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    FSED 53F Application Form (Standalone) Rev00

    Uploaded by

    Tirador Ng Suman
    This document is a fire safety clearance application form from a Bureau of Fire Protection station. It requests information about a standalone project, including the project owner, title, location, contractor, and total floor area. It checks which type of standalone application is being applied for, such as fire suppression systems or electrical installations. It lists documentary requirements like architectural plans, estimates, and clearances. It requires certification of the information and completeness of documents. Upon verification, the form is used to monitor the installation and receive clearance.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    FSED 53F Application Form (Standalone) Rev00

    Uploaded by

    Tirador Ng Suman
    3K views1 page
    This document is a fire safety clearance application form from a Bureau of Fire Protection station. It requests information about a standalone project, including the project owner, title, location, contractor, and total floor area. It checks which type of standalone application is being applied for, such as fire suppression systems or electrical installations. It lists documentary requirements like architectural plans, estimates, and clearances. It requires certification of the information and completeness of documents. Upon verification, the form is used to monitor the installation and receive clearance.

    Original Description:

    for fire safety application

    Original Title

    FSED 53F Application Form (Standalone) Rev00 (1)

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    © © All Rights Reserved

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    This document is a fire safety clearance application form from a Bureau of Fire Protection station. It requests information about a standalone project, including the project owner, title, location, contractor, and total floor area. It checks which type of standalone application is being applied for, such as fire suppression systems or electrical installations. It lists documentary requirements like architectural plans, estimates, and clearances. It requires certification of the information and completeness of documents. Upon verification, the form is used to monitor the installation and receive clearance.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    3K views1 page

    FSED 53F Application Form (Standalone) Rev00

    Uploaded by

    Tirador Ng Suman
    This document is a fire safety clearance application form from a Bureau of Fire Protection station. It requests information about a standalone project, including the project owner, title, location, contractor, and total floor area. It checks which type of standalone application is being applied for, such as fire suppression systems or electrical installations. It lists documentary requirements like architectural plans, estimates, and clearances. It requires certification of the information and completeness of documents. Upon verification, the form is used to monitor the installation and receive clearance.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    BUREAU OF FIRE PROTECTION

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