HomeMy WebLinkAboutAPPLICATION - 07-00025 - SimplexGrinnell LP - Fire Safety CertificationOF V EXB URC
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BUILDING SAFETY DEPARTMENT
° REX
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Americas Family Community 19 E. Main St. Phone: 208 - 359 -3020 x326
Rexburg, Idaho 83440 Fax: 208- 359 -3024
www.rexburg.org janellh @rexburg.org
"SAFETY SYSTEM PERMIT #: 0 DCO3s
CERTIFICATION PERMIT" $100 Fee Paid: Yes /No Permit Approved: Yes /No
APPLICATION
BY:
"A safety gstem certification permit is required to install, mod , maintain, or sermce all nex and existing
fire extinguishers, fire suppression ystems, fire alarm systems, and other life safety systems within the City of
Rexburg"
BUSINESS NAME:
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 Area - Jason Wi lliams
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
X 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,
LIABILITYINSURANCE, ETC. FOR ALL DISIPLINES * **
0 0
BUSINESS NAME: SimolexGrinnell LP
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANYNAME: Tyco Fire & Safety PHONE #:
COMPANY NAME: Ansul
COMPANY NAME: Pyrochem
PHONE #:
PHONE #:
**** *PLEASE LIST ADDITIONAL COMPANY AUTHORIZATIONS ON THE BACK OF THIS FORM 'k***
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 co m a 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 /co ct a" knowledge or consent.
Robert Riegel
PRINT NAME OF APPLICANT APP ICANT'S SIGNATURE
1/23/07
DATE PERMIT VALID UNTIL DECEMBER 31, 2007
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