Republic of the Philippines)

City of Davao )
X…………………….….X

AFFIDAVIT OF UNDERTAKING

I, __________________________________, of legal age, Filipino, married/single and

with a postal address at __________________________________________________________,
Davao City, Philippines, after having been duly sworn to law, do hereby depose and say:

That I am the same person and identical person who caused the execution of this
affidavit;

That I am the registered owner of a business engaged as __________________________

with a business name: ___________________________________________________________
and business address: ___________________________________________________________
bearing Permit No.: ______________________ and Business ID No.:_____________________
Contact No.: ___________________________

That promise to attend the seminar on: (please check)

_______ Meat Handling and Its Relevant Provisions

_______ Fish Handling and Its Relevant Provisions

to be conducted by the City Veterinarian’s Office, City of Davao;

That I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this _________ day of

_______________________, at Davao City, Philippines.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this ____________________________day of

_________________________ at Davao City, Philippines.

Doc. No. _________________;

Page No. _________________;
Book No. _________________;
Series of 201______
 lOMoARcPSD|24891340
Republic of the Philippines
OFFICE OF THE CITY BUILDING OFFICIAL
City of Davao
Name of Applicant:
Address:
Use or Type of Occupancy:
Project location:
Name of Authorized Representative:
Contact Numbers of the Authorized Representative:
CHECKLIST OF GENERAL REQUIREMENTS FOR BUILDING APPLICATIONS
A. PRE-REQUISITE DOCUMENTS:
A.1 Clearances/Certificates (from other Offices)- original with photo copy
1 Zoning Location clearance (CPDO) [sec.302.12.a]
2 BFP Fire Safey Evaluation Certificate (FSEC) [Sec.303.10]
3 CSHP (DOLE) D.O. No. 13, 1998; NBC MC no. 02, 2011.
> up to 2-storey residential or minor repair works: stamped
receive by DOLE
> construction of commercial bldg.: should be dule
Approved by DOLE
4. Others (as deemed applicable) - original with photo copy
DPWH clearance (if along National Highway) [Sec.302.12.b.i]
CAAP (ATO) clearance (if applicable) [Sec. 302.12.b.ii]
DENR ECC for Environmentally Critical Project [Sec. 302.12.b.vi]
Drainage Clearance (from DPWH/CEO) if required in the ECC
and if there is existing drainage/waterway affected
Traffic Impact Assessment (TIA) for major Development such as,
Malls, Convention Centers, Sports Complex, etc. duly approved
by the Traffic Management and Control Board (TMCB)
> Submit approved Site Development plan and parking lay-out
and tabulation signed by technical working group.
CEO RROW Clearance (if along City/Brgy/Subd Road)
A.2] Legal Documents (original with photo copy)
1 Certified True Copy of Land Title (from the Land Registrtion
Authority) [section 302.a.2.ii]
2 Certified True Copy of Tax Declaration of the property (from
the City Assessor's Office) [Sec.302.a.2.ii]
3 Certified True Copy of Current Real Property Tax
Reciept (from the City Treasurer's Office) [Sec.302.2.a.iii]
4 Barangay clearance of NO SITE CONFLICT
5 If Applicant is:
Not the Owner of the lot (whichever is applicable) [Sec.302.2.b]
Notarized Deed of Absolute Sale
Notarized Contract of Lease
Notarized Contract of Sale
Notarized Authority to Construct from the Lot Owner
And, Notarized Special Power of Attorney (SPA)
Corporation:
Notarized Secretary Certificate appointing the authorized
person who will sign for and in behalf of the company
Community Association: (for residential buildings)
Association Board resolution
Applicants Certificate of membership in that community
association
City Housing Clearance (if Gov't housing project)
a. if City; Box9 should be signed by the City Administrator
b. If NHA: Box9 should be signed by the regional manager
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Subdivision
Approved Development permit (from SP/HLURB)
Building plans (should
app be stamped
le) approved by subdivision
5. other Legal Requirements
Photo copy of Owners/Applicants valid I.D with three (3)
specimen signatures.
Photocopy of PRC IDs and current PTR and TIN of all the
Signing professionals [NBC MC No.01, 2005; Item 4]
B] Technical Documents (by Owner and Hired Professionals)
1 Application letter with duly filled up forms of the following:
[Sec. 302]
2 Building Permit Form with 6-7 sets of Civil/Architectural
Plans duly signed and sealed by a licensed Civil
Engineer/Architect [Sec. 302.3.b-c, Sec. 302.4-5]
3 Sanitary/Plumbing Permit Form with 6-7 sets Plumbing plans
duly signed and sealed bt licensed Sanitary Engineer/Master
Plumber [Sec.302.3.g, Sec.302.9]
4 Electrical Permit Form with 6-7 sets Electrical Plans Duly signed
and sealed by a licensed (Registered Professional) Electrical
Engineer/Electronic Engineer [Sec.302.3.d, Sec.302.6]
5 Sketch/lot plan with vicinity map drawn to scale signed and
sealed by a licensed geodetic engineer (Sec.302.3.a,Sec.32.11)
and relocation survey plan and reports. (4 copies)
6 Mechanical permit form with 6-7 sets mechanical plans signed
and sealed by a licensed mechanical engineer.
7 Project Technical Specification (signed and sealed)[Sec.302] (2 copies)
8 Bill of materials and cost estimates (signed and sealed)[Sec.302] (4 copies)
9 Boring and plate load test result/report by licensed civil/
geotechnical engineer (for Building three storeys and above)
[Sec.302.5] if extending building for additional storey; submit
affidavit that the foundation can carry the proposed additional
floors. (2 copies)
10 Structural Design analysis for all building (except one storey
building and single dettached structure with total floor area of
20sq.m or less)[Sec.302.5.c] (2 copies)
11 Seismic analysis [Sec.302.5.3]
12 Picture on Site with landmarks
Note: INCOMPLETE DOCUMENTS WILL NOT BE ACCEPTED
(dili dawaton kung kulang ang mga dokumento)
all forms must be filled-up properly, use black ink
only and write legibly
Received/pre-evaluated as to checklist by:
Name/Position:
Date/Time:
Signature:
 lOMoARcPSD|24891340

