Smoke Detector Application
Dear Irving Resident:
This is in response to your inquiry regarding the Irving Fire Department Smoke Detector Program. The City of Irving and the Professional Firefighters Association are providing and installing FREE smoke detectors to qualified residents within the City of Irving.
You must meet one of the following requirements to have a free smoke detector installed:
A. You are a low income family
B. You are 62 years of age or older
C. One or more family members has a mobility impairment
D. You have other extenuating circumstances
*Smoke detectors will not be installed on rental property.
Attached below is an application form. Please fill out the form completely; all information will be kept confidential. A release form is also attached, which must be completed and notarized. This can be done at no cost by bringing the form to Fire Administration, 845 West Irving Boulevard, Irving, Texas 75060.
If you have further questions, please feel free to call 972.721.3695. Thank you for your interest in Fire Safety.
Mario Molina, Chief
Irving Fire Department
FIRE DEPARTMENT
APPLICATION FOR SMOKE DETECTOR
This application is to be used by the Irving Fire Department solely to determine your eligibility for a free smoke detector. All information that you provide will be kept strictly confidential.
1. Name
Address
Phone
2. Is this rental property? Yes No
3. Number of persons in family at this address
4. Number of persons employed or receiving income
5. Total family income per year $
6. Does any family member have a physical handicap or mobility impairment that would prevent escape from a fire? If yes, state nature of impairment. .
7. Extenuating circumstances.
After completing this application, please bring to:
Irving Fire Department
845 West Irving Boulevard.
Irving, TX 75060
If you have any questions regarding this application, feel free to call the Irving Fire Department at 972/721-3695. Following a review of your application, a Fire Department representative will contact you.
DO NOT WRITE BELOW THIS LINE
Approved
Detector Installed Date
Disapproved
By
Release Signed
Officer/Station
Release and Hold Harmless
In exchange for a smoke detector furnished by the City of Irving Fire Department and the Irving Professional Firefighters’ Association, I,
____________________________________________________________(printed name) agree on behalf of myself, my heirs, and assigns, to release, defend, indemnify and hold harmless the City of Irving and the Irving Professional Firefighters’ Association and their officers, agents, and employees, from and against any and all claims and damages of every kind, for injury to or death of any person or persons and for damage to or loss of property, arising out of or attributed to the smoke detector, and including but not limited to, claims and damages arising in whole or in part from the negligence of the City of Irving and the Irving Professional Firefighters’ Association, and their officers, agents and employees.
(Signature)
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