Texas Form Sf044 PDF Details

In Texas, the use of fireworks for public display is regulated by the Texas Department of Insurance, specifically through the State Fire Marshal’s Office, which stipulates that anyone seeking to hold a fireworks display must successfully apply for and receive a Class B Fireworks (Fireworks 1.3G) Display Permit. This requirement is codified in the SF044 application form, a comprehensive document that outlines the procedural steps, necessary fees, and detailed information required from applicants. The form incorporates a range of checks, from the applicant's personal information, their legal status as a business or individual, and their adherence to specific rules and regulations governing fireworks displays in the state. Importantly, it addresses safety measures by requiring a detailed plan of the display, information on the fireworks to be used, storage details, and safety measures for spectators and participants alike. It further mandates the applicant’s acknowledgement of legal responsibilities and an agreement to comply with Chapter 2154 of the Texas Occupations Code and the Fireworks Rules, symbolized through the applicant's signature at the end of the form. Applicants must also submit additional documentation depending on their business type, including proof of insurance and possibly, corporate charter or assumed name certificates, among others. This meticulous approach ensures that fireworks displays are conducted safely, responsibly, and in full compliance with state laws, thereby safeguarding both the participants and the general public from potential hazards associated with fireworks displays.

QuestionAnswer
Form NameTexas Form Sf044
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namestx, class b fireworks, Pyrotechnic, E-MAIL

Form Preview Example

Texas Department of Insurance

State Fire Marshal’s Office Mail Code 112-FM

333 Guadalupe • P. O. Box 149221, Austin, Texas 78714-9221 512-305-7900512-305-7922 fax • www.tdi.texas.gov

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 non-refundable, except for overpayments resulting from mistakes of law or fact.

PERMIT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHECK ONE

TYPE OF PERMIT

PERMIT FEE

 

CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

Singular Display Permit

$50.00

 

570-07

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Multiple Display Permit

$400.00

 

570-08

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF APPLICANT

 

 

 

 

 

Telephone No. ___________________

 

 

 

 

 

 

 

 

 

 

 

 

Fax No.

________________________

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

CITY

 

 

STATE

 

ZIP

 

 

 

 

 

 

 

 

 

E-MAIL ADDRESS FOR NOTIFICATION PURPOSES (optional)

WEB SITE ADDRESS (optional)

Applicant doing business as (Check One)

Individual.

Yes

No

 

 

Is the individual 21 years of age or older?

 

Corporation

Partnership.

Yes

No

 

 

Is each partner 21 years of age or older?

 

Other – describe:

Federal employer's identification (FEI) number:

DISPLAY INFORMATION

 

Date of display

__________________________________

Time

________________________

 

 

Alternate date of display

__________________________________

Time

________________________

 

 

 

 

 

 

 

Exact location description or address of display and/or alternate location for the display

 

 

Pyrotechnic operator licensed in Texas who will be at the display site to supervise the display:

Name

License number

 

 

Name

License number

 

 

Name

License number

 

 

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

 

Mail Code 9999

 

333 Guadalupe

 

P. O. Box 149221

 

Austin, TX 78701

 

Austin, TX 78714-9221

Fax No.

512-305-7922

 

512-305-7930

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 512-475-1757 or visit the Corrections Procedure section of TDI’s web page at www.tdi.texas.gov.

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 ______________________________________________________________________________________

 

Address _________________________________________________

Telephone _______________________________

 

City __________________________________________________

State ____________

Zip Code ______________

2.

Date of display ___________________________________________________

Time

____________________________

 

Alternate date of display ___________________________________________

Time

____________________________

3.

Location and/or alternate location for the display ______________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

4.

As the fire prevention officer, I approve of the display site and have reviewed the site diagram.

Yes

No

5.

I approve of the location and manner for storage of display fireworks before and during the display.

Yes

No

6.

I approve of the potential landing area for fireworks debris.

 

 

 

Yes

No

7.

The display is to be conducted in compliance with TX Occupations Code,

 

 

 

 

 

Regulation of Fireworks & Fireworks Displays and the Fireworks Rules.

 

 

 

Yes

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

_________________________

Printed name of fire prevention officer _____________________________________

Title

_________________________

Department __________________________________________________

Telephone No. ________________________

Email address:_________________________________________________

Mobile Phone No. _____________________

Telephone No.

512-305-7930

Fax No.

512-305-7922

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: 512-463-5578

Texas Comptroller of Public Accounts 800-252-1386

SF044 Rev. 12/13

Page 5 of 5

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