HomeMy WebLinkAboutALL DOCS - 08-00100 - Fire Engineering Company - Fire Safety CertificationOF gEYBURG
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CITY O F
REX
Ow
America's Family Community
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 #: f 0 � 0
CERTIFICATION PERMIT $100 Fee Paid- Yes/ o Permit Approved: Yes /No
APPLICATION �- 3/ � lU �
BY Date•
"A safety system certification permit is required to install, mod, maintain, or service all new and existing
fire extinguishers, fire suppression ystems, fire alarm systems, and other life safety systems within the City of
Rexburg"
BUSINESS NAME:
Fire Engineering Company, Inc.
OFFICE ADDRESS:
4717 South 500 West, SAlt Lake City, Utah 84123
OFFICE PHONE NUMBER:
(801) 262 3329
CONTACT PERSON:
Bart Leeflang
CELL PHONE #: ( 801) 633 1473
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
� AU TOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have a minim 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,
LIABILITYINSURANCE, ETC. FOR ALL DISIPLINES***
BUSINESS NAME: Fire Engineering Company,Inc.
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 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, ification, service, maintenance of new and existing
life safety systems. I hereby authorize representatives of this city to inspect any wor r comp ' ce purposes. am either the contractor responsible for
the work, or I represent the owner as signified above and am acting with the owgee �ctoes ow dg e or c ent.
B ar t L eeflang //
PRINT NAME OF APPLICANT APPLICANT'S SIGNATURE
DATE 2 - 2 S— Q PERMIT VALID UNTIL DECEMBER 31, 2007
SAFETY
SYSTEM
CERTIFICATION
i
Fire Engineering
4717 South
Salt Lake City
Company, Inc.
500 West
UT 84123
C PERMIT# 08 00100
0 2008
' CITY OF
REXBURG
SIGNATURE
AYt7G'Y ca' Family CamYY unigr
3 /4/ /a e
DATE
VALID THROUGH DECEMBER 31, 2008.