NBC Form No.

B-11
Republic of the Philippines
City of Baguio
Province of Benguet

OFFICE OF THE BUILDING OFFICIAL

APPLICATION FOR CERTIFICATE OF OCCUPANCY

FULL PARTIAL

Building Permit No. : _______________________

Date Issued : _______________________
_________________________________
(Date)

Name of Owner/Applicant: ___________________________________________________________________________

(Last Name) (Given Name) (Middle Initial)
Address of Owner/Applicant: __________________________________________________ ZIP Code: 2600
__________________________________________________________________________ Tel. No.: ________________

Requirements Submitted:
Approved Building Permits and Plans Issued Fire Safety Evaluation Clearance (FSEC)
Daily Construction Works Logbook Other documents deemed necessary: (Specify)
Photos of Site/Project showing substantial completion _______________________________________
Certificate of Completion, duly notarized _______________________________________
As-Built Plans and Specifications, duly signed and _______________________________________
Sealed by respective professional discipline _______________________________________
(if changes were made from the approved building plans)

Name of Project: ____________________________________________________________________________________

BAGUIO CITY
Location: __________________________________________________________________________________________
(Lot No.) (Blk. No.) (Street) (Barangay) (City/Municipality)

Use/Character of Occupancy: ___________________________________

No. of Storeys: ________________________________________________
No. of Units: ________________________________________________
Total Floor Area (Square meter):___________________________________
Date of Completion: __________________________________________

Submitted by:
__________________________
OWNER/APPLICANT
(Signature over Printed Name)
Community Tax Certificate: ________________
Date Issued: ____________________________
Place Issued: ____________________________

Attested by:
FULL-TIME SUSPERVISOR OR INSPECTOR OF CONSTRUCTION

_____________________________________________
ARCHITECT OR CIVIL ENGINEER
(Signed and Sealed over Printed Name)
Date: ___________________________

PRC. No. Validity

PTR No. Date Issued
Issued at TIN
CTC No. Date Issued Issued at