OFFICE OF THE B U I L D I N G OFFICIAL

CITY OF TACLOBAN

EVALUATION S H E E T

OWNER APPLICANT: CONTACT NO. -------

---------------
__________________ DATE RECEIVED: _

SUBMITTED LACKING REMARKS:

BRGY. CLEARANCE FOR BLDG. PERMIT-------------------------0----- 0------­

i:r"'" BRGY. DRAINAGE CERTIFICATE-------------------------------0----- 0 ------­

� LOCATIONAL CLEARANCE FROM CITY P LA N N I N G ------------0----- 0------­

� LATEST TAX DECLARATION-----------------------------------0------D------­

� LATEST TAX CLEARANCE---------------------------------------0-------0 -------

� TITLE OF PROPERTY (Cert. True Copy by Reg. of Deeds)------Q-------0 _

ef'.: SKETCH PLAN OF LOT DULY CERT. BY GEODETIC ENGR.-------0------0

� APPROVED SUBDIVIS I O N PLAN FROM D.E.N. R ---------------0--------0-------

� PHOTOCOPY OF PRC LICENCE & P TR OF S IGNING PR OF.---0-------0 _

ARCHITECT IW/ IAPOAI/C E./P.E.E/M.P. OR S.E./MECH /P.E C.E) . .

C OMPLETE BLDG. PLAN 6 SETS 8 SETS F OR LOAN A-3 BLUE P RINT

A RCHITECTUR NS signed & sealed by ARCHITECT W/ IAPOA ID-D---{J

� STRUCTURAL PLAN S signed & seale y CIVIL STRUCTURAL E --------

fa"' STRUCTURAL DESIGN ANALYSI (F OR 2- STOREY & AB OVE)-- ---O -------

/(Signed and sealed by CIVIL/ STRUCTU L ENGR.)-ATTACH SOIL BO FOR 3 STOREY AND ABOVE BUILDING

z ,/'P LUMBING & SA NITARY PLANS.,,-- ARYfNGR./MAST!R PLUMBER--0 ------o _

.ef E LECTRICAL PLANS signed & sealed by PROF. ELEC. ENGR.---Q--0 -------­

Attached Electrical Design Analysis for Commercial Building

ME C HANICAL PLANS for Commercial Bldg.--------------0------0 -------­

V/ Si gned & sealed by PROF. MECHANI CAL ENGR .

/tJ E LECTRONIC PLANS for CCTV & Fire Detection & Alarm System-0---0 -------­

signed &sealed by E el ctronics Comm. Engr. (For Commercial Bldg.)

DULY A CCOMPLISHED BLDG. PERMIT APPLICATION FORMS WITH RESPECTIVE A NCILLARY PERMITS

/UNIFIED APPLICATION FOR BLDG. PER MIT/NOTARIZED (7 copies)--0------0 -------­

� ELE CTRICAL PERMIT (5 copies)---------------------0------ 0 ------­

�LUMBING/SANITARY PERMIT (5 copies)--------------0------0 ------­

..ef" _..M E CH A NICAL PE RMIT (5 copies)------------------------0-------- 0 -------

12-' ELECTRONIC P E RMIT (5 copies)-----------------------------0------ 0 -------

ft MATERIAL SPECIFICATIONS--------------------------------0----- 0 ------­

by ARCHITE CT(sl1ned &s eoled)& WNER(s/gned)(3 COPIES)

O

ef BILL O F MATERIAL, SCOPE OF WORKS & C OST ESTIMATE----0------0

_/ b y ARCHITECT/ I
C VIL ENGR.(slgned &s ealed)& O WNER(slgned)(4 COPIES)
--------

_.,r'.T C ONSTR UCTION LOG BOOK 2 pcs)-----------------------0------ 0 -------

(

O LONG FOLDER with F astener 2 pcs)------------------------0------ 0 --------

(

O LONG E XPANDING ENVELOPE-------------------------0----- 0

-------
O PRESCRIBED TARPAULIN CONSTRUCTION PROJECT SIGNAGE--0---0 --------

CHECKED BY; NOTES :

