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HomeMy WebLinkAboutAPPLICATION - 19-00183 - 610 Mallard - Fire Services of Idaho - Annual Certification�y CITY TO F ('� RE B�,/RG fy Americas family Community Building Safety Department City of Rexburg 35 North 1st East Rexbura,Idaho 83440 Safety System Certification Permit Application For Office Use Permit Number: Permit approved: D Yes ❑ No $100 Fee Paid: O Yes ❑ No 1. Property Owner- (n1 Business Name: Rj fG &r%LLe s Office Address: / City: l L44- State: Zip Code: Office Phone: Contact Person: Cell Phone: 2. Project Description Please identify systems to be covered by this permit Che k all that apply: e Alarm Systems -Alarm Contractors shall have minimum NICET Level I Certification or equivalent •R?quired Documentation: - NICET Level 1: System Certification - NICET Level III: System Design - Proof of Liability Insurance. B"Automatic Fire Suppression Systems- Fire Sprinkler Contractors shall have minimum NICET Level I Certification or equivalent •Required Documentation: w NICET Level I: System Certification - NICET Level III: System Design - Proof of Liability Insurance. WAutomatic Extinguishing Systems for Commercial Cooking arquired Documentation: Proof of training for commercial cooking hoods Fire Extinguishers • Required Documentation: Proof of Certification and Training 3. Represented Companies Please list all r companies thatyour business is authorized to represent Company Namej-'P e fl Ift1Ry«t cXlc. h Phone Number: -10�7$[-o?3d-t'3&4(p Company Name: (-Fs' Phone Number: !)0!i"e�3d' 3LPYO Company Name: Vii[ Number: JQ%'��y� Sbgn Company Name:c7in{rmip _Ftt-r _ �If_ dta J 15CXVyt 0 Phone Number: A5-ago-AsLIN Company Name: Phone Number: Company Name: Phone Number: ***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS, LIABILITY INSURANCE, ETC. FOR ALL DISCIPLINES*** APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l 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. I agree to comply withal]City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of Ute 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 m 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 work stops for 180 days, P Applicant's Name (print): 162.d1 Signature: ~ Date:y'9 /� Inspections must be called In before a on the day the l spection is requested. Inspect equestscaied in after BAM will be sc for theow business day. Inspection Hutilne-(208)372.2344 www.ret urg.arg ermi[Technicimt-(208J 372.2341 Revised March, 2016 A 1,11 ul wn LAI t :2:(A O z V .7w N N C Y. w ul Pim Ljj l7 Gu O ro p a o Q ..l Q L O p� N d � kV) w 0 N L dde a 4. z V M. Q a LU F V LL ~ C) A ? OO Lu _d F . Z � H r LI. © w ro r w -. l U '�' P ° a iZ `-' o a vW u z a W t� �_ �A E N N Z s m y_ o QW On 2 iJ HR v ui s\ LL O LU z O ac a. d °C ' o qz 5 hm LLJ �+ -a �] o « W w u u d F- LU u v v; Oko o� N Q v o ? a LL. .^ uj z F W vo t xa o � o Zuj ° � z It a J o _ F O F- W V O = z0 F' m O ww F �z 2 z Q J W a o a o O c m a z a z '.., W p T 7 �aI � - W LL 2 4 4. 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