APPLICATION LETTER

Date :

ENGR. CIRINIA GRACE L. CATUBIG

Officer-In-Charge
Davao City

Sir/Maam:

I
(First Name) (Middle Name) (Family Name)

would like to aplply for for my

located at
(Complete Address)

I also authorize to
(Authorized Representative of the Company)

transact the application with your Office in my behalf.

I/We hereby certify that the documents submitted herein are all true and correct, therefore
falsification on the supporting document in any way will cause disapproval of the permit
application without prejudice t further action that may be undertaken pursuant to Articles 171 &
172 of R.A. 3815, otherwise known as the Revised Penal Code of the Philippines.

(Signature over Printed Name of Owner) (Signature over Printed Name of Authorized Representative)

Address: Address:
Contact Number: Contact Number:

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 Republic of the Philippines
OFFICE OF THE CITY PLANNING AND DEVELOPMENT COORDINATOR
City of Davao

APPLICATION FOR LOCATIONAL CLEARANCE

Application No.:_______________________
Name of Applicant: ___________________________________________________________________
Address of Applicant: _________________________________________________________________
Name of Corporation: _________________________________________________________________
Type of Project: ______________________________________________________________________
Project Location: _____________________________________________________________________
Lot Area: ______________________________ Building Area: _________________________________
Nature of Application: New Development ( ) Improvement ( ) Others ( ):_________________________
Right over Land: Owner ( ) Lessee ( ): ___________________________________________________
Existing Land Use of Project Site: Residential ( ) Commercial ( ) Industrial ( ) Institutional ( )
Agricultural ( ) Others specify ( ): _______________________________________________________
Project Cost: ________________________________________________________________________

____________________________________
Applicant
Representative of the Owner:
____________________________________
____________________________________________________________________________
REPUBLIC OF THE PHILIPPINES >
_____________________________> S. S.

SUBSCRIBED AND SWORN TO before me this _______ day of _________________________

2021 in the City / Province of ___________________________________________________________,
affiant Exhibit to me his / her Certificate No.:________________________________________________
issued at ___________________________________ on _____________________________________

Notary Public
Doc. No.:________
Page No.:_______
Book No.: _______
Series of: ________
 lOMoARcPSD|24891340

NBC Form No. B-17

Republic of the Philippines
Davao City
Davao Del Sur
OFFICE OF THE BUILDING OFFICIAL

TO : CITY/MUNICIPAL FIRE MARSHALL

Bureau of Fire Protection, DILG

SUBJECT : APPLICATION FOR BUILDING PERMIT

Pursuant to the provision of Section 303 10 of the Revised Implementing Rules and
Regulation of PD 1093, I have the honor to endorse to your three (3) sets of plans and specification
for the building to be constructed at
for your evaluation, review and/or
recommendation with respect to fire safety and control requirements.

