Republic of the Philippines

City of Pasig
National Capital Region
UNIFIED APPLICATION FORM FOR BUILDING PERMIT
OFFICE OF THE BUILDING OFFICIAL
86431111 LOC. 1682
 SIMPLE  COMPLEX*
 NEW  RENEWAL  AMENDATORY
THIS APPLIES ALSO FOR:  LOCATIONAL CLEARANCE  FIRE SAFETY EVALUATION CLEARANCE

APPLICATION NO. BUILDING PERMIT NO. DATE ISSUED

- - - -
BOX 1 (TO BE ACCOMPLISHED BY THE OWNER / APPLICANT/ COMPANY) DO NOT FILL-UP (PSA USE ONLY)
OWNER / APPLICANT/COMPANY LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED BY AN FORM OF OWNERSHIP

ENTERPRISE
ADDRESS LOT NO. _ BLK NO. TCT NO. CURRENT TAX DEC. NO. __________________________________
STREET BARANGAY CITY / MUNICIPALITY OF_____________________________
LOCATION OF CONSTRUCTION TELEPHONE / MOBILE NO.

SCOPE OF WORKS
 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 A – RESIDENTIAL (DWELLINGS)  GROUP E – COMMERCIAL  GROUP H – ASSEMBLY (OCCUPANT LOAD
 SINGLE  DUPLEX  RESIDENTIAL R-1, R-2  BANK  STORE  SHOPPING LESS THAN 1,000)
 OTHERS_______________________________________  DINING DRINKING CENTER /  THEATER AUDITORIUM, CONVENTIONAL HALL,
ESTABLISHMENT MALL GRANDSTAND / BLEACHER
 GROUP B – RESIDENTIAL  SHOP (I.E. DRESS SHOP, TAILORING,  OTHERS_________________________________________
 HOTEL  MOTEL  TOWNHOUSE BARBERSHOP, ETC.)
 DORMITORY  BOARDING HOUSE,  OTHERS________________________________________  GROUP I – ASSEMBLY (OCCUPANT LOAD
 RESIDENTIAL R-3, R-4, R5 LODGING HOUSE 1,000 OR MORE)
 OTHERS__________________________________________  GROUP F – LIGHT INDUSTRIAL  COLISEUM, SPORTS COMPLEX, CONVENTION CENTER
 FACTORY / PLANT (USING INCOMBUSTIBLE / NON- AND SIMILAR STRUCTURE
 GROUP C – EDUCATIONAL & RECREATIONAL EXPLOSIVE MATERIALS)  OTHERS_________________________________________
 SCHOOL BUILDING  SCHOOL AUDITORIUM,  OTHERS________________________________________
 CIVIC CENTER GYMNASIUM  GROUP J –(J-1) AGRICULTURAL
 CLUBHOUSE  CHURCH, MOSQUE,  GROUP G – MEDIUM INDUSTRIAL  BARN, GRANARY, POULTRY HOUSE, PIGGERY, GRAN
TEMPLE, CHAPEL  STORAGE / WAREHOUSE (FOR HAZARDOUS / HIGHLY MILL, GRAIN SILO
 OTHERS__________________________________________ FLAMMABLE MATERIALS  OTHERS_________________________________________
 FACTORY (FOR HAZARDOUS / HIGHLY FLAMMABLE
 GROUP D – INSTITUTIONAL MATERIALS)  GROUP J –(J-2) ACCESSORIES
 HOSPITAL OR SIMILAR STRUCTURE  OTHERS_______________________________________  PRIVATE CARPORT, / GARAGE, TOWER, SWIMMING
 HOME FOR THE AGED POOL, FENCE OVER 1.80M, STEEL CONCRETE TANK
 GOVERNMENT OFFICE  OTHERS_________________________________________
 OTHERS__________________________________________

TOTAL ESTIMATED COST P________________________________

OCCUPANCY CLASSIFIED______________________
BUILDING _______________________ Cost of equipment installed
NUMBER OF UNITS____________________________
ELECTRICAL _______________________ P _______________________________
NUMBER OF STOREY___________________________
MECHANICAL _______________________ P _______________________________
TOTAL FLOOR AREA _____________________ SQ. M. P _______________________________
ELECTRONICS _______________________
LOT AREA ______________________________ SQ. M P _______________________________
PLUMBING _______________________
Proposed date of construction __________________________________________ Expected date of completion ___________________________________________

BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
ADDRESS

_______________________________________
ARCHITECT OR CIVIL ENGINEER PRC NO. VALIDITY
(Signed and Sealed Over Printed Name) PTR NO. DATE ISSUED
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 demolition works)

whose signature appear above, known to me to be the same persons who executed this standard prescribed form and acknowledge to me that the same is their free and voluntary CT and Deed.
WITNESSED MY HAND AND SEAL on the date and place above written
Doc. No. ____________________________ __________________________________________
Page No. ____________________________ Notary Public (Until December ___________)
Book No. ____________________________
Series No. ___________________________
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)

ASSESSED FEES ACCOUNT BASIS OF ASSESSMENT AMOUNT DUE ASSESSED BY

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/APPLICANT SHALL ACCOMPLISH THE PRESCRIBED APPLICATION FORM, WITH THE ASSISTANCE OF
THE CONCERNED DESIGN PROFESSIONAL/S AND/OR THE ARCHITECT/CIVIL ENGINEER, HIRED/COMMISSIONED BY
HIM/HER AS FULL-TIME INSPECTOR/SUPERVISOR OF THE CONSTRUCTION WORKS, BY FILLING UP THE
NECESSARY DATA / INFORMATION REQUIRED THEREAT.

2. THE FULLY ACCOMPLISHED PRESCRIBED 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 OF THE PHILIPPINES (PD 1096), ITS REVISED IRR AND ALL
APPLICABLE REFERRAL CODES AND PROFESSIONAL REGULATORY LAWS, TOGETHER WITH THE OTHER
DOCUMENTARY REQUIREMENTS PURSUANT TO SECTION 302 OF PD 1096 AND ITS REVISED 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