PRLD.0006-A.

02

~ R EP UBLIC OF TH E

Department of Human Settlements and Urban Development

PHILIPPIN E S

\l!!'!I Kagawaran ng Pananahanang Pan tao at Pagpapaunlad ng Kalunsuran

NATIONAL CAPITAL REGION

SITE INSPECTION REPORT/FACT SHEET FOR SUBDIVISION

AND MEMORIAL PARKS

OATE

PROJECT NAME: DOCKET NO. :_ _ _ _ _ DEVELOPMENT PERMIT ISSUED: _ _ _ _

LOCATION: DEVELOPMENT PERMIT NO.: _ _ _ __
OWNER/DEVELOPER: LICENSE TO SELL ISSUED: _ _ _ __
ADDRESSITEL. NO.: LICENSE TO SELL NO.: _ _ _ _ _ __
LAND AREA: NO. OF SALEABLE LOTS/UNITS: CERT. OF REGISTRATION ISSUED: _ __
PROJECT TYPE: PD 957 [1 BP 200 [1 OTHERS (SPECIFY): CERT. OF REGISTRATION NO.: _ _ __
LATEST DATE OF INSPECTION: CONDUCTED BY: TARGET COMPLETION DATE: _ __ __
PURPOSE OF INSPECTION: LAST REPORTED STATUS OF
DEVELOPMENT:, __________
DATE OF INSPECTION:, _ _ _ __ CONDUCTED BY: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _

DEVELOPMENT DESCRIPTION
TOTAL % REMAINING
COST ACCOMPLlSH-
COST OF REMARKSI
AS PER APPROVED PLANS ACCOMPLISMENT DEVELOPMENT
PER ITEM EVALUATION
MENT COST

1. ROAD WORKS
A. Cleari ng and Grubbing
B. Road Excavation
C. Filling and Compaction
D. Sub-base/Base Coarse
E, Concrete Paveme nt
F. Curbs and Gutters
G. Sidewalks
2. DRAINAGE & SEWERAGE
SYSTEM
A. Underground
RCP Line
NRCP Line
Cross Dra in
Manholes/Catch Basin
B. Open Canal
3. WATER DISTRIBUTION
SYSTEM
A. Centralized
Water Lines
Fire Hydrants
Elevated Water Tank with
pump
B. Local Water Uti lities System
4. ELECTRICAL DISTRIBUTION
SYSTEM
5. RIPRAP/RETAINING WALL
6. BRIDGE/BOX CULVERT
7. OPEN SPACE
8. AMENITIES

OVERALL:
 PRLD.oooe·A.02

EVALUATION/RECOMMENDATION:

Prepared by: Computation:

PROJECT ENGINEER
Inspector
Date:

YERIFICATION

I, , of legal age, after having sworn, depose and say that I have
read and accomplished this form and contents herein are true and correct.

Name, Signature and Seal of the Project

Engineer/Architect
PRe No.: Date & Place Issued:
PTR No.: Date & Place Issued:

SUSCRIBED AND SWORN to before me in this _ _ _ day of _~_ _ _ _ _ _ _ affiant

exhibiting to me his/her_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ No._ _ _ _ _ _ _ __
issued at on - - - - - - - - - - -

Doc. No.:
Book No.:
Page No.:
Series of