Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
Regional Office-IX
Zamboanga del Norte Provincial Office
Dipolog City Fire Station
Office of the City Fire Marshal
Dipolog City, Zamboanga del Norte
Date: ________________
SUBJECT

FOR

: CITY/MUNICIPAL FIRE MARSHAL

ATTN: CHIEF, FIRE SAFETY ENFORCEMENT SECTION

REFERENCE

: INSPECTION ORDER NO._____________ DATE ISSUED: _______________

DATE OF INSPECTION: __________________

NATURE OF INSPECTION CONDUCTED: [Check Appropriate Box]
[ ] Building Under Construction
[ ] Periodic Inspection of Occupancy
[ ] Application for Occupancy Permit
[ ] Verification Inspection of Compliance to NTCV
[ ] Application for Business Permit
[ ] Verification Inspection of Complaint Received
[ ] Others (Specify) ________________________________________
STORAGE OCCUPANCY CHECKLIST
I. GENERAL INFORMATION
Name of Building ___________________________________________________________________________________
Business Name _____________________________________________________________________________________
Address ___________________________________________________________________________________________
Name of Owner/Occupant_______________________________________________ Contact No.___________________
Name of Representative _________________________________________________Contact No. ___________________
No. of Storey ________________ Height of Bldg.___________ m Portion Occupied_____________________________
Area per Flr. _______________________________ sqm
Total Flr. Area ______________________________sqm
Building Permit No.____________ Date Issued_________ Occupancy Permit No. ___________ Date Issued__________
Latest FSIC Issued Control No.____________________ Date Issued __________________ FC Fee _________________
Certificate of Fire Drill __________________________Date Issued ___________________FC Fee__________________
Latest Notice to Correct Violations Control No. __________________________ Date Issued ______________________
Name of Fire Insurance Co/Co-Insurer_________________________ Policy No.__________ Date Issued ____________
Latest Mayors/Bus. Permit _____ Date Issued ________ Municipal License No. __________Date Issued ____________
Latest Certificate of Electrical Inspection No. _____________________________Date Issued ______________________
Other Information ___________________________________________________________________________________
II. BUILDING CONSTRUCTION
Beams _________________________ Columns______________________ Flooring _____________________________
Exterior Walls ___________________Corridor Walls _________________ Room Partitions_______________________
Main Stair ______________________Windows_______________ ______Ceiling _________________________ ______
Main Door _____________________Trusses________________________ Roof ________________________________
III. SECTIONAL OCCUPANCY (Note: Indicate specific usage of each floor, section or rooms)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
___________________________________________________________________________________________
IV. CLASSIFICATION
A. CLASSIFICATION
[ ] Warehouse
[ ] Yards
[ ] Garage
[ ] Hangars
[ ] Others (specify)_______________________
Contents _____________________________ Height of Stacks ____________________________________________
Any renovation: [ ] Yes [ ] No
Underground: [ ] Yes [ ] No
Windowless: [ ] Yes [ ]
No