SECURE CNC FOR PRO POSED COMMERCIAL BUILDINGS

AN D 2-STOREY & ABOVE RESIDENTIAL BUILDINGS W/ ROOF DECK

RECEIVI NG CL ERK PLS I

V SI T: emb.fov.ph FOR APPLICAT ION P ROCEDURES.
,.
Mtf!JUUU.._ uo II oa , ,._....,.... ·--

CtlyfMUnic/pahly or _

Province of _

UNIFIED APPLICATION FORM FOR BUILDING PERMIT

II •
.
D

D
Slld'IE

tlEVI ORBIEW.ll.
D
D

D
COIREX'

At.EtlOATOOY

Fl<E SAFETY EV.ll.UATION CLEARANCE

THIS N'PllES ALSO FOR D LOCATKltW.. a..EARAtlCE

AREA NO
APPUCA TION NO

I I I I I I I I I I I
I I I I I I I I I I I

BOX 1 0 BE ACCOIIPUSHED m PRlfT BY THE AWi.iC

FRSTHAME Tiii
"' T ,U.W O'SA USE Oil.Y)
00 IIO

FORM Of OWIIERSHIP

CITY 11.lJtOCPAllTY ZIPCOOE COHT,iCTf/0

ADDRESS NO, STREET, BARANGAV,

LOCATION Of CONSTRUCTION. LOT NO __ Ill.I( NO __ TCT NO CURRENT TAX DEC NO ------

STRfET BARAN�Y CITY/WUCPAUTYOf

SCOPE Of WORK
D NEW CONSTRUCTION D RENOVATION ----- D RAISING___________ 1'"':-:-,,1:;,it::-!""1

O ERECTION 0 CONVE.RSJON O ACCESSORYBUllDING'STRUCTURE btfl!l'-.,./r�

D ADOmON o REPAR O LEGAUZATIOtlOFEXISTll!GBULDt�----

O ALTERATION O MOWIG O OTHERS (Sp,o)y)

USE OR CHARACTER OF OCCUPANCY

O GROUP H: ASSEMBLY (OCCVPANT
D GROOP A : RESDENTlAL. (DKEWNGSJ D GROUP E : COUlfERClAL LOAD LESS THAN l,000}
D SiNQ.£ 0 Oll'l£.l 01lfSl>EJITW.R-1 R2 O sw: 0 STOilf D SHJPA'I'., O llEATER. AJ.DTcmJl,I CONE:tll(),I IWJ.
O ORlf«INGIOI� CENTER/ WALL GIW.OSJJ.t081.£1,Ct-£A
DD """"'
GROUP B '
:Rf
�Sll)f
= �
.=TIAl.
- -----
ESTABUSt..iOO
D OTfl:RS _

O HOTU
OORVl10RY
O MOTEL B 'OW>f<JUS'
8CWU'GtOUSE,
D ��· DRES&Sl«:lP T
,.,,.,,_,,, .. ,
M..ORJ,IG,
O GROUP I: ASSEMBLY (OCCUPANT
D OMRS _

§ RESIOE),'JW.R-3,R-4 R5

OIHERS
LOOGNGHOOSE

D GROUP F: LJGHTINOOSTRJAL
LOAc8JSE�.°D&�ftl..PLEX.
O �'ffi�CE.'llE.RAl()SI�
O GROUP C_
E
_
:
D<JC
_ _
A
no_N
AL
_ _
&
RE__
C
REA
_ TIO
_ NAL
_
O FACTOR'l'/P\N,,'T(llSINGtCOit9USTEW STRl.CTURE
SCl<lOt.BIAOHG D SQt:XJ."1.0IT�UI,(
Q OTHERS _
tOl-cXf'I.OSNE MA.TERIAl.S
CM: CENTER GYIL'W;I\J!A
O OTH�------­ D GROUP J : (J-f} AGRJCUL TIIRAL
cu.&OJSE O Ol.RCH, MOSQUE,

OTHERS TEMPI.£, Ctw'El.

O GROUP G; MEDIUM INDUSTRIAL Q SAAN,CiAAUAAl,POlA,lAYHOIJSE.

