HomeMy WebLinkAboutALL DOCS - 13-00141 - A-1 Fire Pro Annual Safety Certification35N t.tE
Rexburg, lD 83440 www.rexburg.org
*A tortA ystun mtfication permit is required to install, modtfi, maintain, or service a// new and existingfire
extinguisbers, fre suppression ystems, fre alarrn s-1tstems, and other lfe safe4t ystems within the Citjt of Rexburg"
Rexburg -Mqdison Cou nly
Emergency Services
Phone: 208.372.2326
Fox: 208.359.3022
BUSINESS NAME: / -/ 6" C- Parcel:
U
OFFICE ADDRESS, ,277
-
Umalr^,(( ?" 6r" J96 (*ruuoolrwft ?" 6,";, r l/o#(L D2 3rq.2-
oFFIcE PHoNE NUMBER, Q2- lh I
coNTACT PERSoN: /hr/L cELL pHoNE #:
PLEASE IDENTIFY SYSTEMS TO BE COYERED BY THIS PERMIT. CHECKALL
THAT APPLY.
FIRE ALARM SYSTEMS - Alarm Contractors shall have a minimum of NICET Level 1
Cetifications or equivalent.
{. PLEASE PROVIDE CE,RTIFICATIONS :
{.NICET Certification
i.Panel Cetification
i.Proof of LiabiJity Insurance
i.NICET Level II required for A- '
-AUTOMATIC SPRINKLER SYSi
minimum of NICET Level I Cetifications c
'PLE,ASE PROVI
.lNiCET Certi{icati
UFilry'rwl
:r"rffi,.i.Any Additional Cer
{.Proof of Liability Inr
{. NICET Level II reqr
(,
XIRE EXTINGUISHERS
r . *Proof of Cetification &
)'(a.uroMATrc FrRE ExTTNGUTsHTNG s
COOKING
{.Proof of training for comn
-STANDPIPE SYSTEMS
-SMOKE CONTROL SYSTEMS
c |l'Y o ll
REXBURG
America\ Fnmily Cotrrttlu ni tl
fM to ,-
rF&td
*
ffi0"
y
-.IAZAR[) SYSTEMS
-'r.d PUMP
***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS,
INSTAI.IA,TION CERTIFICATIONS, LIABILITY INSARANCE, ETC. FOR ALL
DISIPLINES*r.*
I certifr that I have tead this application and declate under penalty of periury that the infotmation contained
hetein is cottect and complete. I agree to comply with all city otdinances, adopted codes, and state laws
telating to the installation, modification, service, and maintenance of new and existing life safety systems. I
heteby authorize teptesentatives of this city to inspect any wotk for compliance purposes. I am either the
contractor tesponsible fot the wotk, ot I teptesent the ownet as signified above and am acting with the ownetts
/conttactotts full knowledge or consent.
" .'5r*-
PRINT NAME OF APPLICANT
A{- //- / 9
DATE
PERMIT VALID UNTIL DECEMBER 31 OF THE CALENDARYEAR APPLIED FOR.
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APPLICANT'S SIGNATURE
-2-
an'-l hr" ?ro
Nunrber: l3-OO141 Status: REVIEW
tuDEE
Annud Hre Safety Certffication
H{ITFI }}l
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100.oo too.00
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Si.spiaging; r to I
APR I 8 ZON