Contents
Form Example
Texas Department of Insurance
State Fire Marshal’s Office Mail Code
333 Guadalupe • P. O. Box 149221, Austin, Texas
APPLICATION FOR CLASS B FIREWORKS (FIREWORKS 1.3G)
SINGULAR OR MULTIPLE DISPLAY PERMIT
This application must be accompanied by the appropriate fee and all documents and information required by Chapter 2154 of the Texas Occupations Code and the Fireworks Rules. Complete answers must be given to all questions.
Please print or type.
A public fireworks display permit may not be issued to any person who is under 21 years of age. Any fraudulent representation on this application shall be cause for denial, suspension, or revocation of a permit. All fees are
PERMIT |
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CHECK ONE |
TYPE OF PERMIT |
PERMIT FEE |
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CODE |
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ﾅ |
Singular Display Permit |
$50.00 |
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ﾅ |
Multiple Display Permit |
$400.00 |
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APPLICANT |
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NAME OF APPLICANT |
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Telephone No. ___________________ |
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Fax No. |
________________________ |
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ADDRESS |
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CITY |
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STATE |
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ZIP |
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WEB SITE ADDRESS (optional)
Applicant doing business as (Check One)
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Individual. |
Yes |
No |
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Is the individual 21 years of age or older? |
ﾅ |
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Corporation |
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ﾅ |
Partnership. |
Yes |
No |
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ﾅ |
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Is each partner 21 years of age or older? |
ﾅ |
ﾅ |
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Other – describe: |
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Federal employer's identification (FEI) number:
DISPLAY INFORMATION
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Date of display |
__________________________________ |
Time |
________________________ |
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Alternate date of display |
__________________________________ |
Time |
________________________ |
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Exact location description or address of display and/or alternate location for the display |
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Pyrotechnic operator licensed in Texas who will be at the display site to supervise the display:
Name |
License number |
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Name |
License number |
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Name |
License number |
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SF044 Rev. 12/13 |
Page 1 of 5 |
QUESTIONS
Size and estimated number of 1.3G fireworks to be discharged:
Other items (1.4G fireworks, flame effects, set pieces, etc.)
Manner and address of storage of fireworks prior to and during the display
Manufacturer or distributor licensed in Texas who is to supply the fireworks:
Name |
License number |
SIGNATURES
In applying for a fireworks permit, I certify that I am familiar with and will comply with Chapter 2154 of the Texas Occupations Code and the Fireworks Rules.
I hereby authorize the state fire marshal or any of his duly authorized deputies, upon notice, to enter, examine, and inspect any premises, building, room, or establishment used in connection with the permit for which I am applying to determine compliance with the provisions of Chapter 2154 and the Fireworks Rules.
By my signature, I verify that the information on this application and its attachments are true.
I understand that knowingly providing a false answer to any question or submitting false information or documents with this application may be tampering with a governmental record which is punishable under the Texas Penal Code Chapter 37, §37.10.
Printed name
Title
Signature
Date
Printed name
Title
Signature
Date
APPLICATIONS MUST BE SIGNED BY AN INDIVIDUAL APPLICANT, BY AN OFFICER OF A CORPORATION, BY THE SOLE PROPRIETOR, BY EACH PARTNER OF A GENERAL PARTNERSHIP, BY THE GENERAL PARTNER OF A LIMITED LIABILITY PARTNERSHIP OR BY AN OFFICER OR MEMBER OF A LIMITED LIABILITY COMPANY.
APPLICATIONS SUBMITTED BY A GOVERNMENTAL ENTITY MUST BE SIGNED BY THE APPROPRIATE OFFICER. FOR EXAMPLE, A CITY’S APPLICATION SHOULD BE SIGNED BY THE MAYOR, CITY MANAGER, CITY ADMINISTRATOR, CITY SECRETARY, ETC.
Check or money order should be made payable to the TEXAS DEPARTMENT OF INSURANCE.
