HomeMy WebLinkAboutAPPLICATION & CERTIFICATES - 06-00074 - 3-D Fire Protection Inc - Fire Safety Certification~~ ~ ~ i
~ ~~ • ~ CITY 01= ~ __
RE~BLIR
~i 06 000~~
~`~$Ets-~~v"a~` AMtrRtCA'S FAMILY COMMUNITY 19E. Main St.
Rexburg, tdat, 3-D Fire Protection. Ins.
www.rexburp.i
"SAFETY SYSTEM PEf,........
CERTIFICATION PERMIT" $100 Fee Paid: Yes/No Permit Approved: Yes/No
APPLICATION
BY: Date:
"A safety system certification permit is required to install, modify, maintain, or service all new and
existing fire extinguishers, fire suppression systems, fire alarm systems, and other life safety
systems within the City of Rexburg"
BUSINESS NAME: ~// "~(.~ 't'~( (~~~j)r~~ (%V~, , ,~'1~1 ~ Parcel:_ ~ - Q . IUa~( ~Q p _r S
OFFICE ADDRESS: l.P ~ . ~~`~ (`~~(.S / ~ ~3L~Q~
OFFICE PHONE NUMBER: _S~S' 837
CONTACT PERSON: t@€LL PHONE #: SZ'S~ $3~7
PLEASE IDENTIFY SYSTEMS TO BE COVERED BY THIS PERMIT- CHECK ALL THAT APPLY.
FIRE ALARM SYSTEMS -Alarm Contractors shall have a minimum of NICET Level 1 Certifications
•PLEASE PROVIDE CERTIFICATIONS:
•NICET Certification
•Panel Certification
•Proof of Liability Insurance
.AUTOMATIC SPRINKLER SYSTEMS * Fire Sprinkler Contractors shall have a minimum of NICET Level III
Certifications.
•PLEASE PROVIDE CERTIFICATIONS:
•NICET Certification
•Any Additional Certifications
•Proof of Liability Insurance
FIRE EXTINGUISHERS
SPECIAL HAZARD SYSTEMS
STANDPIPE SYSTEMS
FIRE PUMPS
SMOKE CONTROL SYSTEMS
AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS, LIAB/LITYINSURANCE, ETC.
FOR ALL D/SIPLINES.***
r
BUSINESS NAME:
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME:
COMPANY NAME:
PHONE #:
COMPANY NAME: PHONE #:
*****PLEASE LIST ADDITIONAL COMPANY AUTHORIZATIONS ON THE BACK OF THIS FORM****
I certify that I have read this application and declare under penalty of perjury that the information contained herein is
all city ordinances, adopted codes, and state laws relating to the installation, modification, service, and maintenanc
hereby authorize representatives of this city to inspect any work for compliance purposes. I am either the contra r
owner as signified above and am acting with the owner's (contractor's full knowledge or consent.
PRINT NAME OF APPLICANT APPLICANT'S SIGNATURE
2-3- Q~
DATE
PHONE #:
cq)~ct and complete. I agree to comply with
new and existing life safety systems. I
responsible for the work, or I represent the
PERMIT VALID FOR ONE YEAR FROM DATE
OF APPROVAL.
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NATIONAL INSTITUTE FOR CERTIFICATION IN ENGINEERING TI=CHNOLOGIES°
sponsored by fhe National Society o/ Professional Engineers
,~ 1420 King Street, Alexandria, Virginia 22314-2794
1-888-IS-NICET • vyww.nicat.Org
APPROVAL LETTER
Name: Lamar S. I~ayward
bate of Award: May 3, 2005
Certification Number; 79422
Certification Expire Date: 05/01/2008
It is my pleasure to inform you that recertification has been granted as follows:
FIRE P120TECTION ENGINEERING TECHNOLOGY/SPECLAL ~iAZARDS SYSTEMS Y.AYOUT/LIrVEL II
FIRE PROTECTION ENGINEERING TECHNOLOGY/AUTOMATIC SPRINY~LER SYSTEM LAYO>J I'/LEVEL IV
'You will t5nd your new wallet card attached to the bottom of this letter. Also enclosed with this letter is your new certificate.
Your new three-year period of certification is printed on both your wallet card and your certificate. You mill need to
accumulate another 90 continuing professional development points to continue your certification beyond this new expiration
date,
Prior to removing the wallet card from this letter, we advise that you make a copy of the letter for your Piles as the complete
letter may be required as proof of certification.
The interest you have shown in your career development by obtaining professional recognition and status through
certification is most commendable, On behalf of the Board of Governors, please accept our congratulations and best wishes,
Very truly ou/r~s~,
/~~~
Michael A. Clark
General Manager
remove Card slowly
NATIONAL INSTITUTE FOR C[RTIFICATION
IN ENGINEERING TECNNOLOGIES~
•
Lamar S. Hayward
3-D Fire Protection, Inc
PO Box 50845
Idaho Falls, Yb 83405
Y,amar S. Ha~vvard
spLC[AL HAZARDS 6Y31'EMS LAYOUT/tt
AUTOMgTIC SPRINttLBR SYSTEM LAYOUT/tV
CRRT NO. 79422 VALLD T~iRU OSlQ112U08
• Providing Certification Programs Since 1961 •
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