Mercantile Occupancy Checklist

Republic of the Philippines Department of the Interior and Local Government BUREAU OF FIRE PROTECTION Region 1 Naguilian Fire Station (STATION

Brgy. Ortiz, Naguilian, La Union (Station Address

Date: ________________  ________________ 

SUBJECT

: Inspection Inspecti on of______________________ of__________________________________________________ _____________________________________  _________ 

FOR

:

CITY/MUNICIPAL FIRE MARSHAL   ATTN: CHIEF, CHIEF, FIRE SAFETY ENFORCEMENT SECTION

REFERENCE:

 ___________________ ____ DATE ISSUED: __________________  INSPECTION ORDER NO. _______________

DATE OF INSPECTION: __________________ 

NATURE OF INSPECTION CONDUCTED: [Cec! App"op"i#te $o%& [ ] Buili!" U!e# C$!%t#u&ti$! [ ] Pe#i$i& I!%'e&ti$! $( O&&u'a!&) [ ] A''li&ati$! ($# O&&u'a!&) Pe#*it [ ] +e#i(i&ati$! I!%'e&ti$! $( C$*'lia!&e t$ NTC+ [ ] A''li&ati$! ($# Bu%i!e%% Pe#*it [ ] +e#i(i&ati$! I!%'e&ti$! $( C$*'lai!t Re&eie [ ] Ot-e#% S'e&i()/ _________________________ ______________________________________ _______________  __ 

MERCANTILE OCCUPANC C!EC"LIST I. 'ENERAL INFORMATION  Na*e $( Buili!" ________________ _____________________________ _________________________ _________________________ __________________________ __________________________ ________________  ___  Bu%i!e%% Na*e __________________________ ______________________________________ _________________________ __________________________ __________________________ _____________________  ________  A#e%% _________________________ ______________________________________ __________________________ _________________________ _________________________ __________________________ _______________  __   Natu#e $( Bu%i!e%% ______________ ___________________________ __________________________ __________________________ _________________________ _________________________ _________________  ____   Na*e $( O0!e#1O&&u'a!t____________ O0!e#1O&&u'a!t_________________________ _________________________ ______________________ __________ C$!ta&t C$!ta&t N$.___________________  N$.___________________   Na*e $( Re'#e%e!tatie _______________ ___________________________ _________________________ ______________________C$!ta _________C$!ta&t &t N$. ___________________  ___________________   N$. $( St$#e) ________________ ________________ Hei"-t Hei"-t $( Bl".___________ Bl".___________ * P$#ti$! O&&u'ie_______________ O&&u'ie____________________________ ______________  _  A#ea 'e# Fl#. ______________________ __________ _____________________ _________ %2* T$tal Fl#. A#ea ______________________ ___________ _________________%2* ______%2* Buili!" Pe#*it N$.____________ N$.____________ Date I%%ue_________  O&&u'a!&) Pe#*it N$. ___________ Date I%%ue__________  3ate%t FSIC I%%ue C$!t#$l N$.____________________ Date I%%ue __________________ FC Fee _________________  _________________  Ce#ti(i&ate $( Fi#e D#ill __________________________Date __________________________Date I%%ue ___________________FC ___________________FC Fee__________________  3ate%t N$ti&e t$ C$##e&t +i$lati$!% C!t#l N$. _________________________ _____________________________ ____ Date I%%ue ______________________  ______________________   Na*e $( Fi#e I!%u#a!&e C$1C$4I!%u#e#__________ C$1C$4I!%u#e#_______________________ _______________ __ P$li&) N$.__________ N$.__________ Date I%%ue ____________  ____________  3ate%t Ma)$#5%1Bu%. Pe#*it _____ Date I%%ue ________ Mu!i&i'al 3i&e!%e N$. __________Date __________Date I%%ue ________  3ate%t Ce#ti(i&ate $( Ele&t#i&al I!%'e&ti$! N$. __________________________ _____________________________Date ___Date I%%ue ______________________  ______________________  Ot-e# I!($#*ati$! _________________________ ______________________________________ __________________________ _________________________ _________________________ ____________________  _______  CONSTRUCTION II. $UILDIN' CONSTRUCTION

