HomeMy WebLinkAboutALL DOCS - 08-00058 - Gem State Fire Protection - Fire Safety Certification04 RExavR�
i
CITY OF
RE
0v
0
BUILDING SAFETY DEPARTMENT
America's Family Community 19 E. Main St. Phone: 208 - 359 -3020 x326
98t s H E c i 80a A Rexburg, Idaho 83440 Fax: 208 - 359 -3024
www.rexburn.org janellh@rexburg.org
"SAFETY SYSTEM PERMIT #:
CERTIFICATION PERMIT" $100 Fee Paid: Yes o Permit Approved.<&JNO
APPLICATION
"A safety system certification permit is required to install, mod6, maintain, or service all new and existing
fire extinguishers, fire suppression systems, fire alarm systems, and other life safety systems within the City of
Rexburg"
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 or equivalent.
❖PLEASE PROVIDE CERTIFICATIONS:
❖NICET Certification
❖Panel Certification
❖Proof of Liability Insurance
AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have a minimum of
ICET Level III Certifications or equivalent.
❖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 * **
OFFICE PHONE NUMBER L
CONTACT PERSON: jpz CELL PHONE #:
BUSINESS NAME 4X ,1 77
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME: PHONE #:
COMPANY NAME: PHONE #:
COMPANY NAME: 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 pejinst a information co ined herein is correct and complete. I agree to
comply with all city ordinances, adopted codes, and state laws relating ttion, modifica ' service, and maintenance of new and existing
life safety systems. I hereby authorize representatives of this city to insp for complian a urposes. I am either the contractor responsible for
the wor or I represent owner as signified above and am acting wi / s knowledge or consent.
PRINT NAME OF AI&LICANT PLIC I TURE
DATE ' / / PERMIT VA4IDJUNTIL DECEMBER 31, 2007
I& Ah
Gem State Fire Protection
1105 West Iona Rd
Idaho Falls ID 83403 -2620
PERMIT# 08 00058
2008
C I T Y OF
SIGNATURE
4
E 4 America's Family Community
i'� fS -ff 78 &.
8 /d 6
DATE
VALID THROUGH DECEMBER 31, 2008
M AM AM AM AM AM AJ