� PIGClEAY GIWtl ltlL OAAlH S.lO

O STaw.E/W,l,Fi;EMCl.lSE!FCfl�
D GROUP D: liSTTWT10NAL tOt.'t' R.>JAlA8LE IMTffiW.S D OTI<ERS--,---,-,===
D �ALOA.St�l.AA$mt.Cn.J!E O FN:.Tor:tr (FOR Ko\ZARDWSl'tlGtt.1
O GROUP J: (J.2} ACC,ESSORIES

O H:lt,IE FOR 1l£ AGED F1..AWA.IU MATERIALS O PRIVATE CAAPORl IC'.AAACE, TONER,
SWIMMING POCl. FHICEC>IER 1 l!D!I
O GO.'EINIOOOFR:E
D •--------- SlEEl ICOl(:RETE TAI«
Do""" D OltERS

OCCU'ANCY Cl.ASSIFlED, _ TOTALES�TEOOOOT P _

BUWNO COSTOFEQUIPMENTINSTALLEO
'°""'"'um'�--------
tu.18£RCFSTOREY _
ElfC11!,l�CAL;.::=======
MECtw« P
P _
_
TOTAL Floa!.AREA SO. U

aECTROfllCS P _
LOT A.lEA SQ M

'--------
"""'"' EXPECTE.D QATE OF cot.lPl.fl'ION·

,ox,
Flll-TIIIE INSPECTOR ANO SUPERVISOR OF CONSTRUCTION IM>RKS RESOITING TliE OYINERl

.......

PRCtlo Va5cli!v

ARCHITECT OR CML ENGINEER

PTRtlo
(Bipd Sid 5-.:10,. PnrDcl .....,
,... ....... , °'""""'
r..

BOX4

"'"
APPUCAHT: WITH MY CONSENT· LOT OWMERJ AUTHORIZED REPRESENTATIVE

fS9,lln � Prinlld Nsnl)

°'" (&gnlu• O..r P!lldld ,_,.,
°'"
......
-
Got'\ llaled ID No

BOXl
1 0o 1o "'""' 1--
Go¥'1 l-..d {) No
l0o•-

1--

REPUBLIC Of Tl-£ PHllPPUES

aTY�ICf>H.JTY Of J
SS

BEFCAE IE.alt. Cltyl\t.nldpaty al ,., ..

- Pl&, ....

.......
--
LICENSED ARCtfTECT OR CML EtKJt.EER
(F..t l... .,_._.11111....,_�CcnllO'wlJf'.fflj

wt10II ....... appNI' hlnlrleba¥9, � ta m1 b be h lllTllt pnn 'MIO� NI fllndlrd pl'l9Cllled form atw:11� b m1 .., N _....•Ni .... and
\W!Wf .. ard dNd

MTIESS II( HANO ANO S€AL on ... dire rd placlt mow 'Mltlln

...... _
""'""---
....
_ ,.___

_ NOTAAYNILIC!IJIIIIO.-W )

Copy l. 000 Copy J. BFP

·1-- .... � ,_ ....,........

 BOX O (TO BE ACCOMPUSHED BY THE PROCESSING AND EVALUATION IJMSIONJ

BASIS OF AMOUNT
ASSESSED FEES ACCOUNT ASSESSED BY
ASSESSMENT DUE

FOR ZONING (ZONING

ADMINISTRATOR):

" LOCATIONAL I ZONING OF LAND

FOR BUILDING I STRUCTURE (OBO):

u FILIN

0 GFEE

0 LINE AND GRADE (Geodetic)

FENCING

D ARCHITECTURAL

0 CIVIL I STRUCTURAL

D ELECTRICAL

u MECHANICAL

- SANITARY

D PLUMBING

D ELECTRONICS

c INTERIOR

0 SURCHARGES

c PENALTIES

FOR FIRE SAFETY (BFP):

c; FIRE CODE CONSTRUCTION TAX

Ci HOTWORKS

TOTAL

TERMS AND CONDITIONS:

1 The O.Vner/Applicant shall accomplish the prescribed Application Form, with the assistance of the concerned design

professional/sand/or the ArchitecUCivil Engineer, hired/commissioned by himlher as full-time inspector/supervisor of the

construction works, by filling up the necessary data I information required thereat.