Bea*% _________________________ _________________________ C$lu*!%___________________ C$lu*!%______________________ ___ Fl$$#i!" ________________________ _____________________________  _____  E6te#i$# 7all% ___________________C$##i$# 7all% _________________ R$$* Pa#titi$!%_______________________  Mai! Stai# ______________________7 ______________________7i!$0%_______ i!$0%_______________ ________ ______Ceili!" _________________________ _________________________ ______  Mai! D$$# _____________________T _____________________T#u%%e%________ #u%%e%_____________________ ________________ ___ R$$( __________________________ ________________________________  ______ 

III. SECTIONAL OCCUPANCY (Note: In)ic#te specific *s#+e of e#c f,oo"- section o" "oo.s

 _________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________   _____________________________________________________________________   ________________________________________________  __________________________   ____________________________  ______________________  ___________________________________________________  _____________________ ___________________________________________________________ ______________________________  _ 

IV. CLASSIFICATION O&&u'a!&) Cla%%i(i&ati$!: [ ] A [ ]B [ ]C Ot-e#% _________________________________   O&&u'a!t 3$a: _________________  (Requirement: 2.8 square meter per person for street level;5.6 sq.m. for upper  floors and 9.3 sq .m. for offices, storage, sipping and not open to te general pu!lic " A!) #e!$ati$!: [ ] Ye% [ ] N$ I( )e%, %'e&i() _____________________________________________________  U!e#"#$u!: [ ] Ye% [ ] N$ 7i!$0le%%: [ ] Ye% [ ] N$

01 E2IT DETAILS #apacit$ of %ori&ontal 'it (#orridor)%all*a$":+++++ ( Requirement:-- persons per unit of eit *idt per min" #apacit$ of 'it tair:++++++++++++++++++++++++++ (Requirement: 6- persons per unit of eit *idt per min"

 N$. $( E6it% ____________________ Re*$te8 [ ] Ye% [ ] N$  /inimum Requirement: 0o. of 'its: 1*o (2" units per floor 

3$&ati$! $( E6it% _______________________________________________________________________________   /aimum 1ravel istance Requirement from artest Room: 3-.5 m *itout 4  6m *it 4  A!) E!&l$%u#e P#$ie8 [ ] Ye%[ ]N$ MEANS OF E'RESS Reail) a&&e%%i9le8 T#ael i%ta!&e 0it-i! li*it%8 Ae2uate illu*i!ati$! Pa!i& -a#0a#e $'e#ati$!al8 D$$#% $'e! ea%il)8 Bl" 01 Mea!i!e8 C$##i$#% ; ai%le% $( %u((i&ie!t

 /in of 27r fire rating7 7store$ or more, /in of  r fire rating7 less tan 7store$

[ ] Ye% [ ] N$ [ ] Ye% [ ] N$ [ ] Ye% [ ] N$ [ ] Ye% [ ] N$ [ ] Ye% [ ] N$ [ ] Ye% [ ] N$ %ie8 [ ] Ye% [ ] N$

O9%t#u&te8 Dea4e!% 0it-i! li*it% 8 P#$'e# #ati!" $( illu*i!ati$!8 D$$# %0i!" i! t-e i#e&ti$! $( e6it8 Sel(4&l$%u#e $'e#ati$!al8 Mea!i!e 0it- '#$'e# e6it%8

