HomeMy WebLinkAboutAPPLICATION AND DOCUMENTS - 19-00588 - 210 W 4th S Anual Fire Safety 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 Ǥ̷Ǥ Permit Technician – (208) 372.2ͳͲ
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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For Office Use
Permit Number: ____________________ Permit approved: ྅ Yes ྅ No
$100 Fee Paid: ྅ Yes ྅ No
1. Property Owner
Business Name: ___________________________________________________________
Office Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: ____________
Office Phone: _______________________ Contact Person: _______________________________________ Cell Phone: ______________________________
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
༦The 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
༦The Following Certifications are Required: NICET Certification Any Additional Certifications Proof of Liability Insurance.
྅ Automatic Extinguishing Systems for Commercial Cooking ༦ Proof of training for commercial cooking heads Required
྅ Fire Extinguishers ༦ Proof of Certification and Training RRequired
྅ Standpipe Systems ྅ Fire Pumps ྅ Special Hazard Systems ྅ Smoke Control Systems
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 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 t his 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: _______________
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Jeff Christensen
210 W 4th S Rexburg ID 83440
208-356-9018 Jeff Christensen 208-356-9018
Automatic Fire System Services, Inc. 866-395-5082
Mark Longtin, Vice President 09.26.2019
✔
Submit By Email
Mark
Longtin
Digitally signed by Mark Longtin
DN: cn=Mark Longtin, o=Automatic
Fire System Services, Inc., ou,
email=mlongtin@afssmt.com, c=US
Date: 2019.09.26 13:11:15 -06'00'
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