Mail this completed application along with the appropriate fee and additional documents to:
Mail Address: |
State Fire Marshal’s Office |
Physical Address: |
State Fire Marshal’s Office |
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Mail Code 9999 |
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333 Guadalupe |
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P. O. Box 149221 |
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Austin, TX 78701 |
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Austin, TX |
Fax No. |
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Web Site Address: |
www.tdi.texas.gov/fire |
NOTICE ABOUT CERTAIN INFORMATION LAWS AND PRACTICES
With few exceptions, you are entitled to be informed about the information that the Texas Department of Insurance (TDI) collects about you. Under sections 552.021 and 552.023 of the Texas Government Code, you have a right to review or receive copies of information about yourself, including private information. However, TDI may withhold information for reasons other than to protect your right to privacy. Under section 559.004 of the Texas Government Code, you are entitled to request that TDI correct information that TDI has about you that is incorrect. For more information about the procedure and costs for obtaining information from TDI or about the procedure for correcting information kept by TDI, please contact the Agency Counsel Section of TDI’s Legal and Regulatory Affairs Division at
SF044 Rev. 12/13 |
Page 2 of 5 |
SINGULAR OR MULTIPLE DISPLAY PERMIT SITE DIAGRAM/PLAN
Please make sure the below listed items are included on the site diagram
Address of display location
Show location of firing site
Show location of spectators
Show minimum secured area on all sides of firing site
Show method of restraint/security on all sides of firing site
Show location of health care, detention and correctional facilities. If there are no such facilities within the distance required by NFPA 1123, 1995 ed., please indicate such in a statement on the diagram.
Show location of school buildings and/or churches. If there are no buildings within 600 feet of the firing site, please indicate such in a statement on the diagram.
Show location of hazardous materials. If there are no hazardous materials within the distance required by NFPA 1123, 1995 ed., please indicate such in a statement on the diagram.
SF044 Rev. 12/13 |
Page 3 of 5 |
Texas Department of Insurance
State Fire Marshal’s Office
Application for Class B Fireworks (Fireworks 1.3G) Singular or Multiple Display Permit
Site Inspection Certification
1.Name of applicant ______________________________________________________________________________________
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Address _________________________________________________ |
Telephone _______________________________ |
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City __________________________________________________ |
State ____________ |
Zip Code ______________ |
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2. |
Date of display ___________________________________________________ |
Time |
____________________________ |
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Alternate date of display ___________________________________________ |
Time |
____________________________ |
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3. |
Location and/or alternate location for the display ______________________________________________________________ |
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______________________________________________________________________________________________________ |
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______________________________________________________________________________________________________ |
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______________________________________________________________________________________________________ |
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4. |
As the fire prevention officer, I approve of the display site and have reviewed the site diagram. |
ﾅ Yes |
ﾅ No |
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5. |
I approve of the location and manner for storage of display fireworks before and during the display. |
ﾅ Yes |
ﾅ No |
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6. |
I approve of the potential landing area for fireworks debris. |
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ﾅ Yes |
ﾅ No |
7. |
The display is to be conducted in compliance with TX Occupations Code, |
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Regulation of Fireworks & Fireworks Displays and the Fireworks Rules. |
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ﾅ Yes |
ﾅ No |
8.My approval is subject to the following conditions.
List conditions, if applicable, or indicate “None” _______________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
9.As the appropriate fire prevention officer, I have inspected the display site(s) to determine whether this proposed display is of a nature or in a location that may be hazardous to property or dangerous to any person. This form is my notice to the state fire marshal of the results of the inspection as required in Sec. 2154.206, Chapter 2154, Texas Occupations Code.
Signature of fire prevention officer ________________________________________ |
Date |
_________________________ |
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Printed name of fire prevention officer _____________________________________ |
Title |
_________________________ |
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Department __________________________________________________ |
Telephone No. ________________________ |
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Email address:_________________________________________________ |
Mobile Phone No. _____________________ |
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Telephone No. |
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Fax No. |
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Web Site Address |
www.tdi.texas.gov/fire |
SF044 Rev. 12/13 |
Page 4 of 5 |
APPLICATION FOR CLASS B FIREWORKS (FIREWORKS 1.3G)
SINGULAR OR MULTIPLE DISPLAY PERMIT
APPLICANTS FOR A SINGULAR OR MULTIPLE DISPLAY PERMIT MUST SUBMIT THE FOLLOWING:
1.An application for a singular or multiple display permit.
2.A certificate of general liability insurance.
ITEMS TO BE INCLUDED ON INSURANCE CERTIFICATES:
1.The name of the insurer and the policy number.
2.The name of the insured, which must be the same name as on the display application.
3.Effective dates (or days) of the policy.
4.The amount of coverage must not be less than $500,000. The policy shall be conditioned to pay those sums the insured becomes obligated to pay as damages because of bodily injury and property damage caused by an occurrence involving the insured or the insured’s servant, officer, agent, or employee in the conduct of a public fireworks display.
5.The words “fireworks display” and the dates(s) of the display should appear under description of operations on the certificate. Any alternate date(s) should also be included.
6.The State Fire Marshal’s Office should be listed as the certificate holder.
