HomeMy WebLinkAboutAPPLICATION - 07-00042 - Peak Alarm - Fire Safety CertificationOF gEXB URG
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"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
PERMIT #:
$100 Fee Pais No Permit Approved: Yes /No
BY: Date:
"A safety gstem certification permit is required to install, mod , maintain, or service all new and existing
fire extinguishers, fire suppression systems, fire alarm ystems, and other life safety ystems within the City of
Rexburg"
BUSINESS
OFFICE ADDRESS: c2�Li dykll 1'NIIMes XM4.0) =0 9'3g0l
OFFICE PHONE NUMBER: o� ®
CONTACT PERSON: f ));w5J CELL PHONE #:
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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,
L14BILITYINSURANCE, ETC. FOR ALL DISIPLINES ***
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BUSINESS NAME: �i0.✓✓N C1b -tO ��
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 /cons toes full knowledge or consent.
PRINT NAME OF APPLICANT APPLICANT'S SIG@&URE
c 2 -1 -1) 7
DATE PERMIT VALID UNTIL DECEMBER 31, 2007
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