HomeMy WebLinkAboutAPPLICATION - 17-00792 - Shilo Automatic Sprinkler Fire Safety CertificationC I TY OF
REXBURG
America's Family Community
Building Safety Department
Safety System Certification Permit Application
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit approved: ❑ Yes ❑ No
$100 Fee Paid: ❑ Yes ❑ No
1. Property Owner
Business Name: •iWL LA u't•nw►n�i
Office Address: I a&4 it a- LAys_ N City: tsamoAL_ State: -rN Zip Code: A3 1. lk'l
Office Phone: (ADM 4tat,- 66NI Contact Person: C&&= ty- 4tess Cell Phone:t�.AA1 49`1- A96$
2. Project Description
Please identify systems to be covered by this permit
Check all that apply:
❑ Fire Alarm Systems -Alarm Contractors shall have minimum NICET Level 1 Certification or equivalent
•The Following Certifications are Required: °NICET Certification °Panel Certification °Proof of Liability Insurance.
Automatic Sprinkler Systems - Fire Sprinkler Contractors shall have minimum NICET Level III Certification or equivalent
*The Following Certifications are Required: °NICET Certification oAny Additional Certifications °Proof of Liability Insurance
❑ Automatic Extinguishing Systems for Commercial Cooking • Proof of training for commercial cooking heads Required
❑ Fire Extinguishers • Proof of Certification and Training Required
❑ Standpipe Systems ❑ Fire Pumps ❑ Special Hazard Systems ❑ Smoke Control Systems
3. Represented Companies
Please listall companies thatyour business is authorized to represent
Company Name: Phone Number:
Company Name: Phone Number:
Company Name: Phone Number:
Company Name: Phone Number:
Company Name: Phone Number:
Company Name: Phone Number:
***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS, LIABILITY
INSURANCE, ETC. FOR ALL DISCIPLINES'
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I have read this application and state that the information herein
is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
International Code in cases ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void if workstops for 180 days.
Applicant's Name (print): Nraert. M • CSS Signature: Date:
C
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016