2. The fully acoomplished prescribed Application Form, duly notarized, shall be submitted to the ooncemed Office of the

Building Official, accompanied by the various applicable ancillary and accessory permits, plans and specifications signed

and sealed by the oorresponding design professionals who shall be responsible for the comprehensive and oorrectness

of the plans In oompliance to the National Building Code of the Philippines (PD 1096), its Revised IRR and all applicable

referral oodes and professional regulatory laws, together with the other documentary requirements pursuant to Section

302 of PD 1096 and its Revised IRR

I have read this form, understood its oontents and consent lo the processing of my personal data. I understand that my oonsent

does not preclude the existence of other cnteria for lawful processing of personal data, and does nol waive any of my rights under

the Data Privacy Act of 2012 and other applicable laws.

SIGNATURE O\IER PRINTED NAME OF OWNER/APPLICANT

••

tl BCF ORMNO A - OJ

Republic of the Philippines

C1ty/Mun1cipallty of Tacloban

Province of Leyte

OFFICE OF THE B U I L D I N G OFFICIAL

ELECTRICAL P E R M I T

APPUCA TION NO. EPNO BUJLDING PERMIT NO

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

BOX 1 (TO BE ACCOMPLISHED IN PRINT BV THE OWNER/APPLICAND

OWNER/APPLICANT LASTNME FIRST l�IIE Ml

I TIN

L/
FOR CONSTRUCTION OWNED I FORM OF OWNERSHIP I USE OR CHARACTER OF OCCUPANCY

_ /BY A.N ENTERPRISE

ADMESS NO. STREET, BAAA.NGAY. CITYIMJNICIPAUTY ZIP CODE I TELEPHONE uo

/

LOCATION OF CONSTRUCTION: LOT NO. 8LKf10 TCTNO TAX DEC.NO.

ymm BARANGAY CITY/ MUNIC!PAUTY Of

SCOPE OF WORK

D NEW INSTALLATION O RECONNECTION OF SERVICE ENTRANCE O RELOCATIOU OF SERVICE ENTRANCE

D ANNUAL INSPECTION D SEPARATION OF SERVICE EfiTAANCE D OTHERS (S-)

D TEWORARY O UPGRADING OF SERVICE B4TRAl!CE

SUMMARY OF ELECTRICAL LOADS/CAPACITIES APPLIED FOR

TOTAL CONNECTED LOAD TOTAL TRANSFORIJI=� CAPACITY TOTAL GENERATOFIJUPS CAPACITY

kVA WA kVA

BOX 2 {TO BE ACCOMPLISHED IN PRINT av THE DESIGN PROFESSIONAL)

DESIGN PROFESSIONAL., PLANS AND SPECIFICATIONS

,......
,PRC No
,/ a.•
>''"""'
PROFESSIONAL El..ECTRJCAL ENGINEER yrn.No
po•"'""'
(Signed and Sealed Over Printed Name)
;m
JP"'"

BOX3

SUPERVISOR I IN-CHARGE OF ElfCTRJCAL WORKS

O PROFESSIONAL ELECTRICAL ENGINEER O REGISTERED ELECTRICAL ENGINEER D REGISTERED MASTER ELECTRICIAN

,L. De!e
(Signed end Saaliid ON Pmted Nsme)

,vtlifity
"RC tff>

_,.
l"TR No
�-·-
AIN

..,,.,,.-
BOX� BOXS

BUn..DINO OWNER
WITH MY CO"SENT: LOT OWNER

,/ Do•
(Spire OVer Pri1led tleme) (Slgreu9 Over 15rinted rwno)
°""
, _

C T C No
I Datl laued I Ptaol J
auod
·-
C T C No
I Oele lNued I Pll,oo IAUed

l/
 '

TO BE ACCOMPLISHEO BY THE PROCESSING & EVALUATION DIVISION

BOX6

RECENEOBY I DATE

FIVE (5) SETS OF ELECTRICAL DOCUMENTS

O ELECTRICAL Pl.ANS ANO SPECIFICATIONS O EXPECTED DI.TE OF COl&'l.ETIONIIUSTAU..ATIONK:OtlSTRUCTION

D SPECIAL. AXTUREs AND EOOIP�t:trr

O FROPOSED STARTING DATE Of INSTALLATIOKC0'4STRUCT10ll

D OTHERSISpoofyJ _

BOX7

PROGRESS FLOW

I
N OUT �OCESSEDBY

DATE TIMS DATE TIMS

ENGR. ROY V. ENDRIANO

ELECTRICAL
ELECTRICAL ENGINEER

OTHERSISpecilyJ (Siglalln Om Pmted n.:roo)

PRC Reg No

V""'1y"

BOX8

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed electrical wol1<.s shall be In accordance with the electrical plans filed with this Offce and In conlormlly with

the provisions of the latest Philippine Electrical Codes, !he National Building Code and ils IRR.

2. That pnor to any elecirical Installation. the o..ner/Permittee shall submit a duly accomplished prescribed Notice of

Construction to the Office of the Building Official.

3. That for installed eleclrical capacity of 200 amperes and above at 230 volls nominal and above, a specialty electr�al conlractor

duly licensed by the Philippine Contractois Accredilatlon Boaro (PCAB) shall be required.

4. Thal a duly licensed elecincal practitioner shall be in-<:harge of the installation, and ihat upon completion of lhe eleclrical works,

he shall submit the enll)' of the logbook duly signed and sealed to the OBO including_ as-built plans and other documents. He

shall also accomplish the Cellificate of Complelion slating that the electrical wol1<.s conform to the provisions of the Philippine

Electiical Codes, the National Building Code and ils IRR.

5. That this permit is null and void unless accompanied by the building permit except for projects involving purely electrical wol1<.s

in which case only the building permit number of the exisUng building/structure shall be required.

6 That a Certificate of Final Electrical Inspection [CFEI) shall be secured prior to the actual occupancy of the building.

7. That this permit shall be posted at the door or site of wol1<..

PERMIT ISSUED BY:

DIONISIO 0. DE PAZ

BUILDING OFFICIAL
t�1ure Ot'ef Prinl&d r�11mtJ

"""-------
•

NBC FORM NO A -06

Republic or the Ptulrppmes

C1ty/Municipahty of Tacloban

Province or Leyte

OFFICE OF THE BUILDING OFFICIAL

PLUMBING PERMIT
BUILOlt-.G PERMIT NO
APPLICATION NO. PPNO

I i i i i i I i i
I I I I I i I I I
I I I i i I I I I I I

BOX 1 CTO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)

LAST NAME FIRST tlAt.E Ml I TIN

OWNER/APPUCANT

l USE OR CHARACTER �F OCCUPANCY

FOR CONSTRUCTION OWNED I FORM OF OWllERSHIP

'"
CITY/t.t.lNICIPAUTY ZIP CODE I TELEPHONE 110
ADORESS NO, STREET, BARANGAY.

TCTNO TAX.DEC NO
LOCATION OF CONSTRUCTION LOT NO BLK NO

CITY/ MUNICIPALITY OF
_;mm BARANGAY

SCOPE OF WORK

D D RAISING
D NEW CONSTRUCTION RENOVATION

D DEMOLITION

D ERECTION O COtNERSION

D ACCESSORY BUILOlt�GISTRUCTOOE
D ADDITION D REPAIR

D OTHERS (Specify)
/ D ALTERATION D MOVll�G

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

FIXTURES TO BE INSTALLED
EXISTING KIND OF
llEW EXISTING Klt/0 OF QTY NEW
QTY

FIXTURES FIXTURES FIXTURES

FIXTURES FIXTURES FIXTURES

D 0 0 0 ecerte
0 0 'IIATER CUXlCT

0 D LAL'NORYlRAYS
0 0 D ftOORORAJN 0
0 D OEWIAL a.JSPIDOA
0 0 D lAYAroRY 0
O Ofm«IOOFO.Jtlt..UI
0 0 O IOTOIENSltl!. 0 0
0 O BAASlt«
0 0 0
0 0
0 "'""' 500,,\FOLMANSt«
0 0 ••,.......... 0 0
O lAIIORAmRYSIN!(
0 0 O WATEAl.l(TER 0 0
O GREASE TR.AP 0 0 O sm•u""
0 0
D e.o.n,rua O OTI,£RS�)
0 0 0 0
0 0 D SLOPs-i« 0 0
0 0 0 0
0 "'""
0 0 O AIRCOIOTIONNGUM( 0 0
0 0 O WATER IMIYMSOIVOOl 0 0

TOTAL TOTAL

D WATER OISTRIBUTIOtl SYSTEM D SEWAGE SYSTEM D SEPTIC TAtlK

D STORM DRAINAGE SYSTEM

PREPARED BY.