Quoted hereunder is the pertinent provision of Section 303 10 of the Revised

Implementing Rules and Regulations of PD 1096:

“The Building Official shall refer three (3) sets of plans and specifications to the
City/Municipal Fire Marshall (C/MFM), Bureau of Fire Protection (BFP), for his review and
recommendations with respect to fire safety and control requirements. The C/MFM
shall submit his report and recommendations to the Building Official within Five (5)
working days from the date referral. Failure of the C/MFM to act within said period
shall mean that the plans and specifications of non-issuance, suspension or
revocation of the said requirements by the C/MFM, he shall so state in writing the
reasons or grounds therefor”.

ENGR. CIRINIA GRACE L. CATUBIG

Officer-In-Charge

Date referred to C/MFM :

Date referred by C/MFM :
Date returned to Building Official :
Date returned by Building Official :

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 lOMoARcPSD|24891340

NBC FORM 8-01

Republic of the Philippines
Davao City
Province of Davao Del Sur
OFFICE OF THE BUILDING OFFICIAL
APPLICATION FOR BUILDING PERMIT
NEW RENEWAL AMENDATORY
APPLICATION NO. AREA NO.

DATE OF APPLICATION DATE ISSUED

DO NOT FILL-UP (NSO USE ONLY)
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)
OWNER LAST NAME FIRST NAME M.I. TAX ACCT. NO.

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

BY AN ENTERPRISE

ADDRESS : NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION : TCT NO.

SCOPE OF WORK : NEW CONSTRUCTION RENOVATION RAISING

ERECTION CONVERSION ACCESSORY BUILDING STRUCTURE

ADDITION REPAIR OTHERS (SPECIFY)

ALTERATION MOVING

USE OR OCCUPANCY OF BUILDING / STRUCTURE

RESIDENTIAL COMMERCIAL
INDUSTRIAL INSTITUTIONAL
AGRICULTURAL OTHERS

USE OR CHARACTER OF OCCUPANCY

GROUP A RESIDENTIAL DWELLINGS GROUP F INDUSTRIAL OTHERS (specify)

GROUP B RESIDENTIAL HOTEL APARTMENT GROUP G INDUSTRIAL STORAGE AND HAZARDOUS

GROUP C EDUCATIONAL RECREATIONAL GROUP H RECREATIONAL ASSEMBLY OCCUPANT LOAD LESS THAN 1000

GROUP D INSTITUTIONAL GROUP I RECREATIONAL ASSEMBLY OCCUPANT LOAD 1000 OR MORE

GROUP E BUSINESS AND MERCANTILE GROUP J AGRICULTURAL ACCESSORY

OCCUPANCY CLASSIFIED TOTAL ESTIMATED COST P.

NUMBER OF UNITS PROPOSED DATE OF CONSTRUCTION
TOTAL FLOOR AREA PROPOSED DATE OF COMPLETION
BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
ADDRESS

PRC NO. VALIDITY

ARCHITECT OR CIVIL ENGINEER PTR NO. DATE ISSUED

(SIGNED AND SEALED OVER PRINTED NAME)
DATE_______________________ PLACE ISSUED TIN

BOX 3 BOX 4
APPLICANT/OWNER WITH CONSENT : LOT OWNER

(SIGNATURE OVER PRINTED NAME) DATE (SIGNATURE OVER PRINTED NAME) DATE

ADDRESS: ADDRESS:

CTC NO. DATE ISSUED PLACE ISSUED CTC NO. DATE ISSUED PLACE ISSUED

BOX 5
REPUBLIC OF THE PHILIPPINES )
CITY/MUNICIPALITY OF )
BEFORE ME , at the City/Municipality of on personally apreared

APPLICANT NAME C.T.C. No. DATE ISSUED PLACE ISSUED

LICENSED ARCHITECT/CIVIL ENGINEER C.T.C. No. DATE ISSUED PLACE ISSUED

FULL TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION

whose signature appear herein above known to me to be the same persons who executed this standard prescribed form and acknowledged to me
that the same is their free and voluntary act and deed

WITNESS MY HAND AND SEAL on the date and place above written
Doc no.
Page no.
Book no.
Series No. NOTARY PUBLIC (until December________)

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 lOMoARcPSD|24891340

BOX 6 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ASSESSED FEE ASSESSED BY AMOUNT DUE DATE PAID O.R. NUMBER NSO
LOCATIONAL/ZONING OF LAND USE
LINE AND GRADE (Geodetic)
FILING FEE
BUILDING FEE
ELECTRICAL FEE
MECHANICAL FEE
SANITARY/PLUMBING FEE
ELECTRONICS FEE
ONE HALF (1/2) OF FIRE SERVICE FUND (FSF)

OTHERS(SPECIFY)

TOTAL

BOX 7 (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

PROGRESS FLOW
NOTED IN OUT
ACTION/REMARKS PROCESSED BY
TIME DATE TIME DATE
CHIEF,PROCESSING, DIVISION/SECTION
RECEIVING and RECORDING
LAND USE and ZONING
GEODETIC (Line and Grade)
ARCHITECTURAL
STRUCTURAL
SANITARY / PLUMBING
ELECTRICAL
MECHANICAL
WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH
BOX 8 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)
BUILDING PERMIT NO. OFFICIAL RECIEPT NO.
BUILDING PERMIT
DATE ISSUED DATE PAID

