Republic of the Philippines DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT BUREAU OF FIRE PROTECTION OFFICE of the CITY

FIRE MARSHAL Upper Calceta St., Tagbilaran City Telefax: (038) 411-3120 APPLICATION NO. _________________ (To be filled up by applicant/owner) Name of Applicant/Owner _______________________________________________ Type of Building/Occupancy _____________________________________________ Total Number of Floors _________________________________________________ Total Floor Area ______________________________________________________ Location/Address of Building/Establishment/Construction ______________________ Requirements Submitted: (To be checked/filled up by the Customer Relations Officers) FIRE SAFETY EVALUATION CLEARANCE FIRE SAFETY INSPECTION CERTIFICATE (FSEC) (FSIC) FOR OCCUPANCY PERMIT OR BUSINESS PERMIT Endorsement from the Building Official (BO) Endorsement from Building Official (BO)/Business Permit Licensing Office (BPLO) Three(3) Sets of Building Plans and Specifications Photocopy of Building Permit and Assessment of One(1) Set of Bills of Materials and Cost Estimate of Occupancy Permit Fee/ Assessment of Business Permit Fee/BPLO Assessment/Tax Bill Three (3) Sets of Detailed Fire Safety Plans and for Business Permit as the case maybe Specification or Fire and Life Safety Assessment Report- 1(FALAR-1) for Occupancy of at least 50 Copy of Fire Insurance Policy (If any) persons Copy Latest Fire Safety Inspection Certificate Immediately Preceding this Application (If any) Three(3) sets of Fire and Life Safety Assessment Report-2 (FALAR-2) for Occupancy Permit or FALAR 3 for Business Permit (For Occupancy of at least 50 persons) ______________________________________ Signature of Applicant/Owner Time and Date Received: _______________________ Due for Release (FSEC with FS Checklist): _________ (FSIC/NTC): ____________________ _______________ Date

Certified By: ____________________________ Customers Relation Officer

Note: Only application with complete requirements shall be processed. -----------------------------------------------------------------------------CLAIM STUB APPLICATION NO. ______________ ______________________ Date NAME OF APPLICANT/OWNER: ________________________________ Time and Date Received: ______________________________________ Due for Release (FSEC) with FS Checklist): ________________________ Certified By: (FSIC/NTC): ____________________________________ _______________________

FIRE SAFETY IS OUR MAIN CONCERN