Places of Assembly Occupancy Checklist (Theater)

KINDLY ENCODE THE EXACT IO NUMBER

Kindly encode the exact BIN/BAN

Building Under ConstructionApplication for Occupancy PermitFSIC for Business Permit (New)FSIC for Business Permit (Renewal)Periodic Inspection of OccupancyVerification Inspection of Compliance to NTCVVerification Inspection of Complaint ReceivedNotice of Disapproval, if Certificate of OccupancyOther

All Capital Letters (Ex: JUAN DELA CRUZ BUILDING)

All Capital Letters (Ex: JUAN DELA CRUZ STORE)

EX: SARI-SARI STORE, RETAILER, CLINIC, GEN. MDSE, SPA

(requirement: 0.65 sq.m. per person for concentrated used without fixed seat; 1.4 sq.m. per person for less concentrated use and 0.28 sq.m. per person for standing room or waiting space)

Termination of exit from theater building to streets: Facing Entrance

	Clear width	Terminating at
Stair no. 1
Stair no. 2

	Clear Width	Door Width	Location	Terminating at(Ref. Facing Street)
F.E. No. 1
F.E. No. 2

	Width	Direction of Opening
Door no. 1
Door no. 2

	Location	Width
1.
2.

	Width
Front
Left Side
Right Side
Center 1
Center 2
Back

	Clear width	Terminating at
Stair no. 1
Stair no. 2

	Clear Width	Door Width	Location	Terminating at (Ref. Facing Street)
F.E. No. 1
F.E. No. 2

	Width	Direction of Opening
Door no. 1
Door no. 2

	Location	Width
1.
2.

	Width
Front
Left Side
Right Side
Center 1
Center 2
Back

A. EMERGENCY LIGHTS

Minimum AEL Power Duration: at least one (1) hour

Min. Requirement: Height of 11.5 cm & width of 19.0 mm

C. WARNING/SAFETY SIGNS

A. PROTECTION OF VERTICAL OPENINGS

	Yes	No
Properly protected
Atrium
Fire Doors good condition
Elevator opening protected
Pipe Chase opening protected
Aircon Ducts system with damper
Dumb Waiter opening protected
Garbage Chute opening protected
Between Floor & Glass Curtain opening protected

BuddingAir Handling UnitOther

Max. Horizontal Distance Bet. Pull Stations: 61.0 m

C. STANDPIPE SYSTEM

(Note: Min Required Size of Riser & Distribution Pipe: 2 1/2 inch and 1 1/2 inch in diameter, respectively)

D. FIRST AID FIRE PROTECTION EQUIPMENT (PORTABLE FIRE EXTINGUISHERS)

	Yes	No
With PS Mark
With ISO Mark
Properly Maintained
Conspicuously Located
Accessible

E. AUTOMATIC FIRE SUPPRESSION SYSTEM (SPRINKLER SYSTEM)

BFP AFSS Certificate payment under Section 13 B (5) and Fund Code No. D2531–151

F. FIRE PROOFING AND FIRE RESISTIVE MATERIALS

	Yes	No
a) Curtains and screen treated with flame retardant
b) Soundboards or soundproofing materials fire resistive
c) Fireproofing treatment certified

	Yes	No
Building required with firewalls
Provided
Any Opening

	Yes	No
Fire Brigade Organization
Fire Safety Seminar
Employees trained in emergency procedures
Fire/Evacuation Drill

Comply the following DEFFECTS/DEFICIENCIES stated above and pay the corresponding Fire Code Fees including the Storage Clearance Fee , Conveyance Clearance Fee before the issuance of Fire Safety lnspection Certificate (FSIC).

Notice to ComplyNotice to Correct ViolationClosure OrderAbatement Order with Administrative FineClosure Order for the non-Payment of Administrative FineNotice of Disapproval, if Certificate of occupancy is applied

Kindly collect the remaining amount if it is less than Php500

FOR CERTIFICATE OF OCCUPANCYFOR BUSINESS PERMIT (NEW/RENEWAL)Other

Signature of Owner/Representative

Fire Satey Inspector

RECOMMEND ISSUANCE OF FSICRECOMMEND ISSUANCE OF NTC

APPROVED FSICDISAPPROVED FSIC

PLACES OF ASSEMBLY OCCUPANCY CHECKLIST (Theater)

ACKNOWLEDGE BY: