REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

OFFICE OF THE LOCAL BUILDING OFFICIAL
NAGA CITY
DISTRIC/CITY/MUNICIPALITY
AREA CODE: 1724-A

BUILDING PERMIT

_____________________ _______________________
DATE OF APPLICATION DATE ISSUED

ORIGINAL RENEWAL APPENDIX B

BOX 1 (TO BE ACCOMPLISHED BY DESIGNING ARCHITEC/CIVIL ENGINEER IN PRINT) DO NOT FILL-UP (NSO USE ONLY)

OWNER: LAST NAME FIRST NAME M. I. TAX ACCT. NO.

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP MAIN ECONOMIC ACTIVITY/

BY ALL ENTERPRISE KIND OF BUISNESS
ADDRESS TEL. NO.

LOCATION

SCOPE OR WORK: 1. NEW CONSTRUCTION OTHER (SPECIFY)

2. ADDITION OF ______________ 6. _____________ OF ___________
3. REPAIR OF _________________ 7._____________ OF ___________
4. RENOVITION OF ___________ NUMBER OF UNITS__________
USE OF TYPE OF OCCUPANCY
RESIDENTIAL INDUSTRIAL
11. SINGLE 31. FACTORY/PLANT
12. DUPLEX 32. REPAIR SHOP, MACHINE SHOP
13. ROWHOUSE/ACCESSORIA 33. REFINERY
10. OTHER (SPECIFY)____________________ 34. PRINTING PRESS
35. WAREHOUSE
COMMERCIAL 30. OTHER (SPECIFY)_________________
21. BANK
22. STORE INSTITUTIONAL
23. HOTEL, MOTEL, ETC. 41. SCHOOL
24. OFFICE CONDUMINIUM/BU SINESS OFFICE BUILDING 42. CHURCH AND OTHER RELIGIOUS STRUCTURES
25. RESTAURANT, ETC. 43. HOSPITAL OR SIMILAR STRUCTURES
26. SHOP (e.g. DRESS SHOP, TAILORING SHOP, BARBER SHOP, ETC.) 44 . WELFARE AND CHARITABLE STRUCTURES
27. GASOLINE STATION 45. THEATER, AUDITORIUM, GYMNASIUM, COURT
28. MARKET 40. OTHERS (SPECIFY)______________________
29. DORM’TORY OR OTHER LODGING HOUSE
20. OTHRE (SPECIFY)___________________ AGRICULTURAL
51. BARN(S) POULTRY HOUSE (S), ETC.
52. GRAIN MILL
50. OTHERS (SPECIFY)______________________
OTHER
60. SPECIFY _________________________________________
STREET FRURNITURE, LANDSCAPING & SINGBOARDS
71. PARKS, PLAZAS, MONUMENT, POOLS, PLANT BOXES, ETC.
72. SIDEWALKS, PROMENADES, TERRACES, LAMPOST, ELECTREC POLES, TELEPHONE POLES, ETC.
73. OUTDOORS ADS, SINGBOARDS, ETC.
74. FENCE ENCLOSURE

BOX 2 ( TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION

BUILDING DOCUMENTS ( FIVE SETS EACH)
SITE DEVELOPMENT AND LOCATION PLAN MECHANICAL PLANS & SPESIFICATIONS
ARCHITECTURAL PLAN & SPECIFICATIONS LOGBOOK(1COPY)_____________________
STRUCTURAL DESIGN & CON\MPUTATION S OTHERS (SPECIFY)_____________________
SANITARY/ PLUMBING PLANS & SPECIFICATIONS
_______________________________________

BOX 3 ( TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN:
PERMIT IS HEREBY GRANTED TO THE FOLLLOWING CONDITIONS:
1. THAT THE PROPOSED CONSTRUCTION/ADDITION/REPAIR/RENOVATION/DEMOLITION/INSTALLATION ETC. SHALL BE IN CONFORMITY WITH THE
NATIONAL BUILDING CODE (P.D. 1069) AND ITS CORRESPONDING IMPLEMENTING RULES AND REGULATIONS.
2. THAT A DULY LICENSED ARCHETIC/CIVIL ENGINEER HAS BEEN ENGAGED TO PREPARE PLANSAND SPECIFICATIONS AND TO UNDERTAKE THE
SUPERVISION/INSPECTION OF THE –CONSTURCTION OF THE PROJECT.
3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED AND SEALED BY THE DESIGNING ARCHETIC/ ENGINEER AND THE ARCHETIC/ENGINEER IN –
CHARGE OF CONSTRUCTION SHALL BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER COMPLITION OF THE CONSTRUCTION OF THE PROJECT.
4. THAT A “CERTIFICATE OF OCCUPANCY” SHALL BE SECURED PRIOR TO ACCTUAL OCCUPANCY OF THE BUILDING.
NOTE: THIS PERMIT MAY BE CANCELLED OF REVOKED PURSUANT TO SECTION 305 & 306 OF THE “ NATIONAL BUILDING COSDE”.
APPROVED:

LEON B. PALMIANO IV
Building Official

_______________________________
DATE

To be accomplished in five copies , one each for ; applicant (original) , Assessor, National Statistic Office, Building Office , Building Official , Fire Department.

This form is downloaded from www.naga.gov.ph

BOX 3A ( TO BE ACCOMPLISHED BY DESIGNING ARCHETIC/CIVIL ENGINEER IN PRINT)
TOTAL ESTIMATE COST COST OF NUMBER OF__________________________
EQUIPMENT
BUILDING P_____________________ INSTALLED TOTAL FLOOR ARE___________________

ELECTRICAL P_____________________ P_____________________ PROPOSED DATE

OF CONSTRUCTION___________________
MECHANICAL P_____________________ P_____________________

PLUMBING P______________________ P_____________________ EXPECTED DATE

OF COMPLITION______________________
OTHER COST P______________________
MATERIAL COST CONST_______________
TOTAL COST P_______________________ (WOOD, CONC, STEEL, MIXED)

BOX 4 ( TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)

ASSESSED FEES
AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

LAND USE/ZOONING

LINE AND GRADE

BUILDING
ELECTRICAL
MECHANICAL
REVIEWED BY:
OTHERS CHIEF, PROCESSING DIVISION/SECTION
TOTAL
BOX 5 ( TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED
PROGRESS FLOW
NOTED: IN OUT ACTION/ PROCESSED
CHIEF, PROCESSING DIVISION/SECTION TIME DATE TIME DATE REMARK BY
RECEIVING and RECORDING
LAND USE ANS ZONING
GEODITIC ( LINE and GRADE)
ARCHETICTURAL
STRUCTURAL
SANITARY/PLUMBING
ELECTRICAL
MECHANICAL

WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH.

BOX 6
ARCHETIC/CIVIL ENGINEER PRC REG. NO. SIGNATURE
SIGNED AND SEALED PLANS/SPECIFICATION
PRINT NAME

ADDRESS APPLICANT

PTR NO. COMMUNITY TAX CERT. DATE ISUED PLACED ISSUED

SIGNATURE

WITH MY CONSEBT:
BOX 7 BOX 9 ( TO BE ACCOMPLISHED BY LOT OWNER)
ARCHETIC/CIVIL ENGINEER PTR REG. NO. TCT/OCT NO.
IN-CHARGE OF CONSTRUCTION
PRINT NAME PRINT NAME OF LOT OWNER

ADDRESS ADDRESS

PTR NO. DATE ISSUED PLACED ISSUED COMMUNITY TAX CERT.

SIGNATURE TIN SIGNATURE

This form is downloaded from www.naga.gov.ph