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________)
 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.

loymi_lapuz_2000
 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: Subdivision
Approved Development permit (from SP/HLURB)
A.1 Clearances/Certificates (from other Offices)- original with photo copy Building plans (if
Administrator should be stamped approved by subdivision
applicable)
1 Zoning Location clearance (CPDO) [sec.302.12.a] 5. other Legal Requirements
2 BFP Fire Safey Evaluation Certificate (FSEC) [Sec.303.10] Photo copy of Owners/Applicants valid I.D with three (3)
3 CSHP (DOLE) D.O. No. 13, 1998; NBC MC no. 02, 2011. specimen signatures.
> up to 2-storey residential or minor repair works: stamped Photocopy of PRC IDs and current PTR and TIN of all the
receive by DOLE Signing professionals [NBC MC No.01, 2005; Item 4]
> construction of commercial bldg.: should be dule B] Technical Documents (by Owner and Hired Professionals)
Approved by DOLE 1 Application letter with duly filled up forms of the following:
4. Others (as deemed applicable) - original with photo copy [Sec. 302]
DPWH clearance (if along National Highway) [Sec.302.12.b.i] 2 Building Permit Form with 6-7 sets of Civil/Architectural
CAAP (ATO) clearance (if applicable) [Sec. 302.12.b.ii] Plans duly signed and sealed by a licensed Civil
DENR ECC for Environmentally Critical Project [Sec. 302.12.b.vi] Engineer/Architect [Sec. 302.3.b-c, Sec. 302.4-5]
Drainage Clearance (from DPWH/CEO) if required in the ECC 3 Sanitary/Plumbing Permit Form with 6-7 sets Plumbing plans
and if there is existing drainage/waterway affected duly signed and sealed bt licensed Sanitary Engineer/Master
Traffic Impact Assessment (TIA) for major Development such as, Plumber [Sec.302.3.g, Sec.302.9]
Malls, Convention Centers, Sports Complex, etc. duly approved 4 Electrical Permit Form with 6-7 sets Electrical Plans Duly signed
by the Traffic Management and Control Board (TMCB) and sealed by a licensed (Registered Professional) Electrical
> Submit approved Site Development plan and parking lay-out Engineer/Electronic Engineer [Sec.302.3.d, Sec.302.6]
and tabulation signed by technical working group. 5 Sketch/lot plan with vicinity map drawn to scale signed and
CEO RROW Clearance (if along City/Brgy/Subd Road) sealed by a licensed geodetic engineer (Sec.302.3.a,Sec.32.11)
A.2] Legal Documents (original with photo copy) and relocation survey plan and reports. (4 copies)
1 Certified True Copy of Land Title (from the Land Registrtion 6 Mechanical permit form with 6-7 sets mechanical plans signed
Authority) [section 302.a.2.ii] and sealed by a licensed mechanical engineer.
2 Certified True Copy of Tax Declaration of the property (from 7 Project Technical Specification (signed and sealed)[Sec.302] (2 copies)
the City Assessor's Office) [Sec.302.a.2.ii] 8 Bill of materials and cost estimates (signed and sealed)[Sec.302] (4 copies)
3 Certified True Copy of Current Real Property Tax 9 Boring and plate load test result/report by licensed civil/
Reciept (from the City Treasurer's Office) [Sec.302.2.a.iii] geotechnical engineer (for Building three storeys and above)
4 Barangay clearance of NO SITE CONFLICT [Sec.302.5] if extending building for additional storey; submit
5 If Applicant is: affidavit that the foundation can carry the proposed additional
Not the Owner of the lot (whichever is applicable) [Sec.302.2.b] floors. (2 copies)
Notarized Deed of Absolute Sale 10 Structural Design analysis for all building (except one storey
Notarized Contract of Lease building and single dettached structure with total floor area of
Notarized Contract of Sale 20sq.m or less)[Sec.302.5.c] (2 copies)
Notarized Authority to Construct from the Lot Owner 11 Seismic analysis [Sec.302.5.3]
And, Notarized Special Power of Attorney (SPA) 12 Picture on Site with landmarks
Corporation: Note: INCOMPLETE DOCUMENTS WILL NOT BE ACCEPTED
Notarized Secretary Certificate appointing the authorized (dili dawaton kung kulang ang mga dokumento)
person who will sign for and in behalf of the company all forms must be filled-up properly, use black ink
Community Association: (for residential buildings) only and write legibly
Association Board resolution Received/pre-evaluated as to checklist by:
Applicants Certificate of membership in that community
association Name/Position:
City Housing Clearance (if Gov't housing project)
a. if City; Box9 should be signed by the City Administrator Date/Time:
b. If NHA: Box9 should be signed by the regional manager
Signature:

loymi_lapuz_2000
 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:

loymi_lapuz_2000
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 :

loymi_lapuz_2000
NBC FORM NO. A - 01

Republic of the Philippines

City/Municipality of ________________
Province of _________________________
OFFICE OF THE BUILDING OFFICIAL

ARCHITECTURAL PERMIT
APPLICATION NO. AP NO BUILDING PERMIT NO.

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

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

LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO. _____________________
STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF ________________________________

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________ RAISING _______________________________________
ERECTION CONVERSION ________________________ ACCESSORY BUILDING/STRUCTURE________________
ADDITION REPAIR _____________________________ OTHERS (Specify) ________________________________
ALTERATION MOVING _____________________________ ________________________________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

1. ARCHITECTURAL FACILITIES AND OTHER FEATURES PURSUANT TO BATAS PAMBANSA BILANG 344, REQUIRING CERTAIN BUILDINGS, INSTITUTIONS,
ESTABLISHMENTS AND PUBLIC UTILITIES TO INSTALL FACILITIES AND OTHER DEVICES.
STAIRS WASH ROOMS AND TOILETS SWITCHES, CONTROLS, BUZZERS DRINKING FOUNTAINS
WALKWAYS LIFTS/ELEVATORS HANDRAILS PUBLIC TELEPHONES
CORRIDORS RAMPS THRESHOLDS SEATING ACCOMMODATIONS
DOORS, ENTRANCES & THRESHOLDS PARKING AREAS FLOOR FINISHES OTHERS (Specify) __________

2. PERCENTAGE OF SITE OCCUPANCY 3. CONFORMANCE TO FIRE CODE OF THE PHILIPPINES (P.D. 1185)

PERCENTAGE OF BUILDING FOOTPRINT ______________% NUMBER AND WIDTH OF EXIT DOORS FIRE WALLS OTHERS (Specify)
___________
PERCENTAGE OF IMPERVIOUS SURFACE AREA _______% WIDTH OF CORRIDORS FIRE FIGHTING AND SAFETY FACILITIES
PERCENTAGE OF UNPAVED SURFACE AREA __________% DISTANCE TO FIRE EXITS SMOKE DETECTORS
BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGEOF ARCHITECTURAL WORKS

Date____________ Date____________
ARCHITECT ARCHITECT
(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name )
Address Address
IAPOA No. Validity IAPOA No. Validity
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)

Date__________________ Date___________________

Address Address

C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
BOX 7

RECEIVED BY DATE

FIVE (5) SETS OF ARCHITECTURAL DOCUMENTS

1. VICINITY MAP/LOCATION PLAN WITHIN A TWO- 8. DETAILS OF RAMPS, PARKING FOR THE DISABLED, STAIRS,
KILOMETER RADIUS FIRE ESCAPES, CABINETS AND PARTITIONS
2. SITE DEVELOPMENT PLAN 9. SCHEDULE OF DOORS AND WINDOWS
3. PERSPECTIVE 10. SCHEDULE OF FINISHES FOR FLOORS, CEILINGS AND WALLS
4. FLOOR PLANS 11. ARCHITECTURAL INTERIOR
5. ELEVATIONS, AT LEAST FOUR (4) 12. SPECIFICATIONS
6. SECTIONS, AT LEAST TWO (2) 13. COST ESTIMATE
7. CEILING PLANS SHOWING LIGHTING FIXTURES AND 14. OTHERS (Specify)
DIFFUSERS _______________________________________________________
_______________________________________________________

BOX 8

PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME

ARCHITECTURAL DRAWINGS

SPECIFICATIONS

OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That under Article 1723 of the Civil Code of the Philippines, the architect (and engineer) who drew up the plans and
specifications for the building/structure is responsible 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 or 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. That the proposed architectural works shall be in accordance with the architectural plans filed with this Office and in
conformity with the latest Architectural Code of the Philippines, the National Building Code and its IRR.
3. That prior to any construction activity, a duly accomplished prescribed “Notice of Construction” shall be submitted to the
Office of the Building Official.
4. That upon completion of the construction, the licensed full-time inspector and supervisor/in-charge of construction works
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 architectural works conform to the
provision of the Architectural Code, the National Building Code and its IRR.
5. That this permit is null and void unless accompanied by the building permit.