BOX3 BOX4

DESIGN PROFESSIONAL, PLANS ANO SPECIFICATIONS SUPERVISOR/ IN-CHARGE OF PLUIIB�G WORKS

1./ Do• ,/
MASTER PLUMBER MASTER PLUMBER
°'"
...
l&v'*I rd Sealed Ovw Pmtod ti.no) and Sealed Ovar Priltfld N11m9I

,.._
--
J'RC No
"""'"'
nc tlo
,,...,,
)'TR No
=•,
....... """""""
. J-*' "

BOX5
"""'-
,TIN

BOX6
,
,TIN

BUI.DINO OWNER WITH >Kt CONSENT LOT OWNER

,/
(Slpttn 0,.- Pmlad Namll) (Slgreuo Ovw PrlMed Name)

°'" ...,_ °'"

�
ere No CTC CI
t
/Plloll...:1 I Pllcl 1-.ied
1--
I °"' "'""'
I./

�TE. THII PERMIT MA� 8E CNCEUEDOfl M\'OlCO P\.RIUAN1 TO BECTIOl',S 306 00 JOI OF nt: •NAnotw. 8UIL.DINO COOF
 '

TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION

BOX7

REC8VEDBY
I DATE

FIVE (5) SETS OF PLUMBING DOCUMENTS

O PLUMBING l'tANS AND SPECIFICATIONS O COSTESTIMA TES

O BILL OF MATERIALS O OTHERS(si-1) _

BOX8

PROGRESS FLOW

IN OUT
PROCESSED BY

DATE TIME DATE TI�E

RECEMNG AND RECORDING

PLUMBING
ENGR. JIMMY T. BARROT

OTHERS (Specfy)

BOX9

ACTION TAKEN:

PERMIT JS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed plumbing works shall be in accordance with the plumbing plans filed

with this Office and in conformity with the Revised Plumbing Code of the Philippines, the

National Building Code and its IRR.

2. That prior to any commencement of plumbing works, a duly accomplished prescribed

"Notice of Construction" shall be submitted to the Office of the Building Official.

3. That upon completion of the plumbing works, the licensed supervisorfln-charge shall

submit the entry to the logbook duly signed and sealed to the building official including as­

built plans and other documents and shall also accomplish the Certificate of Completion

stating lhat the plumbing works of the building conform to the provision of the Revised

Plumbing Code, the National Building Code and its I R R .

4. That this permit is null and void unless accompanied by the building permit.

PERMIT ISSUED BY:

DIONISIO 0. DE PAZ
BUJLOJNG OFFICIAL

(Signature Over Prlnlod Name)

o,., _
 l\rpnl,ilc ,r lbt .P1Jll!pp1atf

·1 ac:lt1han <..11,

1100-

City P l n n n i n ll a n d Development Office

Applrcallon No.

Date of Receipt

OR No

Date tssued

Amount

APPLICATION FOR LOCATIONAL CLEARANCE/CERTIFICATE OF ZONING COMPLIANCE

1 NAME OF APPLICANT(Last First, Middle) 2 NAME OF CORPORATION

3. ADDRESS OF APPLICANT 4 ADDRESS OF CORPORATION

5 NAME OF AUTHORIZED REPRESENTATIVE 6. ADDRESS OF AUTHORIZED REPRESENTATIVE

7. PROJECT TYPE 8 PROJECT NATURE: D Olhersl

[:J Nev, Development specify

r===i Improvement

9. PROJECT LOCATION(Number, Street,Brgy.,City) 10. PROJECT AREA(in square meters)

Lot Area Total Floor Area

Floor Area Ground Floor__

'

1 1 . RIGHT OVER LAND L_J Others(specify) 12. PROJECT NATURE

Owner I I
Permanent

H Lessee Temoorarvisoecitv vears)

13. EXISTING LAND USES OF PROJECT SITE

D Res!dential Industrial Vacant lands

D D
Institutional
D Others(specify) D A�rai(specify crops)
r,
l f=l Commercial Tenanted Not Tenanted

14. PROJECT COST/CAPITAUZATION(in pesos, write in words and figures)

15. IS THE PROJECT APPLIED FOR SUBJECT OF WRITTEN NOTICE(S) FROM THE CITY OR HLURB

PRESENTATION OF LOCATIONAL CLEARANCE/CERTIFICATE OF ZONING COMPLIANCE(LCIZC) OR

TO APPLY FOR LC/ZC?

