Texas Certificate of Completion
Texas Department of Insurance
State Fire Marshal's Office, Mail Code 112-FM
333 Guadalupe • P. O. Box 149221, Austin, Texas 78714-9221
512-305-7900 • 512-305-7910 fax • www.tdi.state.tx.us
After completion of an installation, modification, or addition of a system or single station detector (excluding a one or two family residence) the licensee shall complete and present this certificate to the owner or their representative or post the certificate near the main control panel according to the Fire Alarm Rules 28TAC§34.617
DISTRIBUTION:
Original to owner or posted on site at control panel. Copy 1 to main authority having jurisdiction. Copy 2 Certifying firm to retain in their office for access by SFMO.
Property Name:
Bldg. or Floor No.:
Street:
City / Zip:
Type of Installation:
New
Modification
Addition
Other
The system complies with the following codes and standards.
Rows
Year/Edition
NFPA 72
NFPA 70
NFPA 101
IBC / IFC
Name of CERTIFYING firm:
City / State / Zip:
Phone Number:
Format: (000) 000-0000.
ACR-
Name of nearest Fire Department:
Fire Department (non-emergency) Phone:
Format: (000) 000-0000.
Emergency Phone Number:
Format: (000) 000-0000.
SYSTEM INFORMATION
Control Panel Manufacturer:
Model #
Other:
Check all the applicable system types below that were installed by the above certifying firm or the system type(s) in which the firm made modifications or additions.
Fire Alarm/Evacuation
Fire Detection
Smoke Damper Control
Sprinkler System Supervision
Voice Notification
Elevator Control
HVAC Control/Shutdown
Other
Magnetic Door Holder/Release
Other
INITIATING DEVICES
Rows
Quantity
Smoke Detectors
Heat Detectors
Duct Smoke Detectors
Beam Smoke Detectors
Fire Alarm Boxes
UV/IR
Isolation Modules
Kitchen Suppression
Sprinkler Flow Switch
Gas Fire Protection System
NOTIFICATION APPLIANCES
Rows
Quantity
Bell, Horn, or Chime
Strobe
Speaker
Horn/Chime/Strobe
Speaker Strobe
Fire Phones
Annunciation Panel
SUPERVISORY DEVICES
Rows
Quantity
Valve Tamper Switches
High/Low Air Pressure
Fire Pump
CIRCUIT STYLE / CLASS
Rows
Quantity
SLC 4
SLC 6
SLC 7
IDC A
IDC B
NAC Y or B
NAC Z or A
RECORD DRAWINGS
Company
City / State
Planner's Name
License Num. PE or APS
Date on Plan
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Revision number/date
Record Drawings (One with original planner's signature.)
Instructions describing operation, test, and maintenance
Information to aid in establishing an Emergency Evacuation Plan
The above required documents were supplied to:
Person's name:
Company's name:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I hereby certify, on behalf of the registered certifying firm, that this fire alarm system has been tested and complies with the requirements of Texas Insurance Code, Art 5.43-2, the Fire Alarm Rules, the applicable codes and standards and the manufacturer's installation requirements.
Signature of Licensee:
Printed name of Licensee:
License Number:
Date signed:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SF035 Rev. 01/06
FML-009A
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