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Repair Permit

This document is a repair permit application form for construction in the Municipality of Tagudin, Philippines. It requires information from the applicant, design professional, and building owner, along with details about the scope of work and compliance with the National Building Code. The permit is issued under specific conditions regarding safety and regulatory compliance.

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40 views2 pages

Repair Permit

This document is a repair permit application form for construction in the Municipality of Tagudin, Philippines. It requires information from the applicant, design professional, and building owner, along with details about the scope of work and compliance with the National Building Code. The permit is issued under specific conditions regarding safety and regulatory compliance.

Uploaded by

girliealemania.15
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

NBC FORM NO.

A - 01
Republic of the Philippines
Municipality of Tagudin
Province of Ilocos Sur
OFFICE OF THE BUILDING OFFICIAL

REPAIR PERMIT
APPLICATION NO. RP NO BUILDING PERMIT NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE 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 SUBDIVISION/BARANGAY

SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ADDITION REPAIR OTHERS (Specify)
ALTERATION MOVING

BOX 2 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL) BOX 3 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF COBSTRUCTION WORKS

Date Date
ARCHITECT OR CIVIL ENGR. ARCHITECT OR CIVIL ENGR.
(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

PROFESSIONAL)

BOX 4 BOX 5

BUILDING OWNER WITH MY CONSENT: LOT OWNER/ AUTHORIZED


REPRESENTATIVE

(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 6

APPLICANT
(Signature Over Printed Name)
Date
Address
C.T.C. No. Date Issued Place Issued
FEE PAID : _______________ OFFICIAL RECEIPT : ______________
DATE PAID : _______________ DATE ISSUED : ______________

BOX 7 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed repair works shall be in conformity with the provisions of the “National Building Code” (PD 1096) and its
implementing Rules and Regulations.

2. That the owner and contractor shall be jointly responsible for the safety, protection, security and the convenience of the general
public and his/her personnel, third parties, the works, equipment and the like.

3. That the permit shall not serve as exemption from the securing permits/written clearances from the various government authorities
exercising regulatory function affecting buildings and other related structures.

PERMIT ISSUED BY:

ENGR. ANTONIO S. VILLANUEVA, JR.


BUILDING OFFICIAL

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