DPWH FORM NO.

2003-001-B Republic of the Philippines

Department of Public Works & Highways
Pagadian City
Province of Zamboanga del Sur

OFFICE OF THE BUILDING OFFICIAL

APPLICATION FOR BUILDING PERMIT

APPLICATION NO AREA NO.

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

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

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 ______________ DEMOLITION ____________________________

ERECTION CONVERSION ______________ ACCESSORY BUILDING/STRUCTURE ________

ADDITION REPAIR ___________________ OTHERS( specify ) ________________________
ALTERATION MOVING __________________ ______________________________________

USE OR CHARACTER OF OCCUPACY

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

NUMBER OF SOTREY(S) _____________________________ PROPOSED DATE OF CONSTRUCTION _______________________

TOTAL FLOOR AREA _________________ SQUARE METERS EXPECTED DATE OF COMPLETION __________________________

TOTAL ESTIMATED COST P _________________________________(For Statistical Purposes Only)

_________________________________________________________

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

__________________________________________
PRC No. Validity:
ARCHITECT OR CIVIL ENGINEER
(Signal and Sealed Over Printed Name) PTR No. Date Issued:

Issued at TIN:
BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER
__________________________________________________________
(Signature Over Printed Name) __________________________________________________________
(Signature Over Printed Name)
Address Address
CTC No Date Issued Place Issued CTC No Date Issued Place Issued

BOX 5

REPUBLIC OF THE PHILIPPINE ) S.S

CITY/ MUNICIPALITY OF _____________________________________)
BEFORE ME, at the City/Municipality of _____________________________________, on ________________________ personally appeared the following:

__________ __________ ___________ ________________ ________________________

APPLICANT C.T.C. No. Date Issued Place Issued

_________________________________________ ___________ ________________ ________________________

LICENSED ARCHITECT OR CIVIL ENGINEER C.T.C. 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 ________

BOX 6 (SUBMITTALS TO BE CHECKED, RECEIVED AND RECORDED)

(FIVE (5) SETS EACH OF BUILDING DOCUMETNS SIGNED & SEALED BY A DULY LICENSED PROFESSIONAL OF RESPECTIVE DISCIPLINES)

LOT PLAN WITH VICINITY MAP SANITARY PLANS AND SPECIFICATIONS

ARCHITECTURAL PLANS AND SPECIFICATIONS PLUMBING PLANS AND SPECIFICATIONS
CIVIL/ STRUCTURAL PLANS (DESIGN AND COMPUTATION) ELECTRONICS PLANS AND SPECIFICATIONS
ELECTRICAL PLANS AND SPECIFICATIONS OTHERS (Specify) _____________________________
MECHANICAL PLANS AND SPECIFICATIONS ______________________________________________
BOX 7 (TO BE ACCOMPLISHED BY THE TECHNICAL STAFF OF THE DIFFERENT SECTIONS OF THE OFFICE OF THE BUILDING OFFICIAL) To be shown to the applicant.
IN OUT PROGRESS FLOW
RECEIVING AND RECORDING
DATE TIME DATE TIME ACTION/REMARKS PROCESSED BY
LOCATIONAL/ZONING OF LAND USE
LINE AND GRADE (Geodetic)
ARCHITECTURAL
CIVIL/STRUCTURAL
ELECTRICAL
MECHANICAL
SANITARY
PLUMBING
ELECTRONICS
INTERIOR
OTHERS (Specify)
NOTED:
CHIEF, PROCESSING AND EVALUATION DIVISION
BOX 8 (TO BE ACCOMPLISHED BY THE TECHNICAL STAFF OF THE DIFFERENT SECTIONS OF THE OFFICE OF THE BUILDING OFFICIAL)
ASSESSED FEES ASSESSED BY AMOUNT DUE DATE PAID O.R. NUMBER
FILING FEE

PROCESSING FE

LOCATIONAL/ZONING OF LAND USE

LINE AND GRADE (Geodetic)

FENCING
ARCHITECTURAL
CIVIL/STRUCTURAL
ELECTRICAL
MECHANICAL
SANITARY
PLUMBING
ELECTRONICS
INTERIOR
ONE HALF (1/2) OF FIRE SERVICE FUND (FSF)
TOTAL
REVIEWED:
CHIEF, PROCESSING AND EVALUATION DIVISION
BOX 9
BP NO. Building Permit DATE ISSUED

Permit is issued to __________________________ for the proposed _____________________ under ___________________________

of
(Owner/Applicant) (Type of Project) (Use or Character of Occupancy)
group _____, located at lot no. ___ block no. ___ OCT/TCT no. __________________ Barangay _____________________________________
City/Municipality of ________________________________ subject to the following:
1. That the designer is aware that under Article 1723 of the Civil Code of the Philippines, he/she is responsible for damages if within fifteen (15) years from
the completion of the building/structure, it should collapse due to defect in the plans or specifications or defect in the ground. He/She is therefore enjoined to conduct
periodic inspections of the building/structure to ensure that the conditions under which the building/structure was designed are not being violated or abused.
2. 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.
1.1 That prior to commencement of the proposed projects and construction an actual relocation survey shall be conducted by a duly licensed Geodetic
Engineer.
2.2 That before commencing the excavation the person making or causing the excavation is to be made shall notify in writing the owner of adjoining
property not less than (10) days before such excavation is to be made and show how the adjoining property should be protected.
2.3 That the supervising Architect/Civil Engineer shall keep at the jobsite at all times a logbook of daily construction activities wherein the actual daily
progress of construction including tests conducted, weather condition and other pertinent data are to be recorded.
2.4 That upon completion of the construction, the said licensed supervising Architect or Civil Engineer shall submit the logbook duly signed and sealed
to the Building Official including 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.
3. 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 the Use/Occupancy of a portion or portions of a building/structure prior to the completion of the entire
building/structure.
4. That this permit shall not serve as an exemption from securing written clearances from various government authorities exercising regulatory function
affecting buildings/structures.
5. When the construction is undertaken by contract, the work shall be done by a duly licensed and registered contractor.
RECOMMENDING ISSUANCE OF BUILDING PERMIT:

_______________________________ _________________________________

CHIEF,PROCESSING AND EVALUATION DIVISION CHIEF,INSPECTION AND ENFORCEMENT DIVISION

(Signature Over Printed Name) (Signature Over Printed Name)
Date _____________ Date ____________
PERMIT ISSUED:
_______________________________
PINUNONG PANGGUSALI
(Building Official)
Date_________