Anda di halaman 1dari 6

Repub

Department of the
BUREAU
Calam
City Hall Compoun

FIRE CODE F

NAME OF ESTABLISHMENT/PROJECT: _______________________________________


LOCATION: ___________________________________________________________________

FIRE SAFETY CLEARANCE APPLYING


____ Fire Safety Evaluation Clearance (FSEC) ____ Fire Safety Inspection

APPLICABLE FEE/S (Fill up)


Fire Code Revenue
Fire Code Construction Tax (0.1% of the verified estimated value of the buildings
Fire Code Realty Tax (0.01% of the assessed value of the buildings or structures
Fire Code Premium Tax (2% of all premiums collected by companies, persons or
Fire Code Proceeds Tax (2% of the services fess received from insurance adjustm
Fire Code Inspection Fee (10% of all charged by the local government or by othe
Storage Clearances (Refer to Schedule of Fees)
I. Calcium carbide
II. Pyroxylin
III. Matches
IV. Nitrate etc.
V. Shredded combustible
VI. Tar, resin etc
VII. Flammable liquids having flashpoints of -6.67 degree centigrade
VIII. Flammable liquids having flashpoints of above -6.67 degree centigrade
IX. Combustible liquids with flashpoint greater than 93.3 degree centigrade
X. LPG for bulk storage
XI. LPG other bulk storage
XII. Flammable gases
Conveyance Clearance Fee (Refere to schedule of fees)
Installation Clearance (Refer to schedule of fees)
Other Clearance Fee
Fire Works Display
Fumigation/Fogging
Fire Drill
Hotworks
Fire Incident Clearance
Certified true copy of FSIC/FSEC/other clearances
B.I.N. 192-00-201__________________ Floor Area _______________

Type of Occupancy Storeys


Business-
Mercantile-
Assembly-
Residential-
Industrial-
Storage-
Educational-
Healthcare-
Miscellaneous-
Mixed-
COMPLIANCE
Fire Extinguisher
Emergency Lights
Evacuation Plan
Smoke Detectors
FDAS
Standpipe System

Name of Owner/Representative: _______________________________________________

____ Fire Safety Evaluation Clearance (FSEC) ____ Fire Safety Inspection
Republic of the Phillipines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
Calamba City Fire Station
City Hall Compound Bacnotan Rd Real, Calamba City

FIRE CODE FEE ASSESSMENT FORM-1

_______________________________________________ Owner/Representative: ________________________


_______________________________________ Contact number/s: ____________________________

____ Fire Safety Inspection Certificate (FSIC) _____ Others: _______________________________

Code Revenue AMOUNT


imated value of the buildings or structures to be erected)
of the buildings or structures)
ed by companies, persons or agents licensed to sell)
eived from insurance adjustment companies)
local government or by other government agencies)

degree centigrade
-6.67 degree centigrade
93.3 degree centigrade

ees)
TOTAL AMOUNT OF FIRE CODE FEES

Name and Signature of Fire Code Fee

Date of Assessment

Floor Area _______________________sq.m.

Storeys Portion Occupied Type of Building


1 1st Commercial
2 2nd Stall/s
3 3rd Residential
4 4th Educational
5 5th Industrial
6 6th Warehouse
7 7th Assembly
8 8th Land
9 9th Farm
Others Others Others
IANCE
Kitchenhood Others: Specify
Fire Insurance Data
Fire Drill
Fire Protection Plan
Building Plan
Others]

CLAIM STUB

________________________________________________________

____ Fire Safety Inspection Certificate (FSIC) _____ Others: _______________________________

C.R.O.
___________________
___________

_____________________

UNT TOTAL
RE CODE FEES

gnature of Fire Code Fee Assessor

Date of Assessment

C.R.O.
SFO3 Mendova
SFO2 Cardinez
SFO1 Oblefias
SFO1 Fronda
SFO1 Castillo

Plan Evaluator
FO3 Alberca
FO2 Pagcaliwangan
FO1 Satuito

HAZARD
_____ MODERATE / LOW
_____ HIGH
REMARKS

Date: ______________________

_____________________

C.R.O.