PERMIT ISSUED BY:

BUILDING OFFICIAL
(Signature Over Printed Name)
Date ____________________
NBC FORM NO. A - 02

Republic of the Philippines

City/Municipality of ________________
Province of __________________________
OFFICE OF THE BUILDING OFFICIAL

CIVIL/STRUCTURAL PERMIT
APPLICATION NO. C/SP NO BUILDING PERMIT NO.

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

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

LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO.___________________

STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF ______________________________

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________ RAISING ______________________________________
ERECTION CONVERSION ________________________ DEMOLITION __________________________________
ADDITION REPAIR _____________________________ ACCESSORY BUILDING/STRUCTURE _____________
ALTERATION MOVING _____________________________ OTHERS (Specify) ______________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

NATURE OF CIVIL/STRUCTURAL WORKS:

STAKING ERECTION/LIFTING PRESTRESS WORKS

EXCAVATION CONCRETE FRAMING MATERIAL TESTING
SOIL STABILIZATION STRUCTURAL STEEL FRAMING STEEL TOWERS
PILING WORKS SLABS TANKS
FOUNDATION WALLS OTHERS (Specify)___________________________

PREPARED BY _______________________________________________________________________________________________________________

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

CIVIL/STRUCTURAL ENGINEER CIVIL/STRUCTURAL ENGINEER

(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)
Date________________________ Date________________________
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)

Date___________________ Date___________________

Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
BOX 7

RECEIVED BY: DATE:

FIVE (5) SETS OF CIVIL/STRUCTURAL DOCUMENTS

CIVIL/STRUCTURAL DESIGNS COMPUTATIONS, PLANS AND SPECIFICATIONS COST ESTIMATES

BILL OF MATERIALS OTHERS (Specify) __________________________________

BOX 8

PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME

CIVIL/STRUCTURAL

OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED 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 the building/structure is responsible 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 or defect sin 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. That the proposed civil/structural works shall be in accordance with the civil/structural plans filed with this office and in
conformity with the latest National Structural Code of the Philippines, the National Building Code and its IRR.
3. That prior to any construction activity, a duly accomplished prescribed “Notice of Construction” shall be submitted to the
Office of the Building Official.
4. That upon completion of the construction, the licensed full-time inspector and supervisor/in-charge of construction works
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 and submit a certificate of completion stating that the civil/structural works conform to
the provisions of the National Structural Code of the Philippines, the National Building Code and its IRR.
5. That this permit is null and void unless accompanied by the building permit.

PERMIT ISSUED BY:

BUILDING OFFICIAL
(Signature Over Printed Name)
Date ___________________
NBC FORM No A.-03

Republic of the Philippines

City/Municipality of Naga
Province of Camarines Sur
OFFICE OF THE BUILDING OFFICIAL

ELECTRICAL PERMIT

APPLICATION NO. EP NO. BUILDING PERMIT NO.

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE
ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO.________ BLK NO. __________ TCT NO. ______________________________ TAX DEC.NO.
_____________________________________
STREET___________________________________ BARANGAY_____________________________________ CITY//MUNICIPALITY OF_________________________________

SCOPE OF WORK
 NEW INSTALLATION  ANNUAL INSPECTION  RELOCATION OF SERVICE ENTRANCE
 ANNUAL INSPECTION  SEPARATION OF SERVICE ENTRANCE  OTHERS (Specify) ___________________________
 TEMPORARY  UPGRADING OF SERVICE ENTRANCE 

SUMMARY OF ELECTRICAL LOADS/CAPACITIES APPLIED FOR

TOTAL CONNECTED LOADS TOATAL TRANSFORMER CAPACITY TOATAL GENERATOR/UPS CAPACITY

_________________________Kva _________________________kVA _________________________kVA

BOX 2 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL)

Address

PRC No. Validity

_____________________________________________ Date_____________________
PROPESSIONAL ELECTRICAL ENGINEER PTR No. Date Issued
(Signed and Sealed Over Printed Name)
Issued at TIN

BOX 3
SUPERVISOR/IN-CHARGE PROFESSIONAL PLANS AND SPECIFICATIONS
  

 PROFESSIONAL ELECTRICAL ENGINEER  REGISTERED ELECTRICAL ENGINEER  MASTER ELECTRICIAN

_________________________________________________ Date_____________________
(Signed and Sealed Over Printed Name)

Address
PRC No. Validity
PTR No. Date Issued
Issued at TIN

BOX 4 BOX 5
BUILDING OWNER WITH MY CONSENT: LOT OWNER

_______________________________________________ Date: _________________ ________________________________________________ Date: _________________

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

Address Address

C.T.C No. Date Issued Place Issued: C.T.C No. Date Issued Place Issued:
 BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
RECEIVED BY: DATE:

FIVE (5) SETS OF ELECTRICAL DOCUMENTS

 ELECTRICAL PLANS AND SPECIFI CATIONS  PRPOSED STARTING DATE OF CONSTRUCTION/INSTALLATION
 SPECIAL FIXTURES AND EQUIPMENTS _______________________________________________________
 PRPOSED STARTING DATE OF CONSTRUCTION/INSTALLATION  OTHERS (Specify) _______________________________________
___________________________________________ 
BOX 7

PROGRESS FLOW

IN OUT PROCESSED BY

DATE TIME DATE TIME

ELECTRICAL
____________________________
ELECTRICAL ENGINEER
OTHERS (Specify) (Signature Over Printed Name)
PRC Reg. No. ___________
Validity _________________

BOX 8

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed electrical works shall be in accordance with the electrical plans filed with this Office and in conformity with the provision latest Philippine
Electrical Codes, the National Building Code and its IRR
2. That prior to the electrical installation, the Owner/Permitee shall submit a duly accomplished prescribe Notice of Construction to the Office of the Building
Official.
3. That for installed electrical capacity of 200 amperes and above at 230 volts nominal and above, a specialty electrical contractor duly licensed by the
Philippine Contractors Accreditation Board (PCAB) shall be required.
4. That a duly licensed electrical practitioner shall be in-charge of the installation, and that upon completion of the electrical works, he shall submit the entry
of the logbook duly signed and sealed to the OBO including as-built plans and other document. He shall also accomplish the Certificate Of Completion
stating the electrical works conforms to the provision of the Philippine Electrical Code, the National Building Code and its IRR.
5. That this permit is null and void unless accompanied by the building permit except for the projects involving purely electrical works in which in case only
the building permit number of the existing 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 the site work.

PERMIT ISSUED BY:

ALEXANDER N. CANING
ACTING BUILDING OFFICIAL
(Signature Over Printed Name)
Date____________________
NBC FORM NO. A - 04

Republic of the Philippines

City/Municipality of ___________________
Province of ___________________________
OFFICE OF THE BUILDING OFFICIAL

MECHANICAL PERMIT
APPLICATION NO. MP NO BUILDING PERMIT NO.

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

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

LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO. ____________________
STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF________________________________

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________ RAISING_______________________________________
ERECTION CONVERSION ________________________ DEMOLITION ___________________________________
ADDITION REPAIR _____________________________ ACCESSORY BUILDING/STRUCTURE ______________
ALTERATION MOVING _____________________________ OTHERS (Specify) _______________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

INSTALLATION AND OPERATION OF:

BOILER CENTRAL AIRCONDITIONING DUMBWAITER

PRESSURE VESSEL MECHANICAL VENTILLATION PUMPS
INTERNAL COMBUSTION ENGINE ESCALATOR COMPRESSED AIR, VACUUM, INSTITUTIONAL
REFRIGERATION AND ICE MAKING MOVING SIDEWALK and/or INDUSTRIAL GAS
WINDOW TYPE AIRCONDITIONING FREIGHT ELEVATOR PNEUMATIC TUBES, CONVEYORS
PACKAGED/ SPLIT TYPE AIRCONDITIONING PASSENGER ELEVATOR and/or MONORAILS
OTHERS (Specify) _____________________ CABLE CAR FUNICULAR

