REPUBLIC OF THE PHILIPPINES OFFICE OF THE CITY MAYOR
QUEZON CITY (BUILDING OFFICIAL) DO NOT FILL UP (NSO USE ONLY)
APPLICATION NO.
PERMIT NO.
BUILDING PERMIT DATE OF APPLICATION
DATE ISSUED
ORIGINAL
RENEWAL
BOX 1 (TO BE ACCOMPLISHED BY DESIGNING ARCHITECT / CIVIL ENGINEER IN PRINT) OWNER
LASTNAME
FIRSTNAME
FOR CONSTRUCTION OWNED BY AN ENTERPRISE
FORM OF OWNERSHIP
M.I.
TAX ACCT. NO.
MAIN ECONOMIC ACTIVITY OF BUSINESS
ADDRESS
TEL. NO.
LOCATION OF CONSTRUCTION SCOPE OF WORK:
OTHERS (SPECIFY)
1. NEW CONSTRUCTION 2. ADDITION OF _____________________ 3. REPAIR OF ________________________ 4. RENOVATION OF __________________ 5. DEMOLITION OF ___________________
USE OR TYPE OF OCCUPANCY RESIDENTIAL 11 SINGLE 12 DUPLEX 13 ROWHOUSE / ACCESSORIA 10 OTHERS (SPECIFY)____________________
6. __________OF______________ 7. __________OF______________
INDUSTRIAL 31 FACTORY (PLANT) 32 REPAIR SHOP, MACHINE SHOP 33 REFINERY 34 PRINTING PRESS 35 WAREHOUSE 30 OTHERS (SPECIFY)____________________
COMMERCIAL 21 BANK 22 STORE 23 HOTEL / MOTEL, ETC. 24 OFFICE CONDOMINIUM / BUSINESS OFFICE BUILDING.
INSTITUTIONAL
26 SHOP (e.g. DRESS SHOP, TAILORING SHOP, BARBER SHOP, ETC.
41 SCHOOL 42 CHURCH OR OTHER RELIGIOUS STRUCTURES 43 HOSPITAL OR SIMILAR STRUCTURES
27 GASOLINE STATION
44 WELFARE & CHARITABLE STRUCTURES
28 MARKET
45 THEATER, AUDITORIUM. GYMNASIUM, COURT
29 DORMITORY OR OTHER LODGING HOUSE
40 OTHERS (SPECIFY)____________________
25 RESTAURANT, ETC..
30 OTHERS (SPECIFY)____________________
OTHER CONSTRUCTION 60 (SPECIFY)____________________
AGRICULTURAL 41 BRAN(S), POULTRY HOUSE(S), ETC. 42 GRAIN MILL 40 OTHERS (SPECIFY)____________________
www.quezoncity.gov.ph OFFICE OF THE BUILDING OFFICIAL
STREET FURNITURE, LANDSCAPING & SIGNBOARDS 71 PARK, PLAZA’S, MONUMENT, POOLS, PLANT BOXES, ETC. 72 SIDEWALKS, PREMONADES, TERRACES, LAMPPOSTS, ELECTRIC POLES, TELEPHONE POLES, ETC. 73 OUTDOOR ADS, SIGNBOARDS, ETC. 74 FENCE ENCLOSURE
BOX 2 (TO BE ACCOMPLISHED BY RECEIVING & RECORDING SECTION) BUILDING DOCUMENTS (FIVE SETS EACH) SITE DEVELOPMENT & LOCATION PLAN ARCHITECTURAL PLAN & SPECIFICATIONS STRUCTURAL DESIGN & COMPUTATIONS SANITARY/PLUMBING PLANS & SPECIFICATIONS
MECHANICAL PLANS & SPECIFICATIONS LOGBOOK (1COPY) OTHERS (SPECIFY)
ELECTRICAL PLANS & SPECIFICATION
BOX 3 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL) ACTION TO BE TAKEN: PERMIT IS HEREBY GRANTED SUBJECT TO THE FOLLOWING CONDITIONS 1. THAT THE PROPOSED CONSTRUCTION/ADDITION/REPAIR/RENOVATION/ DEMOLITION/INSTALLATION ETC SHALL BE IN CONFORMITY WITH THE NATIONAL BUILDING CODE (PD 1096) AND ITS CORRESPONDING IMPLEMENTING RULES AND REGULATIONS 2. THAT A DULY LICENSED ARCHITECT/CIVIL ENGINEER HAS BEEN ENGAGED TO PLANS AND SPECIFICATIONS AND TO UNDERTAKE THE SUPERVISION/INSPECTION OF THE CONSTRUCTION OF THE PROJECT
ENGR. ISAGANI R. VERZOSA JR. LOCAL BUILDING OFFICIAL
3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED AND SEALED BY THE DESIGNING ARCHITECT / ENGINEER IN-CHARGE OF CONSTRUCTION SHALL BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE CONSTRUCTION OF THE PROJECT 4. THAT A CERTIFICATE OF OCCUPANCY “SHALL BE SECURED PRIOR TO ACTUAL OCCUPANCY OF THE BUILDING. NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 & 306 OF THE “NATIONAL BUILDING CODE”.
DATE
BOX 3A (TO BE ACCOMPLISHED BY THE DESIGNING ARCHITECT/CIVIL ENGINEER IN PRINT
BUILDING
P_____________
COST OF EQUIPMENT INSTALLED
ELECTRICAL
P_____________
P____________
MECHANICAL
P_____________
PROPOSED DATE OF CONSTRUCTION _____________
P____________
PLUMBING
P_____________
EXPECTED DATE OF COMPLETION _______________
OTHERS
P_____________
TOTAL COST
P_____________
TOTAL ESTIMATED COST
P____________
DO NOT FILL (NSO USE ONLY)
NUMBER OF STOREYS___________ TOTAL FLOOR AREA____________
MATERIAL OF CONST. ____________ (WOOD, CONC, STEEL, MIXED)
BOX 4 (TO BE ACCOMPLISHED BY THE DIVISION CONCERNED ASSESED FEES
AMOUNT DUE
ASSESSED BY
O.R. NUMBER
DATE PAID
LAND USE / ZONING LINE and GRADE BUILDING PLUMBING ELECTRICAL MECHANICAL OTHERS REVIEWED: TOTAL
CHIEF, PROCESSING DIVISION SECTION
BOX 5 (TO BE ACCOMPLISHED BY THE DIVISION CONCERNED PROGRESS FLOW
NOTED:
IN
CHIEF, PROCESSING DIVISION
TIME
OUT DATE
TIME
ACTION / REMARKS
DATE
PROCESSED BY:
RECEIVING and RECORDING LAND USE and ZONING GEODETIC (LINE and GRADE) ARCHITECTURAL STRUCTURAL SANITARY ELECTRICAL MECHANICAL
WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH BOX 6
BOX 8 www.quezoncity.gov.ph SIGNATURE OFFICE OF THE BUILDING OFFICIAL
ARCHITECT / CIVIL ENGINEER PRC REG. NO. SIGNED AND SEALED PLANS & SPECIFICATIONS PRINT NAME ADDRESS
COMMUNITY TAX CERT. PTR NO.
PTR NO.
PTR NO.
PLACE ISSUED
PLACE ISSUED
SIGNATURE
WITH MY CONSENT: BOX 9 (TO BE ACCOMPLISHED BY LOT OWNER)
BOX 7 ARCHITECT / CIVIL ENGINEER PRC REG. NO. SIGNED AND SEALED PLANS & SPECIFICATIONS
TCT / OCT NO.
PRINT NAME
PRINT NAME OF LO5T OWNER
ADDRESS
ADDRESS
PTR NO. SIGNATURE
PTR NO.
PLACE ISSUED
COMMUNITY TAX RECEIPT DATE ISSUED SIGNATURE
PLACE ISSUED
