Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna
(049) 511-9111 / binanfirestation@yahoo.com

FSCIKHSS NO. R _____ __________________

DATE

FIRE SAFETY CLEARANCE

INSTALLATION OF KITCHEN HOOD SUPPRESSION 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 Revised Implementing Rules and Regulations (RIRR), this Clearance is hereby
issued for the Installation of Kitchen Hood Suppression System to
_____________________________________________________________________________________________
(Name of Building /Facility/Structure)
located at ___________________________________________________________________________________
(Address)
owned by ___________________________ for its business operation as

(Name of Owner)
and to be installed by _____________________________ on the condition that all requirements
(Name of Installer/Company)
of the Fire Code was complied by the contractor, designer and owner.

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 provisions of RA 9514 shall cause this Clearance NULL AND VOID after
appropriate proceeding and shall hold the owner and his/her installer/contractor liable to the
penalties provided under RA 9514.

Fire Code Fees: RECOMMEND APPROVAL:

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

APPROVED:

CITY/MUNICIPAL FIRE MARSHAL

note: “this clearance is accompanied with PLANS SIGNED AND SEALED BY PROFESSIONAL MECHANICAL ENGINEER DULY EVALUATED AND
REVIEWED BY THE BFP 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 installation 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”

DISTRIBUTION: “FIRE SAFETY IS OUR MAIN CONCERN”

Original (Applicant/Owner’s Copy)
Duplicate (BFP Copy)
BFP-QSF-FSED-042 REV.02 (08.24.20)