HomeMy WebLinkAboutAPPLICATION - 08-00276 - Fire Sentry Systems Inc - Fire Safety Certificationt
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By: Fire Sentry Systems; 888 -3191;
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Rexburg- Madison County
Emergency Services
Jun -10 -08 9:39; Page 1
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<<, Airarica's Family Comnunity
19 East Main 5t jane11h9 Phone. 208.359,3020026
Rexburg, ID 83"0 www.rexburg.arg Fox: 208.359.3024
SAFETY SYSTEM CE RTIFICATION PERMIT AP L C.AT ON
PERMIT #: (Y1 00a D (a
$100 Fee Paid: Yes /No Permit Appro . : i /No
BY: Date:_ i _/ g
"A safety rystem cerfificatzonpernr2t is reguarrd to install, math, maintain, or service all new and exi rung fin
extingun hers, fire rr popnsnon ystem.,, frn alarm ystems, and other life safety rystems mtba'n the GO of Rexburg "
BUSINESS NAME: yle— -- eV4" ✓U S+eMgS �V)C • Parcel:
OFFICE ADDRESS: T - 0 ' I)Q X 1 P
-
OFFICE PHONE NUMBER: _ V
CONTACT PERSON: l_ Las atty CELL PHONE #:
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL
THAT APPLY.
�, FIRE ALARM SYSTEMS - Alarm Con=ctors shall have a minimum of NIC r Level 1
Certifications o= equivalent.
❖PLEASE PROVIDE CERTIFICATIONS:
✓ ❖NICET Certification
❖Panel Certification
❖Proof of Liability Insurance
AUTOMATIC SPRINKLER SYSTEMS * Fire SpinUi er Contractors shall have a
minim of NICET Level III Certifications or equivalent.
PLEASE PROVIDE CERTIFICATIONS:
❖NICET Certification
•*Any Adclitional Certifications
°.•Proof of Liability Inswance
FIRE EXTINGUISHERS STANDPIPE SYSTEMS
SMOKE CONTROL SYSTEMS FIRE PUMPS
SPECIAL HAZARD SYSTEMS
AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL
COOKING
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Sent By: Fire Sentry Systems; 888 -3191; Jun -10 -08 9:40; Page 3
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* "PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS,
INSTALLATION CERTIFICATIONS, LIABILITY INSURANCE, ETC. FOR ALL
DISIPLINES * **
BUSINESS NAME: + 'tee- Vie'''+" �/ a ms 4 L
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 dcclarc under penalty of perjury that the information contained
herein is correct and complete. I agree to comply with all city ordinances, adopted codcs, and statc laws
relating to the installation, modification, service, and tnaintcnancs of new and existing life safe 7 ,ystems. I
hereby authorize rcprescntativcs of this city to inspect any work fo compliance purposes. I am leer the
contractor tesponsible for the worl., or I represent the owner as signified above and am acting v h the ownces
/contractor's full knowledge or conscnt.
Ga ,r I L-as a+e�
PRINT NAME OF APPLICANT
" _
DAT
P GANT'S SIGNATURE
PERMIT VALID UNTIL DECEMBER 31 OF THE CALENDAR YEAR APPLIED FOR.
-2-
Fire gentry Systems Inc
1800 Ardell Rd
Kuna, Idaho 83634
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PERMIT#
08 00276
1
2008
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CITE' O
REXBURG
CA' SIGNATURE
America's Family Community
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