PREPARED BY _____________________________________________________________________________________________________________

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

PROFESSIONAL MECHANICAL ENGINEER

(Signed and Sealed Over Printed Name) (Signed and/or Sealed Over Printed Name)
Date________________________ Date___________________
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)

Date__________________ Date__________________
Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
BOX 7
RECEIVED BY: DATE:

FIVE (5) SETS OF MECHANICAL DOCUMENTS

MECHANICAL PLANS AND SPECIFICATIONS COST ESTIMATES

BILL OF MATERIALS OTHERS (Specify) ____________________________________

BOX 8

PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME

MECHANICAL
OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed mechanical works shall be in accordance with the mechanical plans filed with this Office and in conformity
with the latest Philippine Mechanical Code, the National Building Code and its IRR.
2. That prior to any mechanical installation, a duly accomplished prescribed “NOTICE OF CONSTRUCTION” shall be
submitted to the Office of the Building Official.
3. That upon completion of the mechanical 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 mechanical works conform to the provision of the Philippine Mechanical Code, the
National Building Code and its IRR.
4. That this permit is null and void unless accompanied by the building permit.
5. That a Certificate of Operation shall be issued for the continuous use of mechanical installations.

PERMIT ISSUED BY:

BUILDING OFFICIAL
(Signature Over Printed Name)
Date ______________________
NBC FORM NO. A- 05

Republic of the Philippines

City/Municipality of ________________
Province of _________________________

OFFICE OF THE BUILDING OFFICIAL

SANITARY PERMIT
APPLICATION NO. SP NO BUILDING PERMIT NO.

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

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

LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. _________________ TCT NO. _____________________ TAX DEC. NO. ____________________
STREET___________________ BARANGAY _________________________________________ CITY/ MUNICIPALITY OF ___________________________________________

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________ RAISING________________________________________
ERECTION CONVERSION ________________________ DEMOLITION ____________________________________
ADDITION REPAIR _____________________________ ACCESSORY BUILDING/STRUCTURE________________
ALTERATION MOVING _____________________________ OTHERS (Specify)_________________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

INSTALLATION AND OPERATION OF:

WATER SUPPLY: SYSTEM OF DISPOSAL:

SHALLOW WELL WASTE WATER TREATMENT PLANT SURFACE DRAINAGE

DEEP WELL & PUMP SET IMHOFF TANK STREET CANAL

CITY/MUNICIPAL WATER SYSTEM SANITARY SEWER CONNECTION WATER COURSE

OTHERS (Specify) ______________ SUB-SURFACE SAND FILTER OTHERS (Specify) ________________

PREPARED BY: ______________________________________________________________________________________________________________________________

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

Date_____________ Date_____________
SANITARY ENGINEER SANITARY ENGINEER
(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)

Date_________________ Date_________________
Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION

BOX 7

RECEIVED BY: DATE:

FIVE (5) SETS OF SANITARY DOCUMENTS

SANITARY PLANS AND SPECIFICATIONS COST ESTIMATES

BILL OF MATERIALS OTHERS (Specify) ______________________________

BOX 8

PROGRESS FLOW
IN OUT
PROCESSED BY
DATE TIME DATE TIME

SANITARY

OTHERS (Specify)

BOX  9  

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 on 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:

BUILDING OFFICIAL
(Signature Over Printed Name)
Date ____________________
NBC FORM NO. A -06
Republic of the Philippines
City/Municipality of ________________
Province of _________________________

OFFICE OF THE BUILDING OFFICIAL

PLUMBING PERMIT
APPLICATION NO. PP NO BUILDING PERMIT NO.

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

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

LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO. _____________________
STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF ________________________________

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________ RAISING________________________________________
ERECTION CONVERSION ________________________ DEMOLITION ____________________________________
ADDITION REPAIR _____________________________ ACCESSORY BUILDING/STRUCTURE ________________
ALTERATION MOVING _____________________________ OTHERS (Specify)_________________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

FIXTURES TO BE INSTALLED
QTY. NEW EXISTING KIND OF QTY. NEW EXISTING KIND OF
FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES
WATER CLOSET BIDETTE
FLOOR DRAIN LAUNDRY TRAYS
LAVATORY DENTAL CUSPIDOR
KITCHEN SINK DRINKING FOUNTAIN
FAUCET BAR SINK
SHOWER HEAD SODA FOUNTAIN SINK
WATER METER LABORATORY SINK
GREASE TRAP STERILIZER
BATH TUB OTHERS (Specify)
SLOP SINK __________________________
URINAL __________________________
AIR CONDITIONING UNIT __________________________
WATER TANK/RESERVOIR __________________________

