HomeMy WebLinkAboutPERMITS - 07-00029 - 3-D Fire Protection Inc - Fire Safety CertificationOF µEX B URC
A. �O
A
U � G
l 9
ryEr:
C I T YOF
R L X V 1 <4J
-- --'--- -- -- Cry - ---_�_.
Americas Family Community
"SAFETY SYSTEM
CERTIFICATION PERMIT"
APPLICATION
•
BUILDING SAFETY DEPARTMENT
19 E. Main St. Phone: 208 - 359 -3020 x326
Rexburg, Idaho 83440 Fax: 208 - 359 -3024
www.rexburg.org janellh@rexburg.org
$100 Fee Paid: ( Yes /No Permit Approved: Yes /No
BY: Date:
"A safety system certification permit is required to install, mod , maintain, or serer' all new and existing
fire extinguishers, fire suppression systems, fire alarm ystems, and other life safety ystems within the City of
Rexburg"
BUSINESS NAME: p ?Q B� 51)s'+} „�
D l r'e P ro all In(,. Parcel: �dGIhn VakkS, ib. z3gt)
OFFICE ADDRESS: te3l2 S • 1',waq 1ra V Y oul ' VIQ,h(,)
+ry fi
OFFICE PHONE NUMBER: ( 2�a `
CONTACT PERSON: IL0, CLr rlowwo— A CELL PHONE #:
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,
LIABILITYINSURANCE, ETC. FOR ALL DISIPLINES * **
BUSINESS NAME:
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'k***
I certify that I have read this application and declare under penalty of perjury that the information contained herein is co ect and complete. I agree to
comply with all city ordinances, adopted codes, and state laws relating to the installation, modification, service, and m ' tenance of new and existing
life safety systems. I hereby authorize representatives of this city to inspect any work for compliance purposes. I am er the contractor responsible for
the work, or I represent the owner as signed above and am acting with the owner's /contractor's full knowledg consent.
Y
PRINT NAME OF A4LICANT APPLICANT'S SIGNA URE
i .Y
DATE PERMIT VALID UNTIL DECEMBER 31, 2007
ay
h
m
p
�7 w
IL
z
m
a
r _
0
O
c
v
m
A
m
m
w
m
N
O
O
v
0
O U
lyi
N�
0
0.0
q q
0
0
0
N
c�
•
n
O
Z
'0
m
N
m
-C
N
m
�M
0)
r 1
I
xN�
0
;u
>
M
~o
r
c
;u
r
0
ISM
o x
"I
Oo
)WTI
Now
N
0
0>
0.0
N04
z
0
n
O
Z
'0
m
N
m
-C
N
m