Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(STATION)
(Station Address)

FSCKH NO. R ______________

DATE

FIRE SAFETY CLEARANCE

(INSTALLATION OF KITCHEN HOOD SUPRESSION SYSTEMS)

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as Fire Code of the Philippines of 2008 and its
Implementing Rules and Regulations (IRR) , this FIRE SAFETY CLEARANCE for the Installation of Kitchen Hood
Suppression System is hereby issued to _________________________________________________________________
(Building/Establishments, Address)
Owned by for its business operation as
on the condition that all of the following
requirements of the Fire Code shall be complied with the contractor, designer and owner of the said installation,
to wit:
A. Hood E. Detector H. Fuel
B. Exhaust duct F. Pipes I. Agent Storage Containers
C. Appliances G. Nozzles J. Manual Activation Device
D. Fire Protecting System (Special Extinguishing System)

Violation of the Fire Code provisions shall ipso facto cause this CLEARANCE null and void, and shall
hold the owner and his/her installer/contractor liable to the penalties provided for by the said Fire Code.

Fire Code Fees:

Amount Paid: RECOMMEND APPROVAL:
O.R. Number:
Date:
CHIEF, FSES

APPROVED:

CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Clearance is accompanied by Fire Safety Checklist and does not take the place of any license required by law and is not
transferable. Any change or alteration in the design and specification during construction shall require a new clearance”

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-042 REV.00 (06.01.18) Commented [A1]: