Republic of the Philippines

Province of Quezon
City of Tayabas
—oOo—
OFFICE OF THE CITY ENGINEER/BUILDING OFFICIALS
AREA CODE 04028
DO NOT FILL-UP(FOR NSO ONLY)

APPLICATION NO. PERMIT NO.

BUILDING PERMIT
DATE OF APPLICATION DATE ISSUED
□ORIGINAL □RENEWAL
BOX 1 (TO BE ACCOMPLISHED BY DESIGNING ARCHITECH/CIVIL ENGINEER IN PRINTING)
OWNER LAST NAME FIRST NAME M.I. TAX ACCT. NO.

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

ADDRESS TEL. NO.

LOCATION OF CONSTRUCTION

SCOPE OF WORK:
1. NEW CONSTRUCTION _____________________
2. ADDITIONAL OF__________________________
3. REPAIR OF______________________________
4. RENOVATION OF_________________________
OTHERS (SPECIFY)
6. _______________OF_________________
7. _______________OF_________________

5. DEMOLITION OF__________________________ NUMBERS OF UNITS __________________

USE OR TYPE OCCUPANCY RESIDENTIAL

11. SINGLE INDUSTRIAL
12. DUPLEX 21. FACTORY,PLANT
13. ROWHOUSE/ACCESSORIA 22. REPAIR SHOP, MACHINE SHOP
10. OTHERS (SPECIFY) 23. REFINERY
24. PRINTING PRESS
COMMERCIAL 25. WAREHOUSE
11. BANK 26. OTHERS (SPECIFY)
12. STORE
13. HOTEL/MOTEL, ETC. INSTITUTIONAL
14. OFFICE CONDOMINIUM/BUSINESS OFFICE BUILDING 27. SCHOOL
15. RESTAURANT, ETC. 28. CHURCH & OTHERRELIGIOUS STRUCTURES
16. SHOP (e.g. DRESS SHOP, TAILORING SHOP, BARBER SHOP, ETC.) 29. HOSPITAL/SIMILAR STRUCTURES
17. GASOLINE STATION 30. WELFARE & CHARITABLE STRUCTURES
18. MARKET 31. THEATER, AUDITORIUM GYMNASIUM, COURT
19. DORMITORY/OTHER LODGING HOUSE 32. OTHERS (SPECIFY)
20. OTHERS (SPECIFY)
AGRICULTURAL
OTHER CONSTRUCTION 33. BARN(S) POULTRY HOUSE(S), ETC.
36. OTHERS (SPECIFY) 34. GRAIN MILL
35. OTHERS (SPECIFY)
STREET FURNITURE, LANDSCAPING & SIGNBOARDS
37. PARKS, PLAZA, MONUMENTS, POLLS, PLANT BOXES, ETC.
38.SIDEWALKS, PROMONADES, TERRACES, LAMPOSTS, ELECTRIC POLES, TELEPHONES POLES, ETC.
39. OUTDOOR ADS, SIGNBOARDS, ETC.
40. FENCE ENCLOSURE

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

SITE DEVELOPMENT AND LOCATION PLAN BUILDING DOCUMENTS (FIVE SETS EACH)
ARCHITECTURAL PLAN & SPECIFICATIONS MECHANICAL PLANS & SPECIFICATIONS
STRUCTURAL DESIGN & COMPUTATIONS LOGBOOK (1 COPY)
SANITARY/PLUMBING PLANS & SPECIFICATIONS OTHERS (SPECIFY)
ELECTRICAL PLANS & SPECIFICATIONS

BOX 3 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIALS)

ACTION TAKEN:
PERMIT IS HEREBY GRANTED SUBJECTS TO THE FOLLOWING CONDITIONS:
1. THAT THE PROPOSED CONSTRUCTION/ADDITIONAL/REPAIR/RENOVATION/
DEMOLITIONS/INSTALLATION ETC. SHALL BE IN CONFIRMITY WITH THE NATIONAL BUILDING
CODE (P.D. 1096) AND ITS CPRRESPONDING IMPLEMENTING RULES AND REGULATIONS.

2. THAT A DULY LINCENSED 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 CERTIFICATION OF COMPLETION DULY SIGNED AND SEALED BY THE DESIGNING

ARCHITECT/ENGINEER IN-CHARGE OF CONSTRUCTON SHALL BE SUBMITTED NOT LATER THAN
SEVEN(7) DAYS AFTER COMPLETION OF THE CONSTRUCTION OF THE PROJECT.
RADITO C. LABITA
CGADH-1, OIC - CITY ENGINEER/ BUILDING OFFICIAL

DATE
NOTE:
PERMIT MAY BE CANCELLED/REVOKED PURSUANT TO SECTION 305 & 306 OF THE "NATIONAL BUILDING CODE"
BOX 3A (TO BE ACCOMPLISHED BY DESIGNING ARCHITET/CIVIL ENGINEER IN PRINT)
TOTAL ESTIMATE COST COST OF EQUIPMENT
INSTALLED NUMBER OF STOREY _____________
DO NOT FILL-UP (MSO USE ONLY)
BUILDING Php __________ TOTAL FLOOR AREA _____________
ELECTRICAL Php __________ Php _________ PROPOSED DATE
MECHANICAL Php __________ Php _________ OF CONSTRUCTION______________
PLUMBING Php __________ Php _________ EXPECTED DATE
OTHERS Php _________ OF COMPLETION________________
MATERIAL OF CONST.____________
TOTAL COST Php ___________ (WOOD,CONC.,STEEL,MIXED)
BOX 4 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)
ASSESSED FEES
AMOUNT ASSESSED BY O.R. NUMBER DATE PAID
FILING FEES
LINE AND GRADE
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
OTHERS
TOTAL
REVIEW:
CHIEF, PROCESSING DIVISION/SECTION
BOX 5 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)
PROGRESS FLOW
NOTED: IN ACTION/ PROCESSED
CHIEF, PROCESSING DIVISION/SECTION TIME DATE TIME DATE REMARKS BY
RECEIVING AND RECORDING
LAND USE/ZONING
GEODETIC (LINE AND GRADE)
ARCHITECTURAL
STRUCTURAL
SANITARY
ELECTRICAL
MECHANICAL
WE HEREBY AFFIX HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFOURTH
BOX 6 BOX 8
ARCHITECT/CIVIL ENGINEER PRC REG NO. SIGNATURE
SIGNED AND SEALED PLANS & SPECIFICATIONS
PRINT NAME

APPLICANT

COMMUNITYBTAX CERT. DATE ISSUED PLACE ISSUED

PTR NO.

SIGNATURE

WITH 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 COMMUNITYBTAX CERT.

SIGNATURE TAN SIGNATURE