HomeMy WebLinkAboutAPPLICATION - 18-00033 - 4547 N 3000 E - Fine Line Alarms - Annual Fire Certification'��� 4F.XAURG,7
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CITY O F
REXBURG
Building Safety Department
City of Rexburg
35 North 1St East
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Amerk6 Family Community Rexburg, Idaho 83440
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Safety System Certification Permit Application
For Office Use
Permit Number: Permit approved: ❑ Yes ❑ No
$100 Fee Paid: 13 Yes ❑ No
1. Property Owner
Business Name: Owner
Office Address: JV✓ '*7 j ego City: State:-� / Zip Code
Office Phone:,',VP '��' ` L L'/Contact Person: -- r� d0/i Cell Phone
2. Project Description
Please identify systems to be covered by this permit
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Check all that apply:
ire Alarm Systems -Alarm Contractors shall have minimum NICET Level I Certification or equivalent
-Required Documentation: - NICET Level I: System Certification - NICET Level III: System Design - Proof of Liability Insurance.
o Automatic Fire Suppression Systems- Fire Sprinkler Contractors shall have minimum NICET Level I Certification or equivalent
-Required Documentation: - NICET Level I: System Certification - NICET Level III: System Design - Proof of Liability Insurance.
❑ Automatic Extinguishing Systems for Commercial Cooking
• Required Documentation: Proof of training for commercial cooking hoods
❑ Fire Extinguishers /
• Required Documentation: Proof of Certification and Training Y J tom- Z
3. Represented Companies
Please list all companies that your 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, I 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 mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct 1 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 of any false statement or misrepresentation of fact in the application or on the plans on which the permit or app val was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): A�,'4 Aelvro"tsignature: Date. ®l
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