DPWH FORM NO.

2003-001-B
Republic of the Philippines
TUGUEGARAO CITY
Province of Cagayan

OFFICE OF THE BUILDING OFFICIAL

APPLICATION FOR BUILDING PERMIT

NEW RENEWAL AMENDATORY
APPLICATION NO. AREA NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APLLICANT)

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

BY AN ENTERPRISE
ADDRESS; NO., STREET, BARANGAY, CITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO. ______ BLK NO. _______ TCT NO. _______________ TAX DEC. NO. ________

STREET ______________________________ BARANGAY _____________________ CITY OF ____________________

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION _____________ DEMOLITION _______________________
ERECTION CONVERSION _____________ ACCESSORY BUILDING/STRUCTURE ____
ADDITION REPAIR ___________________ OTHERS ( Specify) ___________________
ALTERATION MOVING __________________ __________________________________
USE OR CHARACTER OF OCCUPANCY
GROUP A : RESIDENTIAL, DWELLINGS GROUP F : INDUSTRIAL OTHERS (Specify) _____________
GROUP B : RESIDENTIAL HOTEL, APARTMENT GROUP G : INDUSTRIAL STORAGE AND HAZARDOUS
GROUP C : EDUCATIONAL, RECREATIONAL GROUP H : RECREATIONAL, ASSEMBLY OCCUPANT LOAD LESS THAN 1000
GROUP D : INSTITUTIONAL GROUP I : RECREATIONAL, ASSEMBLY OCCUPANT LOAD 1000 OR MORE
GROUP E : BUSINESS AND MERCHANTILE GROUP J : AGRICULTURAL, ACCESSORY
NUMBER OF STOREY(S) _________________________ PROPOSED DATE OF CONSTRUCTION ______________________
TOTAL FLOOR AREA _____________ SQUARE METERS EXPECTED DATE OF COMPLETION _________________________
TOTAL ESTIMATED COST PHP _____________________ ________________________________________________________

BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
Address

ARCHITECT OR CIVIL ENGINEER PRC No. Validity

(Signed and Sealed Over Printed Name) PTR No. Date Issued
Issued at TIN
BOX 3 BOX 4
APPLICANT WITH MY CONSENT: LOT OWNER

Date
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
CTC No. Date Issued Place issued CTC No. Date Issued Place Issued
BOX 5
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF CAGAYAN ) S.S.
CITY OF TUGUEGARAO )

BEFORE ME, at the City of Tuguegarao , on ___________________________ personally appeared the following:

APPLICANT CTC NO. Date Issued Place Issued

LICENSED ARCHITECT OR CIVIL ENGINEER CTC NO. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction Works)

whose signatures appear hereinabove, known to me to be the same persons who executed this standard prescribed from and acknowledged to me that the
same is their free and voluntary act and deed.

WITNESS MY HAND AND SEAL on the date and place above written.

Doc. No.
Page No.
Book No.
Series of NOTARY PUBLIC (Until Dec. ______)
BOX 6 (SUBMITTALS TO BE CHECKED, RECEIVED AND RECORDED)
ASSESSED FEES ASSESSED BY AMOUNT DUE DATE PAID O.R. NUMBER NSO
FILING FEE
PROCESSING FEE
LOCATIONAL/ZONING OF LAND USE
LINE AND GRADE (Geodetic)
FENCING
ARCHITECTURAL
CIVIL/STRUCTURAL
ELECTRICAL
MECHANICAL
SANITARY
PLUMBING
ELECTRONICS
INTERIOR
ONE HALF (1/2) OF FIRE SERVICE FUND (FSF)

TOTAL

BOX 7 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

BUILDING PERMIT
BUILDING PERMIT NO. OFFICIAL RECIEPT NO.

DATE ISSUED DATE PAID

M M D D Y Y M M D D Y Y

Permit is issued to _____________________________________________ for the proposed _______________________________________ under ___________________

(Owner/Applicant) (Type/Project) (Use or Character of Occupancy)
of group ________, located at lot no. ____ block no. ____ OCT/TCT no. ____________ Barangay __________________ City of Tuguegarao subject to the following:
1. That under the Article 1723 of the Civil Code of the Philippines, the engineer or architect who drew up the plans and specifications for a building/structure is liable for damages
if within fifteen (15) years from the completion of the building/structure, the same should collapse due to defect in the plans or specifications or defects in the ground. The
engineer or architect who supervises the construction shall be solidatity liable with the contractor should the edifice collapse due to defect in the construction or the use of
interior materials.
2. This permit shall be accompanied by the various applicable ancillary and accessory permits, plans and specifications signed and sealed by the corresponding design professionals
who shall be responsible for the comprehensive and correctness of the plans in compliance to the Code and its IRR and to all applicable referral codes and professionals
regulatory laws.
3. That the proposed construction/erection/addition/alteration/renovation/convertion/repair/moving/demolition, etc. shall be in conformity with the provisions of the National
Building Code, and its IRR.
a. That prior to commencement of the proposed projects and construction an actual relocation survey shall be conducted by a duly licensed Geodetic Engineer.
b. That before commencing the excavation the person making or causing the excavation is to be made shall notify in writing the owner of adjoining property not less
than ten (10) days before such excavation is to be made and show how the adjoining property should be protected.
c. That no person shall use or occupy a street, alley or public sidewalk for the performance of work covered by a building permit.
d. That no person shall perform any work on any building or structure adjacent to a public way in general use for pedestrian travel, unless the pedestrians are protected.
e. That the supervising Architect/Civil Engineer shall keep at the jobsite at all times a logbook of daily construction activities wherein the actual daily progress of
construction including tests conducted, weather condition and other pertinent data are to be recorded, same shall be made available for scrutiny and comments by the
OBO representative during the conduct of his/her inspection pursuant to Section 207 of the National Building Code.
f. That upon completion of the construction, the said licensed supervising Architect or Civil Engineer shall submit the logbook to the Building Official duly signed and sealed
logbook, as-built plans and other documents and shall also prepare and submit a Certificate of Completion of the project stating that the construction of the building/structure
conform to the provision of the Code, its IRR as well as the plans and specifications.
g. All such charges, modifications and alterations shall likewise be submitted to the Building Official and the subsequent amendatory permit therefor issued before any work on
said changes, modificationsand alterations shall be started. The as-built plans and specifications maybe just an orderly and comprehensive compilation of all documents
which include the originally submitted plans and specifications of all amendments thereto as actually built or they may be an entirely new set of plans and specifications
accurately describing and/or reflecting therein the building as actually built.
4. That no building/structure shall be used until the Building Official has issued a Certificate of Occupancy therefore as provided in the Code. However, a partial Certificate of
Occupancy may be issued for the Use/Occupancy of a portion or portions of a building/structure prior to the completion of the entire building/structure.
5. That this permit shall not serve as an exemption from securing written clearances from various government authorities exercising regulatory function affecting building/structures.
6. When the construction is undertaken by contract the work shall be done by a duly licensed and registered contractor pursuant to the provisions of the Contractor's License Law
(RA 4566).
7. The Owner/Permitee shall submit a duly accomplished prescribed "Notice of Construction" to the Office of the Building Official prior to any construction activity.
8. The Owner/Permitee shall put a Building Permit sign which complies with the prescribed dimensions and information, which shall remain posted on the construction site for the
duration of the construction.

PERMIT ISSUED BY:

ENGR. EMILIO L. MATANGUIHAN, JR

CITY ENGINEER
(Signature Over Printed Name)
Date ___________________

NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE "NATIONAL BUILDING CODE"