[ [ [ [ [ [

] Ye% ] Ye% ] Ye% ] Ye% ] Ye% ] Ye%

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N$ N$ N$ N$ N$ N$

A1 0ERTICAL E2ITS

<. M#in st#i"3#4: 7it- ______________C$!%t#u&ti$! __________________________  A#e t-e#e #aili!"% '#$ie8 [ ] Ye% [ ] N$ Mae $(_____________________________________________  A!) e!&l$%u#e '#$ie8 [ ] Ye% [ ] N$ E!&l$%u#e &$!%t#u&ti$! ________________A!) $'e!i!"8 [ ] Ye% [ ] N$ Fi#e $$# &$!%t#u&ti$!_________________________________ D$$# e2ui''e 01 Sel(4&l$%i!" ei&e8 [ ] Ye% [ ] N$ D$$# '#$'e# #ati!": [ ] Ye% [ ] N$ D$$# '#$ie 01 i%i$! 'a!el: [ ] Ye% [ ] N$ I( Ye%, *ae $( __________________  D$$# %0i!" i! t-e i#e&ti$! $( e6it t#ael 0-e! #e2ui#e/8 [ ] Ye% [ ] N$ Stai#0a)% P#e%%u#ie8 [ ] Ye% [ ] N$ [ ] N1A I( '#e%%u#ie, 0-at t)'e $# *et-$8 __________________________  Date 3a%t Te%te ___________________________________________________________________________________  =. Secon)#"4 St#i"/Fi"e Esc#pe: Nu*9e#______________ 7it- ______________________  C$!%t#u&ti$!_________________ A#e t-e#e #aili!"% '#$ie8 [ ] Ye% [ ] N$ Mae $( ______________________  3$&ati$!: [ ] I!te#i$# [ ] E6te#i$# E6it% a&&e%%i9le8 [ ] Ye% [ ] N$ A!) $9%t#u&ti$!8 [ ] Ye% [ ] N$ Te#*i!ati$!1Di%&-a#"e $( E6it% __________________________  A!) e!&l$%u#e '#$ie8 [ ] Ye% [ ] N$ E!&l$%u#e &$!%t#u&ti$! ________________________________  A!) $'e!i!"8[ ] Ye% [ ] N$ O'e!i!" '#$te&te8 [ ] Ye% [ ] N$ A#e (i#e $$# '#$ie8 [ ] Ye% [ ] N$ 7it- ____________Fi#e $$# &$!%t#u&ti$! ________________  D$$# '#$ie 0it- i%i$! 'a!el8 [ ] Ye% [ ] N$ I( Ye%, *ae $( ______________________________________  D$$# e2ui''e 01 Sel(4&l$%i!" ei&e8 [ ] Ye% [ ] N$ D$$#% ; e!&l$%u#e '#$'e# #ati!"8 [ ] Ye% [ ] N$ D$$#% $'e! ea%il)8 [ ] Ye% [ ] N$ Sel(4&l$%i!" ei&e $'e#a9le8 [ ] Ye% [ ] N$ D$$# e2ui''e 01 'a!i& -a#0a#e8 [ ] Ye% [ ] N$ O'e#a9le8 [ ] Ye% [ ] N$ D$$# %0i!" i! t-e i#e&ti$! $( e6it t#ael8 [ ] Ye% [ ] N$ E!&l$%u#e '#$'e#l) '#$te&te8 [ ] Ye% [ ] N$ Fi#e e%&a'e '#e%%u#ie8 [ ] Ye% [ ] N$ [ ] N1A I( '#e%%u#ie, 0-at t)'e $# *et-$8 __________________________ Date 3a%t Te%te ___________________________________________________________________________________  C1 HORI5ONTAL E2ITS 7it- $( $$#1% ______________________ C$!%t#u&ti$!________________________ 7it- i%i$! 'a!el [ ] Ye% [ ] N$ D$$# %0i!" i! t-e i#e&ti$! $( e"#e%% t#ael8 [ ] Ye% [ ] N$ 7it- Sel(4&l$%i!" ei&e8 [ ] Ye% [ ] N$ 7it- $( &$##i$#% $# -all0a)% _______________________________C$!%t#u&ti$! _______________________________  C$##i$# 0all% e6te!e (#$* %la9 t$ %la98 [ ] Ye% [ ] N$ P#$'e#l) illu*i!ate8 [ ] Ye% [ ] N$ E6it #eail) i%i9le8 [ ] Ye% [ ] N$ Clea# a! u!$9%t#u&te8 [ ] Ye% [ ] N$ P#$'e#l) *a#>e 01 illu*i!ate e6it %i"!8 [ ] Ye% [ ] N$ 7it- illu*i!ate i#e&ti$!al %i"!8 [ ] Ye% [ ] N$ P#$'e#l) l$&ate8 [ ] Ye% [ ] N$ D1 RAMPS P#$ie8 [ ] Ye% [ ] N$ T)'e: [ ] I!te#i$# [ ] E6te#i$# 7it- _______________ Cla%% _______________  Raili!"% '#$ie8 [ ] Ye% [ ] N$ Hei"-t (#$* t-e (l$$# ______________ (Requirement: 9 cm" A!) e!&l$%u#e '#$ie8 [ ] Ye% [ ] N$C$!%t#u&ti$!________________________________________________  A#e (i#e $$#% '#$ie8 [ ] Ye% [ ] N$ 7it- ____________________ Fi#e $$# &$!%t#u&ti$!______________ 

