HomeMy WebLinkAboutAPPLICATION & CERTIFICATION - 08-00204 - Christensen Fire Extinguisher Co - Fire Safety CertificationO1 R xXH p
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CITY O F
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America's Family Community
"SAFETY SYSTEM
CERTIFICATION PERMIT"
BUILDING SAFETY DEPARTMENT
19 E. Main St. Phone: 208 - 359 -3020 x326
Rexburg, Idaho 83440 Fax: 208 - 359 -3024
www.rexburg.ora janellh @rexburg.org
$100 Fee Paid:/Yes`No Permit Approved YO /No
APPLICATION 4
BY- k ti�r + Date: 2 O g
"A safety system certification permit is required to install, modi maintain, or service all new and existing
fire extinguishers, fire suppression systems, fire alarm systems, and other life safety systems adMin the City of
Rexburg"
BUSINESS
OFFICE ADDRESS:
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OFFICE PHONE NUMBER: 3 .+ Z- Y/.7 � �` �
CONTACT PERSON: 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 Con
NICET Level III Certifications or equivalent.
*PLEASE PROVIDE CERTIFICATIONS:
*NICET Certification
❖Any Additional Certifications
****Proof of Liability Insurance
D r tcEiYE
PR 2 4 2008
s ve a minim of
CITY G R F E U RG
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 * **
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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 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 owner's /contractor's full knowledge or consent.
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PRIN , S AME FF APPLICANT PLICANT'S SIGNATURE
DATE / / JT PERMIT VALID UNTIL DECEMBER 31, 2007
SAFETY
SYSTEM
CERTIFICATION
A
Christensen Fire Extinguisher Co.
732.- Falls Dr
Idaho Falls ID 83401
S
PERMIT# OS 00204
2008
CIT 0
3
REX BU R G
} SIGNATURE
0
0
DATE
VALID THROUGH DECEMBER 31, 2008