SINGLE AND TWO-FAMILY DWELLINGS CHECKLIST
REFERENCE:
Inspection Order No. (lO)
*
Date lssued
*
-
Month
-
Day
Year
Date lnspected
*
-
Month
-
Day
Year
NATURE OF INSPECTION CONDUCTED (Check appropriate box)
NATURE OF INSPECTION CONDUCTED (Check appropriate box)
*
Building under Construction
Application for Occupancy Permit
Application for Business Permit
Periodic Inspection of Occupancy
Verification Inspection of Compliance to NTCV
Verification Inspection of Complaint Received
Other
FSI Name
*
FSI Email Address
*
***REMARKS ON ESTABLISHMENT***
*
Please Select
OPEN
PERMANENTLY CLOSED/RETIRED ESTABLISHMENT
CLOSED DUE TO COMMUNITY QUARANTINE GUIDELINES
CANNOT BE LOCATED
BUSINESS TRANSFERRED
NOT OPERATIONAL
NOT EXISTING
CHANGE OF BUSINESS NAME
DOUBLE IO/ALREADY INSPECTED
RESCHEDULED
REFUSED ENTRY
Submit
I. GENERAL INFORMATION
Business Name
Name of Owner/Representative
Address
Email Address of Owner/Representative
Phone Number of Owner/Representative
Ex: 09191234567
Total Land Area
Total Floor Area
Building Permit
Date lssued
-
Month
-
Day
Year
Fire Code Fee
OR No.
Date lssued
-
Month
-
Day
Year
II. BUILDING CONSTRUCTION
Beams
Columns
Flooring
Exterior Walls
Corridor Walls
Room Partitions
Main Stairs
Windows
Ceiling
Main Door
Trusses
Roof
III. SECTIONAL OCCUPANCY (Note: Indicate specific usage of each floor, section or rooms)
(Note: Indicate specific usage of each floor, section or rooms)
IV . MEANS OF EGRESS
Means of Egress
Yes
No
Readily accessible?
Travel distance within limits?
Adequate illumination
Panic hardware operational?
Doors open easily?
Bldg w/Mezzanine?
Obstructed?
Dead-ends within limits?
Proper rating of illumination?
Door swing in the direction of exit?
Self-closure operational?
Mezzanine with proper exits?
V . DEFECTS/DEFICIENCIES (Attached pictures, sketch and others)
DEFECTS/ DEFICIENCIES
VII. RECOMMENDATIONS
FSI Recommendation
Please Select
FSIC For Occupancy
For NTC
AMOUNT PAID
Kindly collect the remaining amount if it is less than Php500
O.R. NUMBER
Date of Payment
-
Month
-
Day
Year
FIRE SAFETY INSPECTION CERTIFICATE
FOR CERTIFICATE OF OCCUPANCY
FOR BUSINESS PERMIT (NEW/RENEWAL)
Other
THIS CERTIFICATION IS VALID FOR
Please Select
issuance of FSIC for business permit only
issuance of FSIC for occupancy permit only
ADDRESS DESCRIPTION
ACKNOWLEDGE BY:
Name of Owner/Representative
Owner/ Representative Signature
Signature of Owner/Representative
Date
-
Month
-
Day
Year
Fire Safety Inspector(s) NAME
FSI Signature
Fire Satey Inspector
FSI Email Address
C,FSES Email Address (For Recommendation)
Preview
Submit
FOR CHIEF OF FIRE SAFETY ENFORCEMENT SECTION
Please enter verification code
CHIEF, FSES RECOMMENDATION
RECOMMEND ISSUANCE OF FSIC
RECOMMEND ISSUANCE OF NTC
Chief, FSES Signature
CFM Email Address (For Approval)
Preview PDF
Submit
FOR CFM/MFM (ISSUANCE OF NTC)
Please enter verification code
APPROVAL(NTC)
APPROVED
DISAPPROVED
Date of Approval(NTC)
-
Month
-
Day
Year
CFM/MFM Signature(NTC)
Preview PDF
Submit
C,FSES Email Address(NTC)
Email Address of Owner/Representative (NTC)
NTC Serial Number
NTC Serial Number Generator
NTC INVALID FSIC
if disapproved(ntc)
FOR CITY/MUNICIPAL FIRE MARSHAL
Please enter verification code
APPROVAL
APPROVED FSIC
DISAPPROVED FSIC
Date of Approval
-
Month
-
Day
Year
Date
CFM/MFM Signature
Preview PDF
Submit
C,FSES Email Address
Email Address of Owner/Representative
Date+1 year
-
Month
-
Day
Year
Date
FSIC Serial Number
FSIC Serial Number Generator
if disapproved
Should be Empty: