Republic of the Philippines

Department of the Interior and Local Government

Bureau of Fire Protection
(Region)
(District/Province Office)
(Station)
(Station Address)
(Telephone No./Email Address)
March 04, 2021
Efren Torricer ___________________
(Name of Owner) DATE Torricer
Residence
(Name of Establishment)
Blk, 2, Ihwa, Rosalina, Toril St. Davao City
(Address)

FOR : CITY/MUNICIPAL FIRE MARSHAL

ATTN : CHIEF, FIRE SAFETY ENFORCEMENT SECTION

REFERENCE: INSPECTION ORDER NO.______________________ DATE ISSUED March 05, 2021_

DATE OF INSPECTION: March 05, 2021

NATURE OF INSPECT ION CONDUCTED: [ ] Check Appropriate Box

[ ] Building under Construction [/] Periodic Inspection of Occupancy
[ ] Application for 0ccupancy Permit [ ] Verification Inspection of Compliance to NTCV
[ ] Application for Business Permit [ ] Verification Inspection of Complaint Received
[ ] Others (Specify) _________________________________________________________________________________

SINGLE AND TWO-FAMILY DWELLINGS CHECKLIST

I. GENERAL INFORMATION
Owner/Representative: Efren T. Torricer
Address: Blk, 2, Ihwa, Rosalina, Toril St. Davao City
Contact No. 09108702693
Total Land Area: 40 sqm Total Floor Area: 36.30 sqm
Building Permit: 16-02-084 Date Issued: February 10, 2021
Fire Code Fee ₱694.00 OR No. 00001 Date Issued: March 04, 2021

II.BUILDING CONSTRUCTION
Beams 23 Columns 19 Flooring 2
Exterior Walls 0 __________________ Corridor Walls 0 Room Partitions 0
Main Stair 1 Windows 10 Ceiling 7
Main Door 2 Trusses 0 Roof 0 _________________________

III. SECTIONAL OCCUPANCY (Note: Indicate specific usage of each floor, section or rooms)
1 Open Floor Living Room, Kitchen and Dining Area, 1 Bathroom, 3 Bedrooms and 1 Rooftop Terrace.

IV. MEANS OF EGRESS

Readily accessible? [ / ] Yes [ ] No Obstructed? [ ] Yes [ ] No
Travel distance within limits? [ ] Yes [ ] No Dead-ends within limits? [ ] Yes [ ] No
Adequate illumination [ ] Yes [ ] No Proper rating of illumination? [ ] Yes [ ] No
Panic hardware operational? [ ] Yes [ ] No Door swing in the direction of exit? [ ]Yes [ ] No
Doors open easily? [ ] Yes [ ] No Self-closure operational? [ ] Yes [ ] No
Bldg w/Mezzanine? [ ] Yes [ ] No Mezzanine with proper exits? [ ]Yes [ ] No

V. DEFECTS / DEFICIENCIES NOTED DURING INSPECTION (Attached pictures, sketch and others)
__________No defects were found during inspection.____________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
____________________________________________________________________________.

BFP-QSF-FSED-021 Rev. 01 (07.05.19) Page 1 of 2

 Republic of the Philippines
Department of the Interior and Local Government
Bureau of Fire Protection

VI. RECOMMENDATIONS
The applicants complied all requirements hence fire safety clearance/ certification is being granted.

ACKNOWLEDGED BY:

Efren T. Torricer Efrel Jean A. Torricer

________________________________________ _____________________________________________
Signature Over Printed Name of Owner/ Fire Safety Inspector/s
Representative

March 05, 2021 Juan Dela Cruz

Date & Time ___________________________ _______________________
__________________________________________________ __________
Team Leader

RECOMMEND ISSUANCE OF FSIC/NTC/NTCV:

Alex Pamaybay
______________________________________________
CHIEF, FIRE SAFETY ENFORCEMENT SECTION

APPROVED / DISAPPROVED:

Honee Fritz Alagano

_____________________________________________
CITY / MUNICIPAL FIRE MARSHAL

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”

DISTRIBUTION:
Original (Applicant/Owner’s Copy)
Duplicate (BO or BPLO, as the case may be)
Triplicate (BFP Copy)

BFP-QSF-FSED-021 Rev. 01 (07.05.19) Page 2 of 2