HomeMy WebLinkAboutAPPLICATION - 06-00203 - Professional System Technology - Fire Safety Certification~Iun, 15. 2005 8:47AM
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CITY QF
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AMERICA5 FAMILY COMMU 19 E. Main St
Rexburg, Idaho 83440
www te~u.. r~cra
No. 0820___ P. 1
Phone: 208-359-3020x326
Fax: 201#-359~302~
cdd~rexburg,org
="SAFELY SYSTEM IT#• CC'
CERTIFlCATION PERMIT" $100 Fee Paid: Yes/No Permit Approved: Yes/No
APPLICATION
B ~9. ~..,~. Date- ~ 2 o-.~
"A safety system cerf~cation permit is required fo install, modify, maintain, or service all new and
exisfing fire extinguishers, fire suppression systems, frre alarm systems, and other life safety
systems wifhin the Cify of Rexburg°
BUSINESS NAME: ASS '~'1 ~ arcel:
OFFICE ADDRESS: ~~-z L~ . /(~~~(%p (,>ryQ ~ ~~( ~,, ~(~" ~~~ p --i ~
OFFICE pI10NE NUMt3l:l2: ~~ ' ~..v "! ~ ~ lp ~ d
CONTACY PEi~SON: ~% `' ,_,_~ CELL PHONE #; ~?~ " ~~ ~P - I S~
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL, THAT APPLY.
AFIRE ALARM SYSTEMS -Alarm Contractors shall have a minimum of NICET Level 9 Certifications
r~PLEASE PROVIDE CERTIFICATIONS:
NICET Certification
Panel Certifcation
Proof of liability Insurance
AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shaii have a minimum of NICET Level III
Certifications.
fi-PLEASE PROVIDE CERTIFICATIONS:
tNICET Certification
~-Any Additional Certifications
Proof of Liability Insurance
FIRE EXTINGUISHERS
SPECIAL HAZARD SYSTEMS
STANDPIPE SYSTEMS
FIRE PUMPS
SMOKE CONTROL SYSTEMS
AtTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
""PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS 1NSTALLAT/ON CERTIFICATIONS,
FORALL DlS-PUNES.*'*
.~~ ~ p
APA 2 7 2006
CITY OF REXBURG
Jun. 15. 2005 8:47AM ~ • No, 0820 P, 14
BUSINESS NAME~I~ ~~ ~' L~ti'1~~~L~c~~'~~ ~-( C.~(~-~17~
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPAA'Y NAME: PHONE #:
COMPANY NAME: PHONE #:
COMPANY NAME: PHONE #:
'*"`PLEASE LIST ADDITIONAL COMPANY AUTHORIZATIONS ON THE BACK OF THIS FORM""
1 certlfy that I have read this applleafion and declare under penahy of perjury that the int'armatlon tdalned h Is wrrect and complete. I spree to comply with
all Clb+ordhrdrlC9e,~dopted codes, and state laws nrlating t0 the installation, modiRcatlon, serv mafnten ce of naw and erg life Safety systems. l
hereby authorize threra o cky io hrspect any work for compGeace purposes. I e e co r roepoaah+ie for fhe worly or 1 represent the
owner as sign and am acting the owners fcorrtractor's tug krrowledge or co
v ~ ~ s `.
PRINT 0 APPLiC NATURE
T ~~ -~/',., PERMIT VALID FOR ONE YEAR FROM DATE
,_,_ ___ / ll/ OFAPPROVAL.