7.Must be issued by an insurer authorized to do business in Texas and countersigned by an insurance agent licensed in Texas.
ADDITIONAL DOCUMENTS
If you are a
Texas or Foreign
Corporation
submit the following
Certificate of general liability insurance
Corporate Charter, Certificate of Existence, or Certificate of Authority issued by the Texas Secretary of State
Franchise Tax Account Status must be ACTIVE with the TX Comptroller of Public Accounts
Assumed Name Certificate from Texas Secretary of State (if using a d/b/a)
If you are a
Sole Proprietorship or General Partnership
submit the following:
Certificate of general liability insurance
Assumed Name Certificate from your County Clerk (if using a d/b/a)
If you are a
Texas or Foreign
Limited Partnership
submit the following
Certificate of general liability insurance
Certificate of Limited Partnership, Registration Application for Foreign Limited Partnership
Franchise Tax Account Status must be ACTIVE with the TX Comptroller of Public Accounts
Assumed Name Certificate from Texas Secretary of State (if using a d/b/a)
If you are a
Texas or Foreign
Limited Liability
Company
submit the following
Certificate of general liability insurance
Certificate of Organization, or Certificate of Authority issued by the Texas Secretary of State
Franchise Tax Account Status must be ACTIVE with the TX Comptroller of Public Accounts
Assumed Name Certificate from Texas Secretary of State (if using a d/b/a)
Texas Secretary of State: |
Texas Comptroller of Public Accounts |
SF044 Rev. 12/13 |
Page 5 of 5 |
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Common mistakes
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Incomplete Information: Applicants often leave sections blank or provide incomplete answers. Every question on the form must be answered fully to avoid delays in processing.
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Incorrect Fee Payment: Submitting the wrong fee is a common mistake. Ensure the correct amount is included based on whether you are applying for a singular or multiple display permit.
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Age Verification: Failing to confirm that the applicant is at least 21 years old can lead to immediate denial. This requirement is crucial and must be clearly indicated.
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Missing Signatures: Applications must be signed by the appropriate individuals. Omitting signatures can result in the application being rejected.
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Insufficient Documentation: Not including required documents, such as the certificate of general liability insurance or the assumed name certificate, can halt the application process.
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Incorrect Contact Information: Providing outdated or incorrect contact details can lead to communication issues. It is essential to ensure that all contact information is accurate.
Key takeaways
Key Takeaways for Filling Out the Texas SF044 Form:
- Ensure all questions are answered completely; incomplete applications may be denied.
- The applicant must be at least 21 years old to qualify for a fireworks display permit.
- Choose the correct permit type: a singular display permit costs $50, while a multiple display permit costs $400.
- Include a site diagram that clearly shows the display location, firing site, spectator area, and any nearby facilities.
- Submit proof of general liability insurance with coverage of at least $500,000, including specific details about the fireworks display.
- Applications must be signed by the appropriate individual, such as the applicant, an officer, or a partner, depending on the business structure.
- Mail the completed application, along with the fee and required documents, to the Texas Department of Insurance, State Fire Marshal’s Office.
Steps to Using Texas Sf044
Completing the Texas SF044 form is a crucial step in applying for a Class B fireworks display permit. After filling out the form, it is essential to gather all required supporting documents and submit them along with the application fee to the State Fire Marshal’s Office. Ensure that all information is accurate and complete to avoid delays in processing.
- Obtain the Texas SF044 form from the Texas Department of Insurance website or the State Fire Marshal’s Office.
- Indicate the type of permit you are applying for by checking either the Singular Display Permit or the Multiple Display Permit box.
- Fill in your name, telephone number, fax number, and address in the designated applicant section.
- Provide your email address for notification purposes, and optionally include your website address.
- Indicate the business structure by checking the appropriate box (Individual, Corporation, Partnership, or Other) and confirm age requirements where applicable.
- Enter your Federal Employer Identification (FEI) number.
- Provide the date and time of the display, as well as an alternate date and time if necessary.
- Describe the exact location of the display and any alternate location.
- List the names and license numbers of the licensed pyrotechnic operators who will supervise the display.
- Estimate the size and number of 1.3G fireworks to be discharged, along with any other items involved in the display.
- Detail the manner and address of storage for the fireworks before and during the display.
- List the name and license number of the manufacturer or distributor supplying the fireworks.
- Sign and date the application, ensuring that it is signed by the appropriate individual based on your business structure.
- Prepare a check or money order for the application fee made payable to the Texas Department of Insurance.
- Mail the completed application, fee, and any required documents to the State Fire Marshal’s Office at the provided address.