~~5~ OFFICE PHONE NUMBER: O~ '" ~ ~-3 ~,/~ _ CONTACT PERSON: ~ I' i'~~~`ELL PHONE #: `~ ~-~'C~,,,3'~j /~ , 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 .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 D/SIPLINES.*** ~~ MAR 1 7 2006 ~V ~ • • BUSINESS NAME: _~~ R.E. ~ ~~ ~ ~ ~,~j V ~j~ ~~ S 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 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 knowledge or consent. , PRINT NAME OF APPLICANT P (CANT'S SIGNATURE DATE PERMIT VALID FOR ONE YEAR FROM DATE OF APPROVAL. ~.. ,. k. ~. "y%~, i ~ ~=, ~~ ~~ R z m r v -~ s C T O m m a m w N O O 0 m c 111 N~ O O~ a~ ~ O 0 Ijl ~_ 1 ~~ ~ ~ ~° '~° ~~ .~. ~ ~: ~ .. ~~~.~ _,, ~' . 11 ~~ ~ ~..ii r~~ r ~~ ~ ~ ~~C d~~ z~ ~~ 00 ~ W O 1 I~~ V 1 1'1 W W n m ~~ ~ '~ ~n ~m a ~' -~ ~ o~ z~ -o -' mm ~ 3 3 1