The Texas SF044 form is an Application for Class B Fireworks (Fireworks 1.3G), which is required for obtaining a singular or multiple display permit. This application must be filled out completely and submitted with the appropriate fee and necessary documents as outlined by Texas law. Ensuring compliance with the regulations is crucial for anyone looking to host a fireworks display in Texas.
The Texas SF044 form is a crucial document for anyone looking to host a fireworks display in the state. This application is specifically designed for obtaining a Class B Fireworks Permit, which encompasses both singular and multiple display options. Applicants must be aware that the form requires detailed information, including the type of permit being requested, the applicant's personal and business details, and a comprehensive description of the planned display. To ensure compliance with state regulations, the application must be submitted alongside the appropriate fee, which varies based on the type of permit. For a singular display, the fee is $50, while a multiple display permit costs $400. Additionally, applicants must provide information about the pyrotechnic operator overseeing the event, the estimated number of fireworks to be discharged, and the storage methods for the fireworks prior to the display. Importantly, the form emphasizes the necessity for accuracy; any fraudulent information can lead to severe consequences, including the denial or revocation of the permit. Furthermore, the application must be signed by an authorized individual, such as a corporate officer or a general partner, ensuring that the responsibility for the display is clearly established. Understanding these requirements is essential for a successful application process and for ensuring a safe and compliant fireworks event.
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 • 512-305-7922 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
ﾅ
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.
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
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
SF044 Rev. 12/13
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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:
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
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:
Mail Code 9999
333 Guadalupe
P. O. Box 149221
Austin, TX 78701
Austin, TX 78714-9221
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.
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.
Page 3 of 5
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 ___________________________________________________
____________________________
Alternate date of display ___________________________________________
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.
ﾅ Yes
ﾅ No
5.
I approve of the location and manner for storage of display fireworks before and during the display.
6.
I approve of the potential landing area for fireworks debris.
7.
The display is to be conducted in compliance with TX Occupations Code,
Regulation of Fireworks & Fireworks Displays and the Fireworks Rules.
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 ________________________________________
_________________________
Printed name of fire prevention officer _____________________________________
Department __________________________________________________
Telephone No. ________________________
Email address:_________________________________________________
Mobile Phone No. _____________________
Telephone No.
Web Site Address
Page 4 of 5
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
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)
Sole Proprietorship or General Partnership
submit the following:
Assumed Name Certificate from your County Clerk (if using a d/b/a)
Limited Partnership
Certificate of Limited Partnership, Registration Application for Foreign Limited Partnership
Limited Liability
Company
Certificate of Organization, or Certificate of Authority issued by the Texas Secretary of State
Texas Secretary of State: 512-463-5578
Texas Comptroller of Public Accounts 800-252-1386
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