HomeMy WebLinkAboutAPPLICATION - 06-00132 - Western Automatic Sprinkler - Fire Safety CertificationCITY OF
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"SAFETY SYSTEM
CERTIFICATION PERMIT"
APPLICATION
PERMIT#: t�� t--Nri 19,-
$100
Fee Paid: es/No Permit Approved
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BY: Date;
Yes/No
"A s a fe ty system certification permit is required to install, modify, m aintain, or service all new and
existing fire extinguishers, fire suppression s ystems, fire alarm systems, and other lrfe safety
systems within the City of Rexburg"
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OFFICEADDRESS- 2510 SOUTH WEST TEMPLE SALT LAKE CITY UT 84115
OFFICE PHONE NUMBER: (801) 484-3531
CONTACT PERSON: CELL PHONE #: —(Rol.) RpR-201 I
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMITo CHECK ALL THAT APPLY.
_FIRE ALARM SYSTEMS -Alarm Contractors shall have a minimum of NICET Level 1 Certifications
❖PLEASE PROVIDE CERTIFICATIONS:
rNICET Certification
**4,p Panel Certification
Proof of Liability Insurance
x AUTOMATIC SPRINKLER SYSTEMS ` Fire Sprinkler Contractors sha11h V a minimum of NICET Level III
Certifications,,
3PLEASE PROVIDE CERTIFICATIONS;
:•NICET Certification
-:•Any Additional Ce.�jfication.s
S•Proof of Liability Insurance
_FIRE EXTINGUISHERS
X SPECIAL HAZARD SYSTEMS
STANDPIPE SYSTEMS
x FIRE PUMPS
_SMOKE CONTROL SYSTEMS
- X AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, IN11,TALLATION CittRTIFICATIONS, IL ONSURANCE, ETC.
FOR ALL DISIPLINES. ***
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BUSINESS NAME; WR-qTFRN A TUNIATI E PRI KLER
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME: PHONE #.lk
COMPANY NAME: PHONE #:
0
COMPANY NAME: PHONE #:
'`*PLEASE LIST ADDITIONAL COMPANY AUTHORIZATIONS ON THE BACK OF THIS FORM`***
I CerfifY that I have read this application and declare underpenalty that t rf r tp rju ion o i�n h
all city ordinances, adopted codes, and state Jas relating to#h installation o r.
n icorreandcomplete.
l agree t comply
with
h
, , , ntena of new and existing life safety systems.her uthorize representatives f this city to 'Inspect work for compliance purposes. . i a either
theon ontra t �� ibi for th
owner a inIfi d above and a actin with the owner's Icon y � � � r frepresent t
BRUCE HAGS
- -- - : -.
PRINT NAME 4F APPLICANT
MARCH 13 2006
- - --- - � -PATE
APPLLCANP� SIGNAT U -RE
PERMIT VALID FOR ONE YEAR FROM DATE
OF APPROVALA