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Get TX TDI SF035 2009

FIRE ALARM INSTALLATION CERTIFICATE 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. texas. gov 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. Type of Installation Property Name Bldg. or Floor No* The system complies with the following codes and standards. New Street Code or Std. Modification Addition City / Zip Year/Edition NFPA 72 Name of CERTIFYING firm IBC / IFC 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 Type Quantity NOTIFICATION APPLIANCES SUPERVISORY DEVICES CIRCUIT STYLE 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 Company Planner s Name License Num* PE or APS Date on Plan Revision number/date Record Drawings One with original planner s signature. Instructions describing operation test maintenance Information to aid in establishing an Emergency Evacuation Plan The above required documents were supplied to Person s name Company s name 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 Rev* 05/09 FML-009A. 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. Type of Installation Property Name Bldg. or Floor No* The system complies with the following codes and standards. .

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