Fire Alarm Installation Certificate - Texas Department Of Insurance
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1FIRE ALARM INSTALLATION CERTIFICATE
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:
Type of Installation:
The system complies with the following codes and standards.
Bldg. or Floor No.:
New
Code or Std.
Year/Edition
Code or Std.
Year/Edition
Street:
Modification
NFPA 72
IBC / IFC
City / Zip:
Addition
NFPA 70
Name of CERTIFYING firm:
NFPA 101
City / State / Zip:
Name of nearest Fire Department:
Phone Number:
Fire Department (non-emergency) Phone:
ACR-
Emergency Phone Number:
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
Magnetic Door Holder/Release
INITIATING DEVICES
INITIATING DEVICES
NOTIFICATION APPLIANCES
SUPERVISORY DEVICES
CIRCUIT STYLE
CIRCUIT STYLE/CLASS
Type
Quantity
Type
Quantity
Type
Quantity
Type
Quantity
Quantity
Quantity
Smoke Detectors
UV/IR
Bell, Horn or Chime
Valve Tamper Switches
SLC 4
NAC Y or B
Heat Detectors
Isolation Modules
Strobe
High / Low Air Pressure
SLC 6
NAC Z or A
Duct Smoke Detectors
Kitchen Suppression
Speaker
Fire Pump
SLC 7
Beam Smoke Detectors
Sprinkler Flow Switch
Horn/Chime/Strobe
IDC A
Fire Alarm Boxes
Gas Fire Protection Syst.
Speaker Strobe
IDC B
Fire Phones
Annunciation Panel
Record Drawings (One with original planner’s signature.)
RECORD DRAWINGS
Company
Instructions describing, operation, test & maintenance
City / State
Information to aid in establishing an Emergency Evacuation Plan
The above required documents were supplied to:
Planner's Name
License Num. PE or APS
Person's name:
Company’s name:
Date on Plan
Revision number/date
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, Chapter 6002, the Fire Alarm Rules, the applicable codes and standards
and the manufacturer's installation requirements.
Signature of Licensee:
License Number:
Printed name of Licensee:
Date signed:
SF035 | 0615
FML-009A
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