D$$# e2ui''e 01 Sel(4&l$%i!" ei&e8 [ ] Ye% [ ] N$ D$$# 0it- '#$'e# #ati!"8 [ ] Ye% [ ] N$ D$$# '#$ie 01 i%i$! 'a!el8 [ ] Ye% [ ] N$ I( Ye%, *ae $( _____________________________________________  D$$# %0i!" i! t-e i#e&ti$! $( e6it t#ael 0-e! #e2ui#e/8 [ ] Ye% [ ] N$ A!) $9%t#u&ti$!8 ________________________________ Te#*i!ati$!1Di%&-a#"e $( e6it _________________________  E1 AREA OF SAFE REFU'E P#$ie8 [ ] Ye% [ ] N$ T)'e: [ ] I!te#i$# [ ] E6te#i$# 3$&ati$! _________________________________  A!) e!&l$%u#e '#$ie 8 [ ] Ye% [ ] N$ C$!%t#u&ti$!________________________________________________  A#e (i#e $$# '#$ie8 [ ] Ye% [ ] N$ 7it- _______________ Fi#e $$# &$!%t#u&ti$!___________________  D$$# e2ui''e 01 %el(4&l$%i!" ei&e8 [ ] Ye% [ ] N$ D$$# 0it- '#$'e# #ati!"8 [ ] Ye% [ ] N$ D$$# '#$ie 01 i%i$! 'a!el8 [ ] Ye% [ ] N$ I( Ye%, *ae $( ________________________________  D$$# %0i!" i! t-e i#e&ti$! $( e6it t#ael8 [ ] Ye% [ ] N$ 0I1 LI'HTIN'S 6 SI'NS A1 EMER'ENCY LI'HTS Aut$*ati& E*e#"e!&) 3i"-t% P#$ie8 [ ] Ye% [ ] N$ S$u#&e $( P$0e# [ ] AC1DC [ ] Ot-e#% _________________  N$. $( U!it% 'e# Fl$$#________________ 3$&ate at: Hall0a)% _______________ Stai#0a) 3a!i!"% _______________  O'e#ati$!al: [ ] Ye% [ ] N$ E6it 'at- '#$'e#l) illu*i!ate8 [ ] Ye% [ ] N$ Te%te M$!t-l): [ ] Ye% [ ] N$ /inimum 4' o*er  uration : at least one (" our $1 E2IT SI'NS E6it Si"!% Illu*i!ate8 [ ] Ye% [ ] N$ 3$&ati$! _________________________________________________  S$u#&e $( P$0e# [ ] AC1DC ? @ Ot-e#%____________________________________ Reail) i%i9le8 [ ] Ye% [ ] N$ Mi!i*u* 3ette# Sie _______________________  /in. Requirement: %eigt of .5 cm  *idt of 9.- mm E6it R$ute Pla! '$%te $!: Hall0a)%8 [ ] Ye% [ ] N$ R$$*%8 [ ] Ye% [ ] N$ Di#e&ti$!al E6it Si"!%8 [ ] Ye% [ ] N$ 3$&ati$!_____________________________________________________  C1 7ARNIN'/SAFETY SI'NS [ ] N$ S*$>i!"  [ ] Dea4e! [ ] Eleat$# Si"! [ ] ee' D$$# Cl$%e Ot-e#%, %'e&i() _____________________________________________________________________________________  0II1 FEATURES OF FIRE PROTECTION A1 PROTECTION OF 0ERTICAL OPENIN'S P#$'e#l) '#$te&te8 [ ] Ye% [ ] N$ At#iu*8 [ ] Ye% [ ] N$ Fi#e D$$#% "$$ &$!iti$!8 [ ] Ye% [ ] N$ Eleat$# $'e!i!" '#$te&te8 [ ] Ye% [ ] N$ Pi'e C-a%e $'e!i!" '#$te&te8 [ ] Ye% [ ] N$ Ai#&$! Du&t% %)%te* 0it- a*'e#8 [ ] Ye% [ ] N$ Du*9 7aite# $'e!i!" '#$te&te8 [ ] Ye% [ ] N$ a#9a"e C-ute $'e!i!" '#$te&te8 [ ] Ye% [ ] N$ Bet0ee! Fl$$# ; la%% Cu#tai! $'e!i!" '#$te&te8 [ ] Ye% [ ] N$ Date 3a%t Te%te____________________________________________________________________________________  $1 ALARM SYSTEM Fi#e Ala#* P#$ie8 [ ] Ye% [ ] N$ T)'e: [ ] Ma!ual [ ] Aut$*ati& Ce!t#alie8 [ ] Ye% [ ] N$ 3$&ati$! $( Ce!t#al C$!t#$l __________________________________________________________________________   N$. $( Bell% 'e# Fl$$# __________ 3$&ati$!__________________________________________________________  C$e#a"e: [ ] Buili!" [ ] Ai# Ha!li!" U!it [ ] P$#ti$!, %'e&i()__________ M$!it$#e8 [ ] Ye% [ ] N$ T)'e $( I!itiati$! Dei&e8 [ ] S*$>e [ ] Heat [ ] Ma!ual [ ] 7ate# Fl$0 [ ] Ot-e#% ____________________________   N$. $( Pull Stati$!% 'e# Fl$$#______  /a.. %ori&ontal istance et. ull tations: 6.- m S*$>e Dete&t$#%8 [ ] Ye% [ ] N$ N$. $( U!it% 'e# R$$* _______________ I!te"#ate8 [ ] Ye% [ ] N$ Heat Dete&t$#%8 [ ] Ye% [ ] N$ N$. $( U!it% 'e# R$$* _______________ I!te"#ate8 [ ] Ye% [ ] N$ P$0e# S$u#&e $( Dete&t$#% [ ] AC1DC [ ] Ot-e#%___________ T$tal Dete&t$#% 'e# Fl$$# ________________________  Date 3a%t Te%te ___________________________________________________________________________________  +  C1 STANDPIPE SYSTEM T)'e: [ ] 7et [ ] D#) Ta!> Ca'a&it) ____________________3$&ati$! _______________________________  Sia*e%e I!ta>e P#$ie8 [ ] Ye% [ ] N$ 3$&ati$! _________________________________________________  Sie ________________ N$. $( U!it% ___________________________ A&&e%%i9le8 [ ] Ye% [ ] N$ Fi#e H$%e Ca9i!et% P#$ie8 [ ] Ye% [ ] N$ 7it- C$*'lete a&&e%%$#ie% [ ] Ye% [ ] N$ 3$&ati$! ___________________________   N$. $( U!it% 'e# Fl$$# ____________ Sie $( H$%e ___________________ 3e!"t- $( H$%e _______________________  (0ote: /in Required i&e of Riser  istri!ution ipe: 2  inc and   inc in diameter, respectivel$ T)'e $( N$le __________________Date 3a%t Te%te _______________________  Fi#e 3a!e P#$ie: [ ] Ye% [ ] N$ 3$&ati$! $( !ea#e%t Fi#e H)#a!t ______________________________  D1 FIRST AID FIRE PROTECTION E8UIPMENT (PORTA$LE FIRE E2TIN'UISHERS T)'e _________________________ Ca'a&it) ____________________ N$. $( U!it% _____________________________  7it- PS Ma#>8 [ ] Ye% [ ] N$ 7it- ISO Ma#>8 [ ] Ye% [ ]N$ P#$'e#l) Mai!tai!e8 [ ] Ye% [ ] N$ C$!%'i&u$u%l) 3$&ate8 [ ] Ye% [ ] N$ A&&e%%i9le8 [ ] Ye% [ ] N$ Ot-e# T)'e% P#$ie, i( a!) __________________________________________________________________________ 

