REPUBLIC OF THF PHILIPPINES APPENDIX B
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE: a SING TOSTINORA
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12. pueLex ERE on aca son
13 ROWHOU SOrREFINERY, BosaacnoNaiea
30. OTHERS (SPECIFY)
34 PRINTING PRE’
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DSBANRORS | UIGITOR ‘SO OTHERS (SPECI
22 STORE| zune
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24 OFFICE CONDOWINIUM/BUSMIESS OFFICE BUILDING
42 CHURCH AND OTHER RELIGIOUS STRUCTURE
-25-RESTAURANT EFC
“43° HOSPITAL OR SIMMILARSTRUCTURES
26 SHOP (2.9. ORESS SHOF 44 WELFARE, \BLE STRUCTURES...
ZT-SRSOLINE STATION" 45-THeaTER.auororiuul jonas
28 MARKET, 8 .heRS rec
25" OORMTORY OW OTHER LODqiNG HOUSE
20 “OTHERS {SFECIFY
“oTHER————t-
60 SPECIFY.
F STREET FURAITURE, EEE TSGRETTS
.74_ PARKS, PLAZAS, MONUMENT, POOLS, PLANT-BOKES, E7G-—-—
72 SIDEWALKS JPROMENADES, TERRACES, LAMPOSTS, ELECTRIO 7
73 OUTDOOR ADS- SIGNBQARI os, FIs:
74 FENCE ENCLOSURE“ oe
[80x {TO NE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION
BUILDING DOCUMENTS: (FIVE SETS | SEG
SITE DEVELOPMENT AND LOCATION PLAN
ARCHITECTURAL PLAN & SPECIFICATIONS
STRUCTURAL DESIGN & COMPUTATIONS
SANITARY/PLOMBING'PLANS & SPECIFICAT
"ELECTRICAL PLANS-3 SPECIFICATIONS
HSE ACOMESHEY FY THE BLN FFE)
"ACTION TAKEN:
PERMIT IS HEREBY GRANTED TO THE roluowe CONDITIONS:
4. THAT THE PROPOSED CONSTRUCTION/ADDITION/REPAIR/REPAIR/RENOVATION
BULDING CODE afEa ANTE CORMESRONDIG TUMENETIVGRULESAND
iL i iN
|_ BUILDING CODE (20.9086) ANDATSCORRESEONDING (MPLEMEN
2. THAT ADULY LIGENSED ARCHITECT/CIVIL ENGINEER HAS 6
PLANS AND SPECIFICATIONS AND TO UNDE SUPERVISE
| ~OF THE CONSTRUCTION OF THE
$3. THATA CERTIFICATE OF COMPLETION DULY SIGNED AND seit ty THEDESIGNING
-ARGHITECHENGINEER-AND-FHE-ANCHITEC/ENGINEER W-GHARGE OFCOM.
‘STRUCTION SHALL BE SUBMITTED NOT LATER ah EVEN) (7) DAYS; AFTER
GouPl T10W OF THe CONSTRUCTION OF THE PROJECT
| THAT A"CERTIFICATE OF OCCUPANCY” SHALL BE SECURED:PR! ea |ACTUF
gah OF me Bun
LOGBOOK (1 coPY)
OTHERS (SPECIFY
econ: poms & SPECIFICATIONS
avn
This PERMIT MAY B CANGELLED OR REVOKED PURSUIT iat TIONS: 0b 4308 Ty
{._OF THE NATIONAL BUILOING CODE: i
‘Tobe accomplished in five copies, one each for, applicant (original), Assessor, i ‘Staistics Office, Building Oficial, Fre Department,‘BOX 3A (TC BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER IN PRINT)
TOTAL ESTIMATE COST
cost oF
EQUIPMENT
INSTALLED
BUILDING ‘TOTAL FLOOR AREA.
ELECTRICAL P PROPOSED DATE
(OF CONSTRUCTION
MECHANICAL P.
PLUMBING P. EXPECTED DATE
OF COMPLETION,
OTHERS
-____
TOTAL COST P.
NUMBER OF STOREYS.
'DONOT FILL (NSO USE ONLY)
‘MATERIAL cogT const__|
(WOOD, CONC., STEEL, MIXED)
‘BOX 4 (FO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)
ASSESSED FEES
‘AMOUNT DUE _[ ASSESSED BY | 0.A. NUMBER
DATE PAID,
LAND USE/ZONING
LINE AND GRADE
BUILDING
PLUMBING
ELECTRICAL
|
es ese
MECHANICAL
OTHERS
TOTAL,
REVIEWED BY:
CHIEF, PROCESSING DIVISION/SECTION
‘BOX 5 (70 BE ACCOMPLISHED BY THE DIVISIOW/SECTION CONCERNED)
PROGRESS FLOW
NOTED: Ww
our aciow | pRocesseo
CHIEF, PROCESSING DIVISIONVSECTION TIME DATE
TIME DATE REMARKS By
RECEIVING and RECORDING
LAND USE AND ZONING
(GEODETIC (LINE and GRADE)
‘ARCHITECTURAL
STRUCTURAL
SANITARY/PLUMBING
ELECTRICAL
MECHANICAL
BOX 6
‘WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH,
BOX
"ARCHITECT/OIVIL ENGINEER
SIGNED AND SEALED PLANS/SPECIFICATIONS
PRINT NAME
[PRC REG. NO.
“ADDRESS
PIANO,
SIGNATURE
‘SIGNATURE
‘APPLICANT
DATE ISSUED
(COMMUNITY TAX CERT. | PLACE ISSUED
BOx7
WITH MAY CONSENT.
SOX9 (TOBE ACCOMPLIBNED RY LOT OWNER)
"ARCHITECT/CIVIL ENGINEER
IN-CHARGE OF CONSTRUCTION
PRINT NAME,
PRC REG. NO.
TCT/OCT NO. T
[arn tse :
“
"ADDRESS
“ADDRESS a
PIANO, DATE ISSUED | PLACE ISSUED
‘COMMUNITY TAX CERT.
‘SIGNATURE
TW |
‘SIGNATURE