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Application Form

This document is an application for a fire safety evaluation clearance or fire safety inspection certificate from the Bureau of Fire Protection in Baybay City, Leyte, Philippines. It requests information from the applicant such as the name, type and location of the building, and number of floors and floor area. It lists the requirements that must be submitted with the application, which include building plans, fire safety plans, a fire insurance policy, and previous fire safety certificates. The applicant signs to confirm the information is accurate and dates are provided to indicate when the application was received and when the requested certificates will be released.

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Jella Bandalan
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41 views

Application Form

This document is an application for a fire safety evaluation clearance or fire safety inspection certificate from the Bureau of Fire Protection in Baybay City, Leyte, Philippines. It requests information from the applicant such as the name, type and location of the building, and number of floors and floor area. It lists the requirements that must be submitted with the application, which include building plans, fire safety plans, a fire insurance policy, and previous fire safety certificates. The applicant signs to confirm the information is accurate and dates are provided to indicate when the application was received and when the requested certificates will be released.

Uploaded by

Jella Bandalan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Interior and Local Government


BUREAU OF FIRE PROTECTION
Region VIII
Baybay City Fire Station
Baybay City, Leyte
APPLICATION
NO. ______________

__________________
Date
(To be filled up by applicant/owner)

Name of Applicant/Owner ________________________________________________________


Type of Building/Occupancy ______________________________________________________
Total Number of Floors __________________________________________________________
Total Floor Area ________________________________________________________________
Location/Address of Building/Establishment/Construction _______________________________

Requirements Submitted: (To be checked/filled up by the Customer Relations Officer)


FIRE SAFETY EVALUATION CLEARANCE
(FSEC)
Endorsement from the Building Official (BO)

FIRE SAFETY INSPECTION CERTIFICATE


(FSIC) FOR OCCUPANCY PERMIT OR
FOR BUSINESS PERMIT
Endorsement from Building Official (BO)
Photocopy of Building Permit and Assessment of
Occupancy Permit Fee/Assessment of Application for Business
Permit/ BPLO Assessment/Tax Bill for Business Permit, as
the case maybe

Three (3) Sets of Building Plans and Specifications


One (1) set of Bills of Materials and Cost
Estimates
Three (3) Sets of Detailed Fire Safety Plans and
Specifications and Fire and Life Safety Assessment
Report 1 (FALAR-1)I for Occupancy of at least 50
persons

Copy of Fire Insurance Policy


(If any, please specify) _______________________________
Copy of LATEST Fire Safety Inspection Certificate
(FSIC) immediately preceding this application (if any)
Three (3) Sets of Fire and Life Assessment Report-2 (FALAR-2)
or FALAR-3 for Business Permit (For Occupancy of at least 50
persons)

________________________________
SIGNATURE OF APPLICANT/OWNER
Time and Date Received: _____________________________________
Due for Release (FSEC with FS Checklist): _______________________
(FSIC/NTC): _________________________________

Certified By:

___________________________

Customer Relations Officer


Note: Only application with complete requirements shall be processed.
____________________ ____________ __________ _________________

CLAIM STUB
__________________
Date

APPLICATION NO. ______________


NAME OF APPLICANT/OWNER: _______________________________
Time and Date Received: _____________________________________
Due for Release (FSEC with FS Checklist): _______________________
(FSIC/NTC): _________________________________

Certified By:

_________________________________________
Customer Relations Officer

FIRE SAFETY IS OUR MAIN CONCERN

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