Form No. Eng.

01 REPUBLIC OF THE PHILIPPINES

DPWH FORM NO. 77-001-B PROVINCE OF BULACAN
MUNICIPALITY OF BALIWAG
OFFICE OF THE BUILDING OFFICIAL

BUILDING PERMIT APPENDIX B

☐ SIMPLE ☐ COMPLEX DO NOT FILL-UP (PSA USE ONLY)
☐ NEW ☐ RENEW ☐ AMENDATORY

APPLICATION NO. PERMIT NO.

_______________________ ________________________
DATE OF APPLICATION DATE ISSUED

BOX 1 (TO BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER IN PRINT)

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

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP MAIN ECONOMIC ACTIVITY/KIND OF BUSINESS

BY AN ENTERPRISE
ADDRESS: TELEPHONE NO.

LOCATION OF CONSTRUCTION:

SCOPE OF WORK 1. NEW CONSTRUCTION OTHERS (SPECIFY)

2. ADDITION OF _____________________________ 6. _______________ OF _______________
3. REPAIR OF _______________________________ 7. _______________ OF _______________
4. RENOVATION OF __________________________
NUMMBER OF UNIT ______________________
5. DEMOLITION OF ___________________________
USE OR TYPE OF OCCUPANCY INDUSTRIAL
RESIDENTIAL 31 FACTORY / PLANT
11 SINGLE 32 REPAIR SHOP, MACHINE SHOP
12 DUPLEX 33 REFINERY
13 ROW HOUSE / ACCESSORIA 34 PRINTING PRESS
10 OTHER (SPECIFY) _________________ 35 WAREHOUSE
30 OTHER (SPECIFY) _____________________
COMMERCIAL
21 BANK INSTITUTIONAL
22 STORE 41 SCHOOL
23 HOTEL / MOTEL, ETC. 42 CHURCH AND OTHER RELIGIOUS STRUCTURES
24 OFFICE CONDOMINIUM / BUSINESS OFFICE 43 HOSPITALS OR SIMILAR STRUCTURES
25 RESTAURANT, ETC. 44 WELFARE AND CHARITABLE STRUCTURES
26 SHOP (e.g., DRESS SHOP, TAILORING SHOP, BARBER SHOP, (ETC.) 45 THEATER, AUDITORIUM, GYMNASIUM, COURT
27 GASOLINE STATION 40 OTHER (SPECIFY) ____________________
28 MARKET
29 DORMITORY OR OTHER LODGING HOUSE AGRICULTURAL
20 OTHER (SPECIFY) ______________________ 61 BARN(S) PULTRY HOUSE(S), ETC.
62 GRAIN MILL
OTHER TYPE OF OCCUPANCY 60 OTHER (SPECIFY) ____________________
60 SPECIFY ________________________

STREET FURNITURE, LANDSCAPING & SIGNBOARDS

71 PARKS, PLAZAS, MONUMENTS, POOLS, PLANT BOXES, ETC.
72 SIDEWALKS, PROMENADES, TERRACES, LAMPOSTS, ELECTRIC POLES, TELEPHONE POLES, ETC.
73 OUTDOOR ADS, SIGNBOARDS, 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 & SPECIFICATIONS
ARCHITECTURAL PLANS & SPECIFICATIONS LOGBOOK (1 COPY)
STRUCTURAL DESIGN & COMPUTATIONS OTHERS (SPECIFY) __________________
SANITARY / PLUMBING PLANS & SPECIFICATIONS ____________________________________
ELECTRICAL PLANS AND SPECIFICATIONS ____________________________________
BOX 3 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN:
PERMIT IS HEREBY GRANTED SUBJECT TO THE FOLLOWING CONDITIONS:
1. THAT THE PROPOSED CONSTRUCTION / ADDITION / REPAIR / RENOVATION /
DEMOLITION / INSTALLATION
ETC. SHALL BE IN CONFORMITY WITH THE NATIONAL BUILDING CODE (P.D. 1096)
AND ITS CORRESPONDING IMPLEMENTING RULES AND REGULATIONS
2. THAT A DULY LICENSED ARCHITECT / CIVIL ENGINEER HAS BEEN ENGAGED TO
PREPARE PLANS AND SPECIFICATIONS AND UNDERTAKE THE SUPERVISION /
INSPECTION OF THE CONSTRUCTION OF THE PROJECT.
3. THAT A CERTIFICATE OF A COMPLETION DULY SIGNED AND SEALED BY THE
DESIGNING ARCHITECT / ENGINEER AND ARCHITECT / ENGINEER IN-CHARGE OF
CONSTRUCTION SHALL BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER
COMPLETION OF THE CONSTRUCTION OF THE PROJECT.
4. THAT A “CERTIFICATE OF OCCUPANCY” SHALL BE SECURED PRIOR TO ACTUAL __________________________________________________
OCCUPANCY OF THE BUILDING MUNICIPAL ENGINEER / BUILDING OFFICIAL

__________________________________________________
DATE

NOTE:
THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 & 306 OF THE “NATIONAL BUILDING CODE.”

To be accomplished in five copies one each for: Applicant Original, Assessor, Philippine Statistics Authority, Building Official and Fire Department.
BOX 3A (TO BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER IN PRINT)
TOTAL ESTIMATED COST COST OF NUMBER OF STOREY
EQUIPMENT
BUILDING P ___________________ TOTAL FLOOR AREA
INSTALLED
ELECTRICAL P ___________________ P ____________ PROPOSED DATE
OF CONSTRUCTION
P ____________
MECHANICAL P ___________________
P ____________ EXPECTED DATE OF
PLUMBING P ___________________ COMPLETION
MATERIAL OF CONST
OTHERS P ___________________
(WOOD, CONC., STEEL, MIXED)
TOTAL COST P ___________________

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

ASSESSED FEES

AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

LAND USE/ZONING

LINE and GRADE

BUILDING

PLUMBING

ELECTRICAL

MECHANICAL

OTHERS REVIEWED:

TOTAL CHIEF, PROCESSING DIVISION / SECTION

BOX 5 (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

PROGRESS FLOW

NOTED: IN OUT
ACTION / PROCESSED
CHIEF, PROCESSING DIVISION / SECTION
REMARKS BY
TIME DATE TIME DATE

RECEIVING and RECORDING

LAND USE AND ZONING

GEODETIC (LINE and GRADE)

ARCHITECTURAL

STRUCTURAL

SANITARY / PLUMBING

ELECTRICAL

WE HEREBY AFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH
BOX 6 BOX 8

ARCHITECT / CIVIL ENGINEER PRC REG. NO. SIGNATURE

SIGNED AND SEALED PLANS & SPECIFICATIONS

PRINT NAME

ADDRESS
APPLICANT

PTR NO. COMMUNITY TAX CERT. DATE ISSUED PLACE ISSUED

SIGNATURE

WITH MY CONSENT
BOX 7 BOX 9 (TO BE ACCOMPLISHED BY LOT OWNER)

ARCHITECT / CIVIL ENGINEER PRC REG. NO. TCT / OCT NO.

IN-CHARGE OF CONSTRUCTION
PRINT NAME PRINT NAME OF LOT OWNER

ADDRESS ADDRESS

PTR NO. DATE ISSUED PLACE ISSUED COMMUNITY TAX CERT.

SIGNATURE TIN SIGNATURE