E1 AUTOMATIC FIRE SUPPRESSION SYSTEM (SPRIN9LER SYSTEM T)'e $( E6ti!"ui%-i!" A"e!t U%e __________________J$&>e) Pu*' Ca'a&it) ____________-'

________PM

Fi#e Pu*' Ca'a&it): ____________-' _____________PM Ta!> Ca'a&it)8__________________________ "all$!% Mai!tai!i!" 3i!e P#e%%u#e ________________________Fa#t-e%t S'#i!>le# Hea P#e%%u#e _________________________  Ri%e# Sie _______T)'e $( Hea% I!%talle ______________________________________________________________   N$. $( Hea% 'e# Fl$$# ___________T$tal___________________ S'a&i!" $( Hea% _____________________________  3$&ati$! $( Fi#e De'a#t*e!t C$!!e&ti$! ________________________________________________________________ 

Date 3a%t Te%te ___________________________ C$!u&te B)8___________________________________________  Pla! Su9*itte8 _________________________ Ce#ti(i&ate $( I!%tallati$!8 ____________________________________    4 #ertificate pa$ment under ection 3 (5" and und #ode 0o. 25375. 0III1 $UILDIN' SER0ICE E8UIPMENT A. B$ile# P#$ie8 [ ] Ye% [ ] N$ N$. $( U!it% '#$ie_________________________________________  Fuel: [ ] Die%el [ ] e#$%e!e [ ] C$al [ ] Bu!>e# [ ] 3P Ca'a&it) ______________________________________  C$!tai!e#: [ ] A9$e4"#$u! [ ] U!e#"#$u! 3$&ati$! ____________________________________________  3P I!%tallati$! C$e#e 0it- Pe#*it8 [ ] Ye% [ ] N$ Fuel 0it- St$#a"e Pe#*it8 [ ] Ye% [ ] N$

B. e!e#at$# Set P#$ie8 [ ] Ye% [ ] N$ [ ] Aut$*ati& [ ] Ma!ual Fuel:[ ] Die%el [ ] a%$li!e Ca'a&it) _______________________ 3$&ati$! ______________________ Di>e%1Bu!0all P#$ie [ ] Ye% [ ] N$ C$!tai!e#: [ ] A9$e4"#$u! [ ] U!e#"#$u! Di%'e!%i!" S)%te*8 [ ] B) 'u*' [ ] B) "#ait) Out'ut Ca'a&it) __________________>a Me&-a!i&al Pe#*it ______________________Date I%%ue________________  Fuel 0it- St$#a"e Pe#*it8 [ ] Ye% [ ] N$ Ot-e#% %'e&i()/ _____________________________________________  Aut$*ati& T#a!%(e# S0it&- P#$ie8 [ ] Ye% [ ] N$ Ti*e i!te#al ______%e& (Requirement7 ma  seconds" C. Re(u%e a#9a"e/ Ha!li!" Fa&ilit): P#$ie8 [ ] Ye% [ ] N$ E!&l$%u#e '#$ie8 [ ] Ye% [ ] N$ Fi#e #e%i%tie8 [ ] Ye% [ ] N$ Fi#e '#$te&ti$! '#$ie8 [ ] Ye% [ ] N$ T)'e ______________________________________________________  F#e2ue!&) $( &$lle&ti$!1i%'$%al______________________________ H$0 &$lle&te8__________________________  D. Ele&t#i&al S)%te* I% t-e#e a!) ele&t#i&al -aa#8 [ ] Ye% [ ] N$ E. Me&-a!i&al S)%te* I% t-e#e a!) *e&-a!i&al -aa#8 [ ] Ye% [ ] N$  N$. $( eleat$#% '#$ie __________  Fi#e*a!5% eleat$# '#$ie8 [ ] Ye% [ ] N$

