NBC FORM NO.

B - 01
Republic of the Philippines
City/Municipality of Madridejos
Province of Cebu
OFFICE OF THE BUILDING OFFICIAL
APPLICATION
NEW
FOR
RENEWAL
BUILDING PERMIT
AMENDATORY
APPLICATION NO.
AREA NO

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

DO NOT FILL-UP (NSO USE ONLY)
OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

BY AN ENTERPRISE
LOCATION OF CONSTRUCTION: LOT NO. ______ BLK NO. ________ TCT NO. ______________ TAX DEC. NO. ____________________
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.
STREET_____________________ BARANGAY __________________________ CITY/ MUNICIPALITY OF_______________________________

SCOPE OF WORK
RENOVATION RAISING
NEW CONSTRUCTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ERECTION REPAIR OTHERS (Specify)
ADDITION MOVING
ALTERATION
GROUP F : INDUSTRIAL OTHERS (Specify) ________________
USE OR CHARACTER OF OCCUPANCY
GROUP G : INDUSTRIAL STORAGE AND HAZARDOUS
GROUP A : RESIDENTIAL, DWELLINGS
GROUP H : RECREATIONAL, ASSEMBLY OCCUPANT LOAD LESS THAN 1000
GROUP B : RESIDENTIAL HOTEL, APARTMENT
GROUP I : RECREATIONAL, ASSEMBLY OCCUPANT LOAD 1000 OR MORE
GROUP C : EDUCATIONAL, RECREATIONAL
GROUP J : AGRICULTURAL, ACCESSORY
GROUP D :CLASSIFIED
OCCUPANCY INSTITUTIONAL
_________________________________________ TOTAL ESTIMATED COST P __________________________________
NUMBER OF UNITS_______________________________________________
GROUP E : BUSINESS AND MERCANTILE PROPOSED DATE OF CONSTRUCTION _________________________
TOTAL FLOOR AREA ______________________________ SQUARE METERS
EXPECTED DATE OF COMPLETION____________________________
BOX 2 _______________________________________________
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE
OWNER)
Address: BANTIGUE, BANTYAYAN ,CEBU

JULIUS V. OFIANGA PRC No.: 30568 Validity: 10-11-22

PTR No.: 22564299
ARCHITECT OR CIVIL ENGINEER Date Issued:7-29-19
(Signed and Sealed Over Printed Name) Issued at: : BANTAYAN, CEBU
Date_____________________________ TIN: 314-985-087
BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER

Date______________ 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 ) S.S
CITY/MUNICIPALITY OF __________________________________________)
BEFORE ME, at the City/Municipality of _____________________________________________________ , on _________________________ personally appeared the
following:

______________________________________________________
APPLICANT _______________
C.T.C. No. ______________
Date Issued ___________________________________________
Place Issued

JULIUS V. OFIANGA 3028631 6-3-19 BANTAYAN, CEBU

______________________________________________________
LICENSED ARCHITECT OR CIVIL ENGINEER _______________
C.T.C. 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 form 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. ________ NOTARY PUBLIC (Until December _____________ )
Series of ________