Republic of the Philippines

Socorro
City/Municipality of __________________
Oriental Mindoro
Province of __________________________
UNIFIED APPLICATION FORM FOR BUILDING PERMIT
SIMPLE COMPLEX*

NEW RENEWAL AMENDATORY

THIS APPLIES ALSO FOR : LOCATIONAL CLEARANCE FIRE SAFETY EVALUATION CLEARANCE
APPLICATION NO. AREA NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)

OWNER / APPLICANT LAST NAME FIRST NAME M.I. TIN
DO NOT FILL-UP (PSA USE ONLY)

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, CITY / MUNICIPALITY ZIP CODE CONTACT NO.

LOCATION OF CONSTRUCTION: LOT NO. _______ BLK NO. ________ TCT NO. ______________ CURRENT TAX DEC. NO. ____________________
STREET_____________________ BARANGAY __________________________ CITY / MUNICIPALITY OF_____________________________________
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ADDITION REPAIR LEGALIZATION OF EXISTING BUILDING
ALTERATION MOVING OTHERS (Specify)
USE OR CHARACTER OF OCCUPANCY
GROUP H : ASSEMBLY (OCCUPANT
GROUP A : RESIDENTIAL (DWELLINGS) GROUP E : COMMERCIAL LOAD LESS THAN 1,000)
SINGLE DUPLEX RESIDENTIAL R-1, R-2 BANK STORE SHOPPING THEATER, AUDITORIUM, CONVENTION HALL,
OTHERS ______________________________________ DRINKING / DINING CENTER / MALL GRANDSTAND/ BLEACHER
GROUP B : RESIDENTIAL ESTABLISHMENT OTHERS ______________________________
HOTEL MOTEL TOWNHOUSE SHOP (i.e. DRESS SHOP, TAILORING,
DORMITORY BOARDINGHOUSE, BARBERSHOP, etc.) GROUP I : ASSEMBLY (OCCUPANT
RESIDENTIAL R-3, R-4, R-5 LODGING HOUSE OTHERS ______________________________ LOAD 1,000 OR MORE)
COLISEUM, SPORTS COMPLEX,
OTHERS _______________________________________ GROUP F : LIGHT INDUSTRIAL CONVENTION CENTER AND SIMILAR
GROUP C : EDUCATIONAL & RECREATIONAL FACTORY / PLANT (USING INCOMBUSTIBLE/ STRUCTURE
SCHOOL BUILDING SCHOOL AUDITORIUM, NON-EXPLOSIVE MATERIALS OTHERS _______________________
CIVIC CENTER GYMNASIUM OTHERS ______________________________
CLUBHOUSE CHURCH, MOSQUE, GROUP J : (J-1) AGRICULTURAL
TEMPLE, CHAPEL GROUP G : MEDIUM INDUSTRIAL BARN, GRANARY, POULTRY HOUSE,
OTHERS _______________ PIGGERY, GRAIN MILL, GRAIN SILO
STORAGE / WAREHOUSE (FOR HAZARDOUS/
GROUP D : INSTITUTIONAL HIGHLY FLAMMABLE MATERIALS OTHERS _______________________
HOSPITAL OR SIMILAR STRUCTURE FACTORY (FOR HAZARDOUS/ HIGHLY GROUP J : (J-2) ACCESSORIES
HOME FOR THE AGED FLAMMABLE MATERIALS PRIVATE CARPORT / GARAGE, TOWER,
GOVERNMENT OFFICE OTHERS _______________________________ SWIMMING POOL, FENCE OVER 1.80m,
STEEL / CONCRETE TANK
OTHERS _______________________________________ OTHERS _______________________
OCCUPANCY CLASSIFIED_____________________________ TOTAL ESTIMATED COST: P ______________________________________
NUMBER OF UNITS__________________________________ BUILDING ____________________________ COST OF EQUIPMENT INSTALLED:
NUMBER OF STOREY________________________________ ELECTRICAL ____________________________ P ______________________________
TOTAL FLOOR AREA ___________________________ SQ. M. MECHANICAL____________________________ P ______________________________
LOT AREA ____________________________________ SQ. M ELECTRONICS___________________________ P ______________________________
PLUMBING ___________________________ P ______________________________
PROPOSED DATE OF CONSTRUCTION: _______________________________ EXPECTED 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_____________________________ Issued at TIN
BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER / AUTHORIZED REPRESENTATIVE

Date ______________ Date______________

(Signature Over Printed Name) (Signature Over Printed Name)

Address Address
Gov’t Issued ID No. Date Issued Place Issued Gov’t Issued ID No. Date Issued Place Issued
BOX 5
REPUBLIC OF THE PHILIPPINES )
S.S
CITY/MUNICIPALITY OF _________________________________________)
BEFORE ME, at the City/Municipality of _____________________________________________________ , on _________________________ personally appeared the
following:
______________________________________________________ _____________________ _______________ ___________________________________
APPLICANT Gov’t Issued ID No. Date Issued Place Issued

______________________________________________________ _____________________ _______________ ___________________________________

LICENSED ARCHITECT OR CIVIL ENGINEER Gov’t Issued ID No. Date Issued Place Issued
(Full-Time Inspector and Supervisor of Construction Works)

whose signatures appear hereinabove, 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.____________ NOTARY PUBLIC (Until December _____________ )
Series of ____________

Copy 1: Owner Copy 2: OBO Copy 3: BFP Copy 4: Philippine Statistics Authority
*May require additional requirements
 BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)

BASIS OF AMOUNT
ASSESSED FEES ACCOUNT ASSESSED BY
ASSESSMENT DUE
FOR ZONING (ZONING
ADMINISTRATOR):
 LOCATIONAL / ZONING OF LAND

FOR BUILDING / STRUCTURE (OBO):

 FILING FEE

 LINE AND GRADE (Geodetic)

 FENCING

 ARCHITECTURAL

 CIVIL / STRUCTURAL

 ELECTRICAL

 MECHANICAL

 SANITARY

 PLUMBING

 ELECTRONICS

 INTERIOR

 SURCHARGES

 PENALTIES

FOR FIRE SAFETY (BFP):

 FIRE CODE CONSTRUCTION TAX

 HOTWORKS

TOTAL

TERMS AND CONDITIONS

1. The Owner/Permittee shall accomplish the prescribe Unified Application Form, with the assistance of the
concerned design professional/s and/or the Architect/Civil Engineer, hired/commissioned by the Owner/Permittee
as full-time inspector/supervisor of the construction works, by filling up the necessary data / information required
thereat.

2. The fully accomplished prescribed Unified Application Form, duly notarized, shall be submitted to the concerned
Office of the Building Official accompanied by the various 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 National Building Code (PD 1096), its IRR and
to all applicable referral codes and professional regulatory laws, together with the other documentary
requirements pursuant to Section 302 of PD 1096 and its IRR.

I have read this form, understood its contents and consent to the processing of my personal data. I understand that my consent
does not preclude the existence of other criteria for lawful processing of personal data, and does not waive any of my rights under
the Data Privacy Act of 2012 and other applicable laws.

___________________________________________________
SIGNATURE OVER PRINTED NAME OF OWNER/APPLICANT