S'e&i() l$&ati$!_______________________________________ 

S'e&i() l$&ati$! ______________________________________  Fi#e*a!5% >e)1%0it&- '#$ie8 [ ] Ye% [ ]N$

F. Ot-e# Buili!" Se#i&e S)%te*% [ ] 7ate# T#eat*e!t Fa&ilit) [ ] 7a%te 7ate#1Se0a"e T#eat*e!t Fa&ilit) I21 HA5ARDOUS AREAS [ ] it&-e! [ ] 7i!$0le%% Ba%e*e!t [ ] St$#a"e R$$* Ot-e#%____________________   Se'a#ati$! Fi#e Rate8 [ ] Ye% [ ] N$ T)'e $( Fi#e P#$te&ti$! '#$ie_______________________________________   N$. $( U!it% ____________________________ Ca'a&it) __________________________A&&e%%i9le8 [ ] Ye% [ ] N$ Fuel U%e _____________ 7-e#e St$#e _____________________ C$e#e 9) BFP Pe#*it _______________________  C-i*!e): Mae $( ___________________ S'a#> A##e%te# __________________S*$>e H$$ _____________________  P#e%e!&e $( -aa#$u% *ate#ial%8 [ ] Ye% [ ] N$ P#$'e#l) %t$#e a! -a!le8 [ ] Ye% [ ] N$ i!% C$!tai!e# +$lu*e 3$&ati$! <. ___________________________ __________________ __________ ________________________________ 

=. ___________________________

__________________ __________

________________________________ 

. ___________________________ __________________ __________ ________________________________  St$#a"e Pe#*it ($# Fla**a9le%1C$*9u%ti9le% C$e#e 9) BFP Pe#*it8 _______________________________________  Clea#a!&e $( St$&>% F#$* Ceili!" _____________________________________________________________________   /inimum #eiling #learance: .-m for lamma!le iquids and -.5m for #om!usti!le /aterials

21 OPERATIN' FEATURES Fi#e Sa(et) P#$"#a* U!e# t-e %u'e#i%i$! $( t-e C-ie( 3$&al Fi#e Se#i&e/ [ ] Ye% [ ] N$ Fi#e B#i"ae O#"a!iati$!8 Fi#e Sa(et) Se*i!a#  [ ] Ye% [ ] N$ [ ] Ye% [ ] N$ E*'l$)ee% t#ai!e i! e*e#"e!&) '#$&eu#e%8 Fi#e1Ea&uati$! D#ill &$!u&te #e"ula#l)

[ ] Ye% [ ] N$

Date la%t &$!u&te _________  

2I1 DEFECTS / DEFICIENCIES NOTED DURIN' INSPECTION (Att#c pict*"es- s!etces #n) ote"s

 __________________________________________________________________________________________   __________________________________________________________________________________________   __________________________________________________________________________________________   __________________________________________________________________________________________   ____________________________________________________________________________________ 

2II1 RECOMMENDATIONS

 __________________________________________________________________________________________________   __________________________________________________________________________________________________   __________________________________________________________________________________________________   __________________________________________________________________________________________________   ___________________________________________________________________________________________   __________________________________________________________________________________________________  ACNO73EDED BY:

 ____________________________________________ Si"!atu#e Oe# P#i!te Na*e $( O0!e#1Re'#e%e!tatie Date ; Ti*e______________________ 

____________________________________________  Fi#e Sa(et) I!%'e&t$#1%

 __________________________________________  Tea* 3eae# 

RECOMMEND ISSUANCE OF FSIC1NTC1NTC+:

 __________________________________________  CHIEF, FIRE SAFETY ENFORCEMENT SECTION

APPRO0ED/DISAPPRO0ED:

 

Original (BFP copy) Duplicate(BO or BPLO, as the case maybe) Triplicate (Applicant/Owner’s Copy)

____________________________________  Cit4 Fi"e M#"s#,