FORM NO.

B-01 PS-OME-BP-01-00
Republic of the Philippines
MUNICIPALITY OF PILAR
SORSOGON

UNIFIED APPLICATION FORM FOR BUILDING PERMIT

SIMPLE COMPLEX*
NEW RENEWAL AMENDATORY
THIS APPLIES ALSO FOR: LOCATIONAL CLEARANCE
APPLICATION NO. AREA NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT) DO NOT FILL-UP (PSA 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 PROVINCE ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO.________ BLK. NO.__________ TