NBC FORM NO.
B - 01
Republic of the Philippines
Department of Public Works and Highways
Municipality of DARAGA
Province of ALBAY
OFFICE OF THE BUILDING OFFICIAL
UNIFIED APPLICATION FORM FOR BUILDING PERMIT
AND FIRE SAFETY EVALUATION CLEARANCE
NEW RENEWAL AMENDATORY
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
LOCATION OF CONSTRUCTION: LOT NO. ______ BLK NO. ________ TCT NO. ______________ TAX DEC. NO. ____________________
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.
STREET_____________________ BARANGAY __________________________ CITY/ MUNICIPALITY OF_______________________________
SCOPE OF WORK
RENOVATION RAISING
NEW CONSTRUCTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ERECTION REPAIR OTHERS
(Specify)
ADDITION MOVING
ALTERATION
GROUP F : INDUSTRIAL OTHERS (Specify) ________________
USE OR CHARACTER OF OCCUPANCY
GROUP G : INDUSTRIAL STORAGE AND HAZARDOUS
GROUP A : RESIDENTIAL, DWELLINGS GROUP H : RECREATIONAL, ASSEMBLY OCCUPANT LOAD LESS THAN 1000
GROUP B : RESIDENTIAL HOTEL, APARTMENT GROUP I : RECREATIONAL, ASSEMBLY OCCUPANT LOAD 1000 OR MORE
GROUP C : EDUCATIONAL, RECREATIONAL GROUP J : AGRICULTURAL, ACCESSORY
GROUP D : INSTITUTIONAL
OCCUPANCY CLASSIFIED _________________________________________ TOTAL ESTIMATED COST P __________________________________
GROUPOF
NUMBER E :UNITS_______________________________________________
BUSINESS AND MERCANTILE
PROPOSED DATE OF CONSTRUCTION _________________________
TOTAL FLOOR AREA ______________________________ SQUARE METERS
EXPECTED DATE OF COMPLETION____________________________
BOX 2 _______________________________________________
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
Address
PRC No. Validity
ARCHITECT OR CIVIL ENGINEER PTR No. Date Issued
(Signed and Sealed Over Printed Name)
Date_____________________________ Issued at TIN
BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER
Date______________ Date______________
(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 PHILIPPINES ) 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 ________
