HomeMy WebLinkAboutFIRE SYSTEM COVER SHEET - 16-00046 - 525 S 2nd E - AT&T Tower AdditionRexburg -Madison County �ti N�auuF�' CITY 01;
Emergency Services RE?XBURG
35N 1dE Phone: 208.372.2341 Am:rim Family Gmuuunit,
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022
SAFETY SYSTEM CERTIFICATION PERMIT APPLICATION
PERMIT#:
$100 Fee Paid: ❑ Yes ❑ No Permit Approved: ❑ Yes ❑ No
BY. -Date:
"A safety system certification permit is regsdnd to instar modib, maintain, orseroise all new and existing fin
exdngmtsbers, fire suppression systems, fin a/aw systems, and otber life safely systems within the City of Rexburg"
BUSINESS NAME: Nelson Fire Systems Parcel:
OFFICE ADDRESS: 1481 S Major Street Salt Lake City, UT 84115
OFFICE PHONE NUMBER: (801) 468-8300
CONTACT PERSON: Ben Nelson
CELLPHONE #. (801) 652-7990
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL
THAT APPLY.
✓❑ FIRE ALARM SYSTEMS - Alarm Contractorsshall have a minimum of NICET Level I
Certifications or equivalent.
•%PLEASE PROVIDE CERTIFICATIONS:
**+NICET Certification
**•Panel Certification
+Proof of Liability Insurance '
❑ AUTOMATIC SPRINKLER SYSTEMS - Fire; Sprinkler Contractors shall have a
minimum of NICET Level III Certifications or equivalent.
•-PLEASE PROVIDE CERTIFICATIONS:
❖NICET Certification
:•Any Additional Certifications
***Proof of Liability Insurance
❑ FIRE EXTINGUISHERS
4 -Proof of Certification & Training
❑ AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL
COOKING
4 -Proof of training for commercial cooking heads
❑ STANDPIPE SYSTEMS ❑ SPECIAL HAZARD SYSTEMS
❑ SMOKE CONTROL SYSTEMS ❑ FIRE PUMPS
i
***PLEASE PROVIDEDOCUMENTATION OF TRAININGLEVELS,
INSTALLATION CERTIFICATIONS, LIABILITYINSURANCE, ETC. FOR ALL
DISIPLINES***
BUSINESS NAME: Nelson Fife Systems
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO
REPRESENT:
COMPANYNAME: Gamewell-FCI
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
PHONE #: (800) 633-1311
PHONE*
PHONE #:
PHONE #:
PHONE #:
PHONE M
PHONE #:
PHONE #:
PHONE M
I certify that Ihave 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 exiatlog 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 ownees
/contractor's full knowledge or consent.
Ben Nelson
PRINT NAME OF APPLICANT
APPLICANT'S SIGNATURE
DATE
PERMIT VALID UNTIL DECEMBER 31 OF THE CALENDAR YEAR APPLIED FOR.
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