Application For Preliminary Certification For Green Building

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Annex D

APPLICATION FOR PRELIMINARY CERTIFICATION FOR GREEN BUILDING

APPLICATION NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)
OWNER/ APPLICANT NAME For Building Official use

LAST GIVEN MIDDLE


IN CASE OF COMPANY NAME:

TAX IDENTIFICATION NUMBER


of Applicant

DATE OF APPLICATION

MONTH DAY YEAR


LOCATION OF CONSTRUCTION

LOT BLOCK STREET BARANGAY


QUEZON CITY
DISTRICT ZIP CODE CITY

USE OF BUILDING PROJECT (Check one)


CLASSIFICATION BUILDING GROSS FLOOR AREA

Commercial Hotel
Commercial Office Building
Commercial Mall/ market
Institutional School
Institutional Gov't Building
Institutional Hospital
Industrial Factory
Industrial Warehouse
BOX 2
STATEMENT

I/ WE, _____________________, with business address at ________________________


do hereby apply for Preliminary Certificate for Green Building pursuant to the provisions of the
Implementing Rules and Regulations Part I for Green Infrastructures, to wit:

1 That the said location is within the territorial jurisdiction of Quezon City;
2 That the building project is for a (state whether for new construction or retrofitting of
an existing facility):________________________________________________.
3 That the building project is accurately presented by the building plans,
specifications, calculations, manufacturer's data and compliance statements,
schedules, bills of materials and detailed construction, installation, and assembly drawings
which bear the following project title:________________________________
___________________________________________________________________
4 That the project shall have estimated period of (no. of months) _______ for the
facility to be constructed starting (mm/dd/yyyy)___________________ and to be
finished by (mm/dd/yyyy) ___________.
5 That the filing of this application pursuant to Item 5.2 of the IRR is (state if required or not)
______________ prior to the start of construction. (State reason if not required).
_________________________________________________________________.
6 That documentary evidences covering the mandatory and elective requirements are
submitted in compliance with the definition of Green Building and the requirements
of the IRR for the purpose of the application.
7 That the Preliminary Certification for Green Building when obtained shall be basis
for the Whole Building Credit Component which denote the tax to be paid by (state
your name or the owner, in the case of taxpayer) _________________________
_____________________________________
8 That the payment shall be in accordance with Rule IV of the IRR.
9 That as applicant, (state I or we) _____ shall comply with the terms and conditions
of the Preliminary Certification for Green Building for the issuance of the Building
Permit including, but not limited to, the extent specified under the IRR for Green
Infrastructure.
10 In case of applying for exemptions, I/ we shall comply with the requirements of Section 10 of
the IRR.

SIGNED BY APPLICANT: NOTARY:

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