TOTAL TOTAL
WATER DISTRIBUTION SYSTEM SEWAGE SYSTEM SEPTIC TANK STORM DRAINAGE SYSTEM
PREPARED BY: ______________________________________________________________________________________________________________________________

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

Date_______________ Date_______________
MASTER PLUMBER MASTER PLUMBER
(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)

Date_________________ Date__________________
Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
BOX 7

RECEIVED BY: DATE:

FIVE (5) SETS OF PLUMBING DOCUMENTS

PLUMBING PLANS AND SPECIFICATIONS COST ESTIMATES

BILL OF MATERIALS OTHERS (Specify) ________________________________

BOX 8

PROGRESS FLOW
IN OUT
PROCESSED BY
DATE TIME DATE TIME
RECEIVING AND RECORDING
PLUMBING
OTHERS (Specify)

BOX  9    

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:

BUILDING OFFICIAL
(Signature Over Printed Name)
Date ____________________
NBC FORM No A.-07

Republic of the Philippines

City/Municipality of Naga
Province of Camarines Sur
OFFICE OF THE BUILDING OFFICIAL

ELECTRONICS PERMIT
APPLICATION NO. ELP NO. BUILDING PERMIT NO.

BOX 1(TO BE ACCOMPLISHED PRINT BY THE OWNER/APPLICANT)

OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

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

LOCATION OF CONSTRUCTION: LOT NO.________ BLK NO. _____________ TCT NO. _____________________________ TAX DEC.NO. _______________________________

STREET_______________________________________ BARANGAY_____________________________________ CITY//MUNICIPALITY OF_____________________________

SCOPE OF WORK
 NEW INSTALLATION ANNUAL INSPECTION OTHERS (Specify)_____________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

NATURE OF INSTALLATION WORKS/EQUIPMENT SYSTEM:
 TELECOMMUNICATION SYSTEM  ELECTRONICS AND ALARM SYSTEM  ELECTRONICS COMPUTERIZED PROCESS
 BROADCASTING SYSTEM  SOUND COMMUNICATION SYSTEM CONTROLS AUTOMATION SYSTEM
 TELEVISION SYSTEM  CENTRALIZED CLOCK SYSTEM  BUILDING AUTOMATION MANAGEMENT AND
 INFORMATION TECHNOLOGY SYSTEM  SOUND SYSTEM CONTROL SYSTEM
 SECURITY AND ALARM SYSTEM  ELECTRONICS CONTROL AND CONVEYOR SYSTEM  BUILDING WIRING UTILIZING COPPER CABLE
 ANY OTHER ELECTRONICS AND IT SYSTEMS, FIBER OPTIC CABLE OR OTHER MEDIAL
EQUIPMENT, APPARATUS, DEVICE AND/OR ELECTRONICS SYSTEM
COMPONENT (Specify___________________________)

PREPARED BY____________________________________________________________________________________________________________________________

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

_________________________________________________ Date_________________ ______________________________________________ Date__________________

PROPESSIONAL ELECTRONICS ENGINEER ELECTRONICS ENGINEER
(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)
Date: _________________ Date:_________________

Address Address

C.T.C No. Date Issued Place Issued: C.T.C No. Date Issued Place Issued:
BOX 7 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
RECEIVED BY: DATE:

FIVE (5) SETS OF ELECTRONICS DOCUMENTS

 ELECTRONICS PLANS AND SPECIFI CATIONS  COST ESTIMATES

 BILL OF MATERIALS  OTHERS (Specify)

BOX 8
PROGRESS FLOW

IN OUT
PROCESSED BY
DATE TIME DATE TIME

ELECTRONICS

OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed electronics works shall be in accordance with the electronics plans filed with this Office and in conformity with the latest Electronics
Code of the Philippines
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 the completion of the electronic 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 Electronics works
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:

ALEXANDER N. CANING
ACTING BUILDING OFFICIAL
(Signature Over Printed Name)
Date____________________