HomeMy WebLinkAboutAPPLICATION - 08-00101 - Peak Alarm - Fire Safety Certification04 liBXS p�
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C I T Y OF
REX
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BUILDING SAFETY DEPARTMENT
America's Family Community 19 E. Main St. Phone: 208 - 359 -3020 x326
Rexburg, Idaho 83440 Fax: 208 - 359 -3024
www.rexburg.org janellh @rexburg.org
"SAFETY SYSTEM PERMIT #: 0% uvl L
CERTIFICATION PERMIT" $100 Fee Paid: ne /No Permit Approved. Ye o
APPLICATION
BY. . � ' - �, 0
"A safety system certification 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 systems within the City of
Rexburg"
BUSINESS NAME:
P� A�
OFFICE ADDRESS: ; 'duV_^ f 61wes Tda4c G-Als, =t� s34oI
OFFICE PHONE NUMBER. 0a 9- Say -L4 4-)2-
CONTACT PERSON: Y� y 1M� 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 CER
*NICET Certification
❖Panel Certification
❖Proof of Liability Insurance
AUTOMATIC 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,
LL4BILITYINSURANCE, ETC. FOR ALL DISIPLINES * **
BUSINESS NAME: PCA1 wcWryl , &t—.
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 repr
s�e the owner as signified above and am acting with the owner's /contractor's full knowledge or consent.
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PRINT NAME OF APPLICANT APPLICANT'S SI ATURE ,
DATE PERMIT VALID UNTIL DECEMBER 31, 2007
SAFETY
SYSTEM
CERTIFICATION
•
Peak Alarm
240 South Holmes
Idaho Falls ID 83401
C PERMIT# OS 00101
• 2005
�
� '+ CITE` OF
REXBURGI
SIGNATURE
3 /y /o 6
DATE
VALID THROUGH DECEMBER 31, 2008