HomeMy WebLinkAboutALL DOCS - 08-00062 - Simplex/Grinnell LP - Fire Safety Certificationo� g�xav,�c
y i CITY OF
y ------ ----- REXBURG
Americas Family Community
"SAFETY SYSTEM
CERTIFICATION PERMIT"
APPLICATION
Phone: 208 - 359 -3020 x326
Fax: 208 - 359 -3024
janellh @rexburg.org
$100 Fee Paid:e /Nonn Permit Approved. Ye /No
"A safety system certzfication permit is required to install, mod, maintain, or service all new and existing
fire extinguishers, fire suppression systems, fire alarm systems, and other life safety gstems within the City of
Rexburg"
BUSINESS NAME:
SimplexGrinnell LP Parcel:
OFFICE ADDRESS: 2702 South 1030 West, 460
OFFICE PHONE NUMBER: 801 - 262 -9406
CONTACT PERSON:
Jean Court
Salt Lake Citv. UT 8411
CELL PHONE #: Jason Williams /Idaho
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 or equivalent.
*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 or equivalent.
*PLEASE PROVIDE CERTIFICATIONS:
*: *NICET Certification
*Any Additional Certifications
4 . *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
41
BUILDING SAFETY DEPARTMENT
19 E. Main St.
Rexburg, Idaho 83440
www.rexbura.oro
** *PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS,
LIABILITYINSURANCE, ETC. FOR ALL DISIPLINES * **
BUSINESS NAME: SimplexGrinnell LP
1 * r .
PLEAS LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME: Tyco Fire & Safety PHONE #:
COMPANY NAME:
ANSUL
PHONE #:
COMPANY NAME: Pyrochem
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 o ontractor's full knowledge or consent.
Tom O'Gara L- Tom O'Gara
PRINT NAME OF APPLICANT PLICANT'S SIGNATURE Total Service Manager
2/05/08
DATE PERMIT VALID UNTIL DECEMBER 31, 2007
SAFETY
SYSTEM
CERTIFICATION
0
SimplexGrinnell LP
2702 South. 1030. West #60
Salt Lake City UT 84119
0
. 1
P KR M I T # 08
2008
��t
C1TY 0 F
M
REXBURG
' SIGNATURE DATE
America' Family Community
VALID THROUGH DECEMBER 31 2008