HomeMy WebLinkAboutFire Safety System Certification 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 shauna.eaton@rexburg.org Permit Technician – (208) 372.2160
City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Rexburg Building Department
For Office Use Permit Number: ____________________ Permit approved: ⧠ Yes ⧠ No $100 Fee Paid: ⧠ Yes ⧠ No 1. Property OwnerBusiness Name: ___________________________________________________________Office Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: ____________Office Phone: _______________________ Contact Person: _______________________________________ Cell Phone: ______________________________2.Project DescriptionPlease 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 ○Any 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 CompaniesPlease list all companies that your business is authorized to representCompany 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 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 of any 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 work stops for 180 days.
Applicant’s Name (print): ___________________________________ Signature: _____________________________________________ Date: _______________
Safety System Certification Permit Application