D YES
D NO

If yes. please answer the following.

15.a) Name of Officer: 15.b) Date(s) of Notice(s)

15.c\ Order(s\/renuest indicated in the Notice(s):

16 IS THE PROJECT APPLIED FOR THE SUBJECT OF SIMILAR APPLICATIONS WITH OTHER OFFICES

SUCH AS THE CITY ENGINEER'S OFFICE OR THE HOUSING & LAND USE REGULATORY BOARD?

D YES
D NO

If yes, please answer the following:

16 a) Other Office(s) where similar application was/\vere filed:

16.b) Date(s) filed·

16.c\ Actionlsl taken bv Officers) mentioned In 16.a:

17. PREFERRED MODE OF RELEASE OF DECISION:

Pick-up
D By mail, addressed to:
H aoolicaru I I Authorized Representative

18. SIGNATURE OF APPLICANT. 19. SIGNATURE OF AUTHORIZED REPRESENTATIVE:

Ropubhc of the Phll1pp1nes

�------··
SUBSCRIBED AND SWORN TO before me this dey or 201

in the City of Tacloban, Province of leyte affiant exhibiting to me his/her Community Tax Certificate No.

_____ rssued at on 201 __ ,

Doc. No

Book No.
NOTARY PUBLIC

Page No

Serles of
 '
iltJ1t1bl1c ol l!Jr .i)bil1ppinn

IM-lobm, Lii�

�o�

City P l a n n l n e a n d Development Office

APPLICATION REQUIREMENTS FOR LOCATIONAL CLEARANCE CERTIFICATE

OF ZONING COMPLIANCE

One Copy per document:

____ 1. Duly accomplished and notarized APPLICATION FORM

____ 2. Certified true copy of CERTIFICATE OF TITLE (Blue copy from Register of Deeds)

____ 3. Certified true copy of TAX DECLARATION from the C,ty Assessor's Office

____ 4 Tax Clearance {current year) from the City Treasurer's Office

____ 5. Barangay Cleaarance giving consent to the ccnstrucucn of the bu11d1ng

____ 6: Project Cost (including Bill or Matenals and Machinenes/Cap1taltzation)

____ 7. Sketch or Subdivision Plan in case the property is subdivided

____ 8. 1st page of plan (Site Development and Vicinity Map) & Floor Plan

____ 9. Long file folder with fastener

____ 10. Long brown envelope

Addltlonal Requirements (as may be appllcablo):

____ 1 1 . Plumbing and drainage plan for 2 or more storey building.

____ 12. Certificate of Non-Coverage (CNC) from EMB-DENR if building is 2-Storey with roofdeck

or with 3 or more storeys.

____ 13. Certificate of Non-coverage (CNC) from EMB·DENR for commercial buildings

____ 14 . Environmental Compliance Certifiec: le (ECC) for projects such as gasoline stations,

warehouses, holels, etc.

____ 15. In case the property is not regislered in the name of the applicant, submit duly

notarized Deed of Sale or Deed of Donation or Contract of Lease or Authorization

allowing the use of the property whichever is applicable.

____ 16 . Special Power of Attorney (SPA) for non-owner or representative.

____ 17. _

Checked by·

Date:
,,

NBCFORMNO A.-07

Republic of the Phthppmes

City/Mun,c,palily of TACLOBAN

Province or LEYTE

OFFICE OF THE B U I L D I N G OFFICIAL •

•
.

