HomeMy WebLinkAboutALL DOCS - 08-00108 - A-1 Fire Protection Services - Fire Safety Certificationh�o4 ScE:CBURG'�
V O
C I T Y OF
REX V G
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Americas Family Cosm unh);
BUILDING SAFETY D
19 E. Main St.
Rexburg, Idaho 83440
www.rexburo.orci
"SAFETY SYSTEM
CERTIFICATION PERMIT"
Phone: 208 - 359 - 3020 x326
Fax: 208- 3593024
janellh @rexburg.org
$100 Fee Paid: Yes /No Permit Approve
APPLICATION �®
By- Date:
"A safeJ ystem certificationermit is required to install, mod, maintain, or seraice all new and eacisting
fire extinguishers, fire suppression ystems, fire alarm ystems, and other life safety systems within the City of
Rexburg"
Bi3SINESS NAME: �' t C
-- l 1 - ''re- lw1tG� Je . es Par ceL-
OFFICE ADDRESS:
OFFICE PHONE NUMBER "C)
CONTACT PERSON: / � /'r 4 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:
❖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
_�UTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
** *PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CER TIFICATIONS,
LIABZLITYINSURANCE, ETC. FOR ALL DISIPLINES * **
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aaIIS �JeA d9V :£0 80 Co a ?i
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BUSINESS NAME:
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME:
COMPANY NAME:
PHONE #:
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, modification, service, and maintenance of new and existing
life safety systems. I hereby authorize representatives of rhis 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 owner's /contract24 full knowledge or consent.
PRINT NAME OF APPLICANT APPLICANT'S SIGNATURE
DATE PERMIT VALID UNTIL DECEMBER 31, 2007
Z'd
9�9LZZ980Z
d8 - V:C0 80 CO aeN
SAFETY
SYSTEM
CERTIFICATION
•
A -1 Fire Protection
3111 Wright
Idaho Falls ID
Services
Rd
83402
c P ERMIT# 08 00108
� 2008
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CITY OF
REx
' -- SIGNATURE
.Americas i amia v Communi ,
3 /y /e
DATE
VALID THROUGH DECEMBER 31, 2008