M M D D Y Y M M D D Y Y
Permit is issued to for the proposed
(Owner/Applicant) (Type of Project)
Under , of Group , located at
subject to the following
1) THAT UNDER ARTICLE 1723 OF THE CIVIL CODE OF THE PHILIPPINES, THE ENGINEER OR ARCHITECT WHO DREW UP THE PLANS AND SPECIFICATIONS FOR A
BUILDING/STRUCTURE IS LIABLE FOR DAMAGES IF WITHIN FIFTEEN (15) YEARS FROM THE COMPLETION OF THE BUILDING/STRUCTURE, THE SAME SHOULD
COLLAPSE DUE TO DEFECT IN THE PLANS OR SPECIFICATIONS OF DEFECTS IN THE GROUND. THE ENGINEER OR ARCHITECT WHO SUPERVISES THE
CONSTRUCTION SHALL BE SOLIDARILY LIABLE WITH THE CONTRACTOR SHOULD THE EDIFICE COLLAPSE DUE TO DEFECT IN THE CONSTRUCTION OR THE USE
OF INFERIOR MATERIALS.
2). THIS PERMIT ACCOMPANIED BY THE VARIOU S APPLICABLE ANCILLARY AND ACCESSORY PERMITS,PLANS AND SPECIFICATIONS SIGNED AND SEALED
BY THE CORRESPONDING DESIGN PROFESSIONALS WHO SHALL BE RESPONSIBLE FOR THE COMPREHENSIVE AND CORRECTNESS OF THE PLANS IN
COMPLIANCE TO THE CODE AND ITS IRR AND TO ALL APPLICABLE REFERAL CODES AND PROFESSIONAL REGULATORY LAWS.
3). THAT THE PROPOSED CONSTRUCTION/ERECTION/ADDITION/ALTERATION/RENOVATION/CONVERSION/REPAIR/MOVING/DEMOLITION, ETC. SHALL BE IN
CONFORMITY WITH THE PROVISIONS OF THE NATIONAL BUILDING CODE AND ITS IRR.
A. THAT PRIOR TO COMMENCEMENT OF THE PROPOSED PROJECTS AND CONSTRUCTIONS AN ACTUAL RELOCATION SURVEY SHALL BE CONDUCTED BY A
DULY LICENSED GEODETIC ENGINEER.
B. THAT BEFORE COMMENCING THE EXCAVATION THE PERSON MAKING OR CAUSING THE EXCAVATION TO BE MADE SHALL NOTIFY IN WRITING TO THE
OWNER OF ADJOINING PROPERTY . NOT LESS THAN TEN (10) DAYS BEFORE SUCH EXCAVATION IS TO BE MADE AND SHOW THE ADJOINING PROPERTY
SHOULD BE PROTECTED.
C. THAT NO PERSON SHALL USE OR OCCUPY A STREET ALLEY OR PUBLIC SIDEWALK FOR THE PERFORMANCE OF WORK COVERED BY A BUILDING PERMIT.
D. THAT NO PERSON SHALL PERFORM ANY WORK ON ANY BUILDING OR STRUCTURE ADJACENT TO A PUBLIC WAY IN GENERAL USE FOR PEDESTRIAN
TRAVEL, UNLESS THE PEDESTRIANS ARE PROTECTED.
E. THAT THE SUPERVISING ARCHITECT/CIVIL ENGINEER SHALL KEEP THE JOBSITE AT ALL TIMES A LOGBOOK OF DAILY CONSTRUCTION ACTIVITIES
WHEREIN THE ACTUAL DAILY PROGRESS OF CONSTRUCTION INCLUDING TEST CONDUCTED, WEATHER CONDITION AND OTHER PERTINENT DATE ARE TO
INSPECTION PURSUANT TO SECTION 207 OF THE NATIONAL BUILDING CODE.
F. THAT UPON COMPLETION OF THE CONSTRUCTION, THE SAID LICENSED SUPERVISING ARCHITECT/CIVIL ENGINEER SHALL SUBMIT TO THE BUILDING
OFFICIAL DULY SIGNED AND SEALED LOGBOOK, AS-BUILT PLANS AND OTHER DOCUMENTS AND SHALL ALSO PREPARE AND SUBMIT A CERTIFICATE OF
COMPLETION OF THE PROJECT STATING THAT THE CONSTRUCTION OF THE BUILDING/STRUCTURE CONFORM TO THE PROVISION OF THE CODE, ITS IRR AS
WELL AS THE PLANS AND SPECIFICATIONS.
G. ALL SUCH CHANGES,MODIFICATIONS AND ALTERATIONS SHALL LIKEWIS E BE SUBMITTED TO THE BUILDING OFFICIAL AND THE SUBSEQUENT
AMENDATORY PERMIT THEREFORE ISSUED BEFORE ANY WORK ON SAID CHANGES,MODIFICATIONS AND ALTERATIONS SHALL BE STARTED. THE AS-BUILT
PLANS AND SPECIFICATIONS MAYBE JUST AN ORDERLY AND COMPREHENSIVE COMPILATION OF ALL DOCUMENTS WHICH INCLUDE THE ORIGINALLY
SUBMITTED PLANS AND SPECIFICATIONS OF ALL AMMENDMENTS THERETO AS ACTUALLY BUILT OR THEY MAY BE AN ENTIRELY NEW SET OF PLANS AND
SPECIFICATIONS ACCURATELY DESCRIBING AND/OR REFLECTING THEREIN THE BUILDING AS ACTUALLY BUILT.
4). THAT NO BUILDING/STRUCTURE SHALL BE USED UNTIL THE BUILDING OFFICIAL HAS ISSUED A CERTIFICATE OF OCCUPANCY THEREFORE AS PROVIDED IN THE
CODE. HOWEVER, A PARTIAL CERTIFICATE OF OCCUPANCY MAY BE ISSUED FOR USE/OCCUPANCY OF A PORTION(S) OF A BUILDING/STRUCTURE PRIOR TO THE
COMPLETION OF THE ENTIRE BUILDING/STRUCTURE.
5). THAT THIS PERMIT SHALL NOT SERVE AS AN EXEMPTION FROM SECURING WRITTEN CLEARANCES FROM VARIOUS GOVERNMENT AUTHORITIES EXERCISING
REGULATORY FUNCTION AFFECTING BUILDING/STRUCTURES.
6). WHEN THE CONSTRUCTION IS UNDERTAKEN BY CONTRACT, THE WORK SHALL BE DONE BY DULY LICENSED AND REGISTERED CONTRACTOR PURSUANT TO
THE PROVISIONS OF THE CONTRACTORS LICENSE LAW (RA 4566).
7). THE OWNER/PERMITTEE SHALL SUBMIT A DULY ACCOMPLISHED PRESCRIBED 'NOTICE OF CONSTRUCTION' TO THE OFFICE OF THE BUILDING OFFICIAL PRIOR
TO ANY CONSTRUCTION ACTIVITY.
8). THE OWNER/PERMITTEE SHALL PUT A BUILDING PERMIT SIGN WICH COMPLIES WITH THE PRESCRIBED DIMENSIONS AND INFORMATION, WHICH SHALL REMAIN
POSTED ON THE CONSTRUCTION SITE FOR THE DURATION OF THE CONSTRUCTION.
PERMIT ISSUED BY:

ENGR. CIRINIA GRACE L. CATUBIG

Officer-In-Charge
Date:___________________
NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE NATIONAL BUILDING CODE.

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 DPWH FORM NO. 96-001-E
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL

DISTRICT/CITY/MUNICIPALITY
AREA CODE._________

APPLICATION NO. DATE FILED

Date of Proposed start of Installation Expected Date of Completion

APPLICATION FOR ELECTRICAL PERMIT

( Accomplished in print and in Duplicate)

BOX 1 ( TO BE ACCOMPLISHED BY DULY QUALIFIED ELECTRICAL PRACTITIONER)

NAME OF LAST NAME FIRST NAME MIDDLE NAME TIN
OWNER/APPLICANT
NO. STREET BARANGAY CITY/MUNICIPALITY TEL./FAX NO.
ADDRESS

LOCATION OF NO. STREET BARANGAY CITY/MUNICIPALITY

INSTALLATION
SCOPE OF WORK
( ) NEW INSTALLATION ( ) ADDITION OF __________ ( ) OTHERS (Specify)
( ) ANNUAL INSPECTION ( ) REPAIR OF _____________
( ) REMOVAL _____________
TYPE OF OCCUPANCY OR USE:
( ) A. RESIDENTIAL DWELLING ( )
E. BUSINESS & MERCANTILE ( ) I. ASSEMBLY OCCUPANT LOAD 100 OR MORE
( ) B. RESIDENTIAL HOTEL APARTMENT ( )
F. INDUSTRIAL ( ) J. ACCESSORY
( ) C. EDUCATION AND RECREATION ( )
G. STORAGE & HAZARDOUS ( ) K. OTHERS (Specify)
( ) D. INSTITUTIONAL ( )
H. ASSEMBLY OTHER THAN GROUP I
NUMBER OF OUTLETS NUMBER OF EQUIPMENT/WIRING DEVICES
LIGHT SPO COOKING UNIT TOGGLE SWITCH FIRE ALARM/SMOKE DETECTORS
CONVINIENCE/RECEPTACLE SPO. COOKING HEATER BELLS BUZZER OTHERS (See attached List)
SPO. AIRCON SPO WATER PUMP PUSH BOTTON

BOX 2 ( PROFESSIONAL ELECTRICAL ENGINEER WHO SIGNED AND SEALED THE PLANS & SPECIFICATION)
NAME PRC REG. NO. VALIDITY
ADDRESS TEL/FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE ISSUED TIN
BOX 3 ( ELECTRICAL CONTRACTOR 200-AMPERE MAIN AND ABOVE
NAME PCAB LIC. NO. (SPECIALTY - ELECTRICAL)
VALIDITY
ADDRESS TEL./FAX NO.
BOX 4 (PERSON IN-CHARGE OF INSTALLATION)
( ) PROFESIONAL ENGINEER ( ) REGISTERED ELECTRICAL ENGINEER ( ) REGISTERED MASTER ELECTRICIAN
(not exceeding 600 volts and 500 KVA)
NAME PRC REG. NO. VALIDITY
ADDRESS TEL/FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE ISSUED TIN
BOX 5 (OWNER/AUTHORIZED REPRESENTATIVE)
NAME SIGNATURE TIN CTC NO.
DATE ISSUED
PLACE ISSUED
BOX 6 ( TO BE RECEIVED BY RECEIVING/RECORDING SECTION)
RECEIVED BY:

ELECTRICAL PLANS & SPECIFICATIONS (5 SETS) Signature over printed Name

DATE RECEIVED:
DPWH FORM NO. 96-002-E

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIALS

DISTRICT/CITY MUNICIPALITY
AREA CODE

PERMIT NO. APPLICATION NO.

DATE ISSUED ___________________ DATE FILED __________________

UNDER O.R. NO.
AMOUNT
DATE
ELECTRICAL PERMIT
(To be Accomplished by the Office Concerned)
BOX 1
NAME OF OWNER/APPLICANT: LAST NAME, FIRST NAME, MIDDLE NAME TIN

ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY TEL/FAX. NO.

LOCATION OF INSTALLATION: NO., STREET, BARANGAY, CITY/MUNICIPALITY

BOX 2
ASSESSED FEES

AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

REVIEWED
__________________________
CHIEF, PROCESSING DIV. I SEC

BOX 3

PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING, DEVICES AND EQUIPMENT ENUMERATED IN THE APPLICATION SUBJECT
TO THE FOLLOWING CONDITIONS:

1. THAT THE PROPOSED INSTALLATION BE IN ACCORDANCE WITH THE APPROVED PLANS FILED WITH THIS OFFICE AND IN
COMFORMITY WITH THE PROVISIONS OF THE LATEST EDITION OF THE PHILIPPINE ELECTRICAL CODE.

2. THAT A DULY LICENSED ELECTRICAL PRACTITIONER BE INCHARGE OF THE INSTALLATION/CONSTRUCTION.

3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY THE ELECTRICAL PRACTITIONER INCHARGE OF THE INSTALLATION BE
SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.

4. THAT A CERTIFICATE OF FINAL ELECTRICAL INSPECTION BE SECURED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING.

5. THIS PERMIT SHALL BE POSTED AT THE DOOR OR SITE OF WORK.

APPROVED:

ELECTRICAL ENGINEER OF THE BUILDING OFFICE DATE

(Signature Over Printed Name)

PRC REG. NO. & VALIDITY

NOTED:

BUILDING OFFICIAL DATE

(Signature Over Printed Name)

NOTE 1: This permit may be cancelled or revoked pursuant to sections 305 and 306 of the National Building Code
NOTE 2: Alterations on this form are not allowed.
 NBC FORM NO. A-06
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS & HIGHWAYS
OFFICE OF THE BUILDING OFFICIAL

MUNICIPALITY

PLUMBING PERMIT
APPLICATION NO. PP NO. PERMIT NO.

DATE OF APPLICATION DATE ISSUED

BOX 1 (TO BE ACCOMPLISHED BY SANITARY ENGINEER/MASTER PLUMBER, IN PRINT)
NAME OF OWNER/APPLICANT LAST NAME, FIRST NAME, M.I. TAX ACCT. NO.

ADDRESS No., Street, Barangay, City/Municipality TELEPHONE NO.

Location of Installation No., Street, Barangay, City/Municipality

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RISING
ERECTION CONVERSION DEMOLITION
ADDITION REPAIR ACCESSORY BUILDING/STRUCTURE
ALTERATION MOVING OTHERS (specify)

USE OR TYPE OF OCCUPANCY

Residential Agricultural
Commercial Parks, Plazas, Monuments
Industrial Recreational
Institutional Others (Specify)

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGNING PROFESSIONAL)

FIXTURES TO BE INSTALLED
NEW EXISTING KIND OF NEW EXISTING KIND OF
QTY. FIXTURES FIXTURES FIXTURES QTY. FIXTURES FIXTURES FIXTURES
Water Closet Bidet
Floor Drain Laundry Trays
Lavatories Dental Cuspidator
Kitchen Sink Gas Heater
Faucet Electric Heater
Shower Head Water Boiler
Water Meter Drinking Fountain
Grease Trap Bar Sink
Bath Tubs Soda Fountain Sink
Slop Sink Laboratory Sink
Urinal Sterilizer
Airconditioning Unit Swimming Pool
Water Tank/reservoir R.C.S. volume
TOTAL TOTAL Others (Specify)
Water Distribution Sanitary Sewer System Storage Drainage System

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR/IN-CHARGE OF PLUMBING WORKS

MASTER PLUMBER Date MASTER PLUMBER Date

(signed and sealed over printed name) (signed and sealed over printed name)
Address Address
PRC NO. VALIDITY PRC NO. VALIDITY
PTR NO. DATE ISSUED PTR NO. DATE ISSUED
ISSUED AT TIN ISSUED AT TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT : LOT OWNER

(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME)

Address Address
CTC No. Date Issued Place Issued CTC No. Date Issued Place Issued
 BOX 7 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION )
RECEIVED BY: DATE:
THREE (3) SETS OF PLUMBING DOCUMENTS
Plumbing Plans & Specifications Cost Estimates
Bill of Materials Others (Specify)

BOX 8 (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

ASSESSED FEES
AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

BOX 9 (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

PROGRESS FLOW
IN OUT
NOTE ACTION/REMARKS PROCESSED BY
TIME DATE TIME DATE
Chief, Processing Division/Section
Receiving and Recording
Geodetic (Line and Grade)
Plumbing
BOX 10

ACTION TAKEN

PERMIT IS 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 supervisor/in-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 that the plumbing works of the building conform to the provision of the revised
Plumbing Code, the National Building Code and its IRR

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

PERMIT ISSUED BY :

ARCH. KHASHAYAR L. TOGHYANI

Officer-In-Charge

THIS PERMIT MAY BE CANCELLED OR REVOKED PERSUANT TO SECTION. 305 & 306 OF THE "NATIONAL BUILDING CODE".
 NBC FORM NO. A-06
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS & HIGHWAYS
OFFICE OF THE BUILDING OFFICIAL

MUNICIPALITY

SANITARY PERMIT
APPLICATION NO. SP NO. PERMIT NO.

DATE OF APPLICATION DATE ISSUED

BOX 1 (TO BE ACCOMPLISHED BY SANITARY ENGINEER/MASTER PLUMBER, IN PRINT)

NAME OF OWNER/APPLICANT LAST NAME, FIRST NAME, M.I. TAX ACCT. NO.

ADDRESS No., Street, Barangay, City/Municipality TELEPHONE NO.

Location of Installation No., Street, Barangay, City/Municipality

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RISING
ERECTION CONVERSION DEMOLITION
ADDITION REPAIR ACCESSORY BUILDING/STRUCTURE
ALTERATION MOVING OTHERS (specify)

USE OR TYPE OF OCCUPANCY

Residential Agricultural
Commercial Parks, Plazas, Monuments
Industrial Recreational
Institutional Others (Specify)
BOX 2 (TO BE ACCOMPLISH BY THE DESIGNING PROFESSIONAL)
INSTALLATION AND OPERATION

WATER SUPPLY SYSTEM OF DISPOSAL:

SHALLOW WELL WASTE WATER TREATMENT PLANT SURFACE DRAINAGE
DEEP WELL AND PUMP SET IMHOFF TANK STREET CANAL
CITY/MUNICIPAL WATER SYSTEM SANITARY SEWER CONNECTION WATER COURSE
OTHERS (specify) SUB-SURFACE AND FILTER OTHER (specify)

PREPARED BY :

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR/IN-CHARGE OF SANITARY WORKS

SANITARY ENGINEER Date SANITARY ENGINEER Date

(signed and sealed over printed name) (signed and sealed over printed name)
Address Address
PRC NO. VALIDITY PRC NO. VALIDITY
PTR NO. DATE ISSUED PTR NO. DATE ISSUED
ISSUED AT TIN ISSUED AT TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT : LOT OWNER

(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME)

Address Address
CTC No. Date Issued Place Issued CTC No. Date Issued Place Issued
 BOX 7 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION )
RECEIVED BY: DATE:
THREE (3) SETS OF SANITARY DOCUMENTS

Sanitary Plans & Specifications Cost Estimates

Bill of Materials Others (Specify)

BOX 8 (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

ASSESSED FEES
AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

BOX 9 (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

PROGRESS FLOW
IN OUT
NOTE ACTION/REMARKS PROCESSED BY
TIME DATE TIME DATE
Chief, Processing Division/Section
Receiving and Recording
Geodetic (Line and Grade)
Sanitary
BOX 10

ACTION TAKEN

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING ;

1 That the proposed sanitary works shall be in accordance with the sanitary plans filed
with this office and in conformity with the latest Code of Sanitation of the Philippines, the
National Building Code and its IRR.

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

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

3 That upon completion of the sanitary works the licensed supervisor/in-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 that the sanitary works conform to the provision of the Code on Sanitation, the
National Building Code and its IRR

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

PERMIT ISSUED BY :

ARCH. KHASHAYAR L. TOGHYANI

Officer-In-Charge

THIS PERMIT MAY BE CANCELLED OR REVOKED PERSUANT TO SECTION. 305 & 306 OF THE "NATIONAL BUILDING CODE".
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