HomeMy WebLinkAboutAPPLICATION - 07-00031 - New Tech SecurityJao.25. 2007 10:10AM No.3579 P. 2/3
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C S T Y O F
Rj]1T77T7T)!� BUILDING SAFETY DEPARTMENT
1�1�1\1J V 1\l7Ameriwd Family Community 19 E. Main St. Phone: 20835"020 X326
Rexburg, Idaho 83440 Fax 209-359-3024
www.rexbum.org janellh@rexburg.org
"SAFETY SYSTEM PERMIT#: I
CERTIFICATION PERMIT" $100 FCC Paid roe PC1W1L Al,jpxuvc#i: Vca/Nv
APPLICATION
BY: Date:
"A safety system certification permit is required to install, modij, maintain, or service all new and existing
err artew, fire alarm niterm, and other fife rafety rvifti Pithin the City of
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BUSINESS NAME:
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OFFICE ADDRESS:
7-7G/1 sC"e- `�/
OFFICE PHONE NUMBER: &2/ z u` _ / '5;p A6
CONTACT PERSON: t' CELL PHONE M C' v L a L
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL THAT
APPI
FIRE ALARM SYSTEMS -Alarm Contractors shall have a minimum of NICET Level 1
Certifications.
❖PLEASE PROVIDE: CERTIFICATIONS:
•-NICET Certification — S 4144- If c et —lc e �jfl P
Panel Certification /
+Proof of Liability Insurance
AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have a minimum of
NICET Level III Certifications.
4#PLEASE PROVIDE CERTIFICATIONS:
#-NICET Certification
:•Any Additional Certifications
mProof of Liability Insurance
_FIRE EXTINGUISHERS _STANDPIPE SYSTEMS SMOKE CONTROL SYSTEMS
SPECIAL. HAZARD SYSTEMS _FIRE PUMPS
AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
"xPLEASEPRO VIDE DOCUAMWA77ONOF7RAIMNG.LEVELS, INSTALL4770NCER77FICA770NS,
LMBRLITYIIVSURANCF ETC. FOR ALL DISIPLINES***
Jan. 25. 2007 10:10AM
No.3579 P. 3/3
BUSINESS NAME:
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
PHONE #:
PHONE A
PHONE M
PLEASE LIST ADDITIONAL COMPANY AUTHORIZATIONS ON THE BACK OF THIS FORM
I certify that I have n2d this application and declare nndcs penalty of petryty that the Infotmadaa contained herein is cornett and complete. I agree to
comply with aS city on is umm, adopted codes, and state laws sckting to the hotalbdon, modification, scrviec, and maintts mm of new and existing
We safety systems. I hereby authorise representatives of this city to inspect any work for compliance pwposm. I am either the cean W — respomibla for
the work, or I sepreseot the awaes ass ified above and am acting 7AZPP
rISSIGN
60McdV m eoaseni.
t
PRINT N F APPLICANT' RE
DATE PERMIT VALID UNTIL DECEMBER 31, 2007