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Fire Safety Inspection Certificate Application

This document is an application form for a fire safety inspection certificate for occupancy permit from the Bureau of Fire Protection in Quezon City, Philippines. It provides instructions for completing the form and lists the requirements, which include a certificate of completion, assessment fee receipts, a fire safety evaluation clearance, copy of the building permit, approved plans, and an authorization letter if not applying as the owner. The form collects information about the applicant, project, location, scope of work, and contact details. It requires the applicant's certification and signature that the information provided is true and correct.

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rolando dionisio
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236 views1 page

Fire Safety Inspection Certificate Application

This document is an application form for a fire safety inspection certificate for occupancy permit from the Bureau of Fire Protection in Quezon City, Philippines. It provides instructions for completing the form and lists the requirements, which include a certificate of completion, assessment fee receipts, a fire safety evaluation clearance, copy of the building permit, approved plans, and an authorization letter if not applying as the owner. The form collects information about the applicant, project, location, scope of work, and contact details. It requires the applicant's certification and signature that the information provided is true and correct.

Uploaded by

rolando dionisio
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
  • Fire Safety Inspection Certificate Application

Republic of the Philippines

Department of the Interior and Local Government


BUREAU OF FIRE PROTECTION
National Capital Region
QUEZON CITY FIRE DISTRICT
City Hall Compound Diliman, Quezon City

5/31/2020

APPLICATION FORM Date


FIRE SAFETY INSPECTION CERTIFICATE FOR OCCUPANCY PERMIT

Instructions: Accomplish the data needed. Write legibly. Application with incomplete requirements will not be accepted.

NAME OF APPLICANT: ALLIANZ PNB LIFE INSURANCE, INC./GRENZ, ALEXANDER


PROJECT TITLE: INTERIOR RENOVATION: ALLIANZ PNB LIFE
LOCATION OF PROJECT: LOT 17-A, QUEZON CITY CIRCLE, ELIPTICAL ROAD CORNER KALAYAAN AVENUE, CENTRAL, DISTR
BASE BUILDING: PNB BUILDING
TYPE OF OCCUPANCY: COMMERCIAL
TOTAL FLOOR AREA:
SCOPE OF WORK: Interior Renovation
BUILDING PERMIT NUMBER: 1BP201200712
CONTACT NUMBER: +63 912-229-5508

AMOUNT OFFICIAL RECEIPT NO. DATE

FIRE INSPECTION FEE

SALES TAX

OTHERS

1. Certificate of Completion

One (1) Certified true copy & one (1) photocopy of Assessment Fee for
2.
securing occupancy permit from Building Permit.

3. Copy of Fire Safety Evaluation Clearance (FSEC) with Fire Safety Checklist.

4. Copy of Building Permit.

5. Copy of Approved Plans.

6. Authorization letter and copy of government issued ID (if not the owner)

Requirements to be submitted: (To be checked/filled on by the Customer Relation Officer)

REMARKS:

PROCESSED BY: I hereby certify that all information stated above are true and
crrect to the best of my knowledge.

CRO/Assesor Name and Signature of Applicant

(To be filled up by the Customer Relation Officer)

REFERENCE SLIP

Certified By:
Building Permit No.: ____________________ STEPS
Time and Date Received: ______________1. Submitted of application form and
documents
Remarks: __________________________2. Assessment and payment Name and Signature of Customer
Relations Officer

Republic of the Philippines Department of the Interior and Local Government BUREAU OF FIRE PROTECTION National Capital Region

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