HomeMy WebLinkAbout ALL DOCS - 08-00063 - Western Automatic Sprinler - Fire Safety Certification`moo f 9
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CITY OF
REX
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America's Family Community
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BUILDING SAFETY DEPARTMENT
19 E. Main St.
Rexburg, Idaho 83440
www.rexburg.org
Phone: 208 - 359 -3020 x326
Fax: 208- 359 -3024
janellh @rexburg.org
"SAFETY SYSTEM PERMIT #: U
CERTIFICATION PERMIT" $100 Fee Paid: a /No Permit Approved. /No
APPLICATION � 0'8
BY Date: /
"A safety system certification permit is required to install, mod f, maintain, or service all new and existing
fire extinguishers, fire suppression systems, fire alarm systems, and other life safety ystems n ithin the City of
Rexburg"
BUSINESS NAME WESTERN AUTOMATIC SPRINKLER
Parcel:
OFFICE ADDRESS: 2510 S WEST TEMPLE SALT LAKE CITY, UT 84115
OFFICE PHONE NUMBER: (801) 484 - 3531
CONTACT PERSON: Bruce Hagen
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 or equivalent.
❖PLEASE PROVIDE CERTIFICATIONS:
•* Certification
V Panel Certification
*Proof of Liability Insurance
- xX 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
*: *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,
LL4BILITYINSURANCE, ETC. FOR ALL DISIPLINES * **
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BUSINESS NAME: W ESTERN AUTOMATIC SPRINKLER
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 putpos am either the contrac r re ible for
the work, or I represent the owner as signified above and am acting with the owner's. /contractor's full jWftleflge or consent.
PRIN OF APPLICANT APPLICANT'S SIGNATURE
DATE PERMIT VALID UNTIL DECEMBER 31, 2007
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� SAFETY
SYSTEM
i CERTIFICATION
Western Automatic Sprinkler
25105 West Temple
Salt Lake City UT 84115
PERMIT'# 08 00063
• 2008
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REXB
' SIGNATURE
America* Family Community
al"ie,- , 6
DATE
VALID THROUGH DECEMBER 31, 2008