Unified Ocuupancy Permit Form

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DBO 1/12/23, 2:37 PM

Republic of the Philippines


National Capital Region
Quezon City
UNIFIED APPLICATION FORM FOR
CERTIFICATE OF OCCUPANCY
  FULL  
PARTIAL

THIS APPLIES FOR:     


FOR:       FIRE
SAFETY INSPECTION CERTIFICATE

Building Permit  
No:
Date Issued:  
FSEC No:  
Date Issued:   2023-01-12
(DATE)

Name of Applicant/Owner:   
  (Last Name) (Given Name) (Middle Initial)

Address of  
Applicant/Owner

  ZIP Code:   Contact No:


 

Requirements submitted:

   3 copies of CertiXcate of Completion, duly notarized

   Construction Logbook, signed and sealed by the Owner's Architect or Civil Engineer
who undertook full-time inspection and supervision

   As-Built Plans, signed and sealed by the Owner's Architect or Civil Engineer who
undertook full-time inspection and supervision

   1 photocopy of valid licenses of all involved Professionals

   Captioned photographs of Site and Completed Building/Structure showing front

   Yellow Card issued by the Electrical Service Provider

Name of Project: Application for Occupancy Permit

Location of
Project:

Use/Character of    
Occupancy:

No. of Storey/s:    

No. of Units:    

Total Gross Floor Area (Sq Meters):


   

Date of Completion:    

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DBO 1/12/23, 2:37 PM

Submitted by;   
APPLICANT/OWNER
(Signature Over Printed Name)
Community Tax CertiXcate No.
 
Date Issued
Place Issued

Attested by;  
FULL-TIME INSPECTOR OR SUPERVISOR OF
CONSTRUCTION

 
ARCHITECT OR CIVIL ENGINEER
(Signed and Sealed Over Printed Name)
Date 2023-01-12
PRC No. : Validity :
PTR No. : Date Issued :
Issued at TIN
CTC No Date Issued Issued at

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