HomeMy WebLinkAboutAPPLICATION & CERTIFICATES - 06-00076 - Fire Services of Idaho - Fire Safety Certification
~'~'~~.~, CITY O•
a
q$L18i1E~~ AMIrRICA'S FAMILY CO~b1rVtUNITY 19E. Main St.
Rexburg, Idaho 83~
www.rexbura.org
"SAFETY SYSTEM PERMI
CERTIFICATION PERMIT" $100 F
APPLICATION
Fire Services of Idaho
Fire Safety Certification
i
- - - ---- ---
os ooo7s
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: F~t~L U~y ~~'~-.~ u r` -~1~~~_parcel:
OFFICE ADDRESS: Z-~ fJ f t~~L~ (i_ ~l ~ ~~ ~ PJ~~''~~ ~ p 3
OFFICE PHONE NUMBER: ~' ~3 ~ ° ~rp y~ U
CONTACT PERSON: ~"YV I~I~n~CELL PHONE #: ~'~ J 77
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 STANDPIPE SYSTEMS SMOKE CONTROL SYSTEMS
SPECIAL HAZARD SYSTEMS FIRE PUMPS
x AUTOMATIC FIRE EXTINGUISHING SYSTEMS FOR COMMERCIAL COOKING
***PLEASE PROVIDE DOCUMENTATION OF TRAINING LEVELS, INSTALLATION CERTIFICATIONS, LIABIL/TYINSURANCE, ETC.
FOR ALL DISIPLINES.***
~ ~f~ic~~ ~~(-fy
BUSINESS NAME: ~~
PLEASE LIST ALL COMPANIES YOUR BUSINESS IS AUTHORIZED TO REPRESENT:
COMPANY NAME:
COMPANY NAME:
COMPANY NAME:
PHONE #:
PHONE #:
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 correct and complete. I agree to comply with
all city ordinances, adopted codes, and state laws relating to the installation, modification, se 'ce, and maintenance of new and existing life safety systems. I
hereby authorize representatives of this city to inspect any work for compliance purposes. I ei er the co for responsible for the work, or I represent the
owner as signified above and am acting with the owner's (contractor's full knowledge or co e .
PRINT NAME OF PPLICANT CANT'S SIGNATURE
Q~
DATE MIT VALID FOR ONE YEAR FROM DATE
OF APPROVAL.
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~' SIRE P~OTECTIOIV CONSU~'''ANTS
F' 8719 Pete Wiles Road • Middletown, Md. 2~i76~
~~ (301) 371-8685 ~ (888) 670-2965 • FAX: (301) 371-4528
LTU, http:// wvww.FPCLTD.com E-mail: FPCLTll~CCvaol.conY
October 16, 2000
_~ Mr. John HQI__"_
J
Dear John,
This is to confirm your attendance at ow seminar an September 25, 2000 in
Las Vegas, NV. covering the Hydrostatic Testing of Fire Extinguishers, and
D.O.T. Hazardous Material Training Regulations.
Congratulations, you completed this seminar receiving a score of 100% on
the test.
If you have any questions you can call us at 1-888-670-2965.
Sincerely
F.P.C.Ltd //~~
~~er ~ ~lJ~^~
Edward O'Brien
Instructor
~~,
~V! E~. x`113 l~
F FIRE PROTECTION CONSU~'ANTS
~ 8719 Pete Wiles Road • Middietown, nnd. 2~17G9
~. (301) 371-8685 • (888) 670-2065 ~ FAX: ~3UI} 37i--152;
L'1,U, http:/l ww~~~.FPCLTll.con~ h:-~naiL• FPC'L'1,U~ce~aol.iun~
October 16, 2000
Mr. John. Holman
2601 Poleline Rd.
Pocatello, ID. 83201
Dear John,
This is to confirm your attendance at our seminar on September 25, 2000 in
Las Vegas, NV. covering the Hydrostatic Testing of Fire Extinguishers, and
D.O.T. Hazardous Material Training Regulations.
Congratulations, you completed this seminar receiving a score of 100% on
the test.
If you have any questions you can call us at 1-888-670-2965.
Sincerely
F.P.C.Ltd.
Edward O'Brien
Instructor
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