ELECTRONICS P E R M I T

APPLICATION NO ELPNO BUILD1NG PERMIT NO

I 1 1 I 1 1 1 I 1 1 1 I I I I I I I 1 1 1 1 I I I I I I I

BOX 1 ITO BE ACCOMPLISHED PRINT BY THE OWNERIAPPUCANTI

OWNERIAPPUCAm LAST NA.IE FlRSTIWJE Ml

ITIN

l/

FOR CONSTRUCTION OWNED I FORM OF OWNERSHIP I USE OR CHARACTER OF OCCUPANCY

"""VAN ENTERPRISE

AOOR.ESS NO, STREET, BARANGAY, CITY/MUNICIPALITY ZJPCOOE I TEl£PHONE UC

LOCATION OF CONSTRUCTION LOT NO BU< N O TCTNO TAXOEC NO

•TREET BAAANGAY CITY/ MUNICIPALITY OF

SCOPE OF WORK

I / 0 NEW INSTAU.ATION D ANNUAL INSPECTION O OTHERS (Sj>,ofy)

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

NATURE OF INSTALLATION WORKS/EQUIPMENT SYSTEM:

D TELECOMMUNICATION SYSTEM O ELECTRONICS FIRE ALARM SYSTEM O ELECTRONICS COWUTERIZEO PROCESS

COIITROLS AUTOWfflON SYSTEM

D BROADCASTING SYSTEM O SOUND COMMUNICATION SYSTEM

O BUILOINGAUT01'\I.TION MAt�AGEMEUT ANO

CONTROL SYSTEM
O TELEVISION SYSTEM O CENTRALIZED CLOCK SYSTEM
O BUILDING WIRING UTILIZING COPPER CABLE,

O INFORMATION TECHNOLOGY SYSTEM O SOUND SYSTEM FIBER OPTIC CABlE OR OTHER '-£DIAL

ELECTRONICS SYSTEM

D SECURITY AND Al.ARM SYSTEM 0 8.ECTRONICS CONTROL AND CONVEYOR SYSTEM

O A'tfY OTHER ELECTRONICS AND IT. SYSTEMS, EOU!Pt.ENT, APPARATUS, DEVICf AND.OR COWONENT (Specify) _

PREPAREDBY _

BOX3 BOX4

DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR I IN-CHARGE OF ELECTRONICS WORKS

v t-
PROFESSIONAL B.ECTRDNICS ENGINEER "'" PROFESSK>NAL ELECTRONICS ENGINEER
"'"'
(Stgned end Sel!llod CNer Pmled Name) fS....-t and Sealed OY« Prinled Name)

I
·-
JRC No )I- """""'
)'RC I«> ,'ololcify

I }'TR No .Ila«>- )'TR No ...Dela l!IU!ld

.>lN """",, .illN

""""''
BOXS BOXI

BUllDING OWNER WITH Mt CONSENT LOT OWNER

t-
(Sipln O..er Prwilad 1ene1 (slpiiie <fur Pmll!ld Ihm,)

""' "'"
Addct•
�
CTC No
I 0.. ISlt.ed lf>kalaed CTC No
I Diil lllUlld I Pllol lNUld

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TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION

BOX7

R£CE1\IEO BY
I DATE

FIVE (SJ SETS OF ELECTRONICS DOCUMENTS

O ELECTRONICS Pl.ANS ANO SPECIFlCATIONS O COST ESTIMATES

O BILL OF MATERIALS O OTHERS(Speofy) _

BOX 8

PROGRESS FLOW

IN OUT

PROCESSED ev·
DATE Tio.£ OATE TIO,£

ELECTRONICS

OTHERS(Soedvl ENGR. ADONIS 0. ACUIN

BOX9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed electronics wor1<s shall be in accordance with the electronics plans filed with this Office and in

conformity with the latest Electronics Code of the Philippines, the National Building Code and its IRR.

2. That prior to any electronics Installation, a duly accomplished prescribed "Notice of Construction" shall be submitted

to the Office of the Building Official.

3. That upon completion of the electronic works, the licensed supervisornn-charge shall submit the entry to the logbook

duly signed and sealed to the building official including as-built plans and other documents and shall also accomplish the

Certrricate of Completion stating that the electronic wor1<s conform to the provision of the Electronics Code of the

Philippines, the National Building Code and its IRR.

4. That this permit is null and void unless accompanied by the building permit

PERMIT ISSUED BY:

DIONISIO 0. DE PAZ
BUILDING OFFICIAL
(Signature Over Printed Name)
Date _