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FSEC Application Form

The document is an application form for a Fire Safety Evaluation Clearance from the Bureau of Fire Protection in Region V, Camarines Norte. It requires detailed information about the project owner, project title, location, and various documentary requirements to be submitted. Incomplete submissions will be returned, and there are specific notes regarding the prohibition of recommending fire extinguisher brands by BFP personnel.

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Luke Neil Velasquez
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23 views1 page

FSEC Application Form

The document is an application form for a Fire Safety Evaluation Clearance from the Bureau of Fire Protection in Region V, Camarines Norte. It requires detailed information about the project owner, project title, location, and various documentary requirements to be submitted. Incomplete submissions will be returned, and there are specific notes regarding the prohibition of recommending fire extinguisher brands by BFP personnel.

Uploaded by

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

FSEC
-

Region V
Camarines Norte
Paracale Fire Station
Purok 1, Brgy. Tugos, Paracale, Camarines Norte 0948-594-9663
APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):


[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION 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
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

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

VERIFIED BY BFP-CRO: ____________________________ ____________/___________


DATE/TIME
FSEC 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”

BFP-QSF-FSED-001 REV.03 (08.02.23)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(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-001 REV.03 (08.02.23)

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