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FSED 53F Application Form (Standalone) Rev00

This document is an application form for fire safety clearance from the Bureau of Fire Protection for stand-alone projects. It requires information about the project owner, title, location, and contact details. It also requires the applicant to check which type of stand-alone application they are applying for, such as installation of fire suppression systems or gas systems. Documentation requirements include plans, specifications, estimates, and clearance for hot work if needed. The applicant certifies the correctness of the information and completeness of documents. BFP personnel will then note the inspection and clearance dates.

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Talaingod Firestation
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1K views2 pages

FSED 53F Application Form (Standalone) Rev00

This document is an application form for fire safety clearance from the Bureau of Fire Protection for stand-alone projects. It requires information about the project owner, title, location, and contact details. It also requires the applicant to check which type of stand-alone application they are applying for, such as installation of fire suppression systems or gas systems. Documentation requirements include plans, specifications, estimates, and clearance for hot work if needed. The applicant certifies the correctness of the information and completeness of documents. BFP personnel will then note the inspection and clearance dates.

Uploaded by

Talaingod Firestation
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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BUREAU OF FIRE PROTECTION

(Region) STAND-ALONE
APPLICATION
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email)
APPLICATION NUMBER

FIRE SAFETY CLEARANCE APPLICATION FORM (STAND-ALONE)


PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION
OWNER ADDRESS
NAME OF
CONTRACTOR/INSTALLER
AUTHORIZED REPRESENTATIVE
TOTAL FLOOR AREA (m2): NO. OF STOREY :
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
CHECK STAND-ALONE APPLICATION APPLIED FOR:
INSTALLATION OF AUTOMATIC FIRE SUPPRESSION SYSTEM (AFSS)
INSTALLATION OF BUILDING SERVICE EQUIPMENT (UTILITIES, HEATING, VENTILATING, AIR-
CONDITIONING, SMOKE CONTROL SYSTEMS, ELEVATORS,ESCALATORS, RUBBISH CHUTES,
LAUNDRY CHUTES, INCINERATOR FLUE,ETC)
INSTALLATION OF LPGAS SYSTEM
ELECTRICAL INSTALLATION
INSTALLATION OF KITCHEN HOOD SUPPRESSION SYSTEMS
INSTALLATION OF FLAMMABLE AND COMBUSTIBLE LIQUIDS TANKS
INSTALLATION OF FIRE DETECTION, ALARM AND COMMUNICATION SYSTEM

CHECKLIST OF REQUIREMENTS (CHECK THE REQUIREMENTS SUBMITTED)


THREE COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):
[ ] ARCHITECTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] PLUMBING DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

*Documents (Plans and Specification)

NOTE: Incomplete documentary requirements will be returned to the applicant.


I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_____________/____________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

INSTALLATION CLEARANCE MONITORING (To be filled-up by BFP Personnel only)


CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION


(Region)
STAND-ALONE
(District/Provincial Office)
(Station) APPLICATION
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-053 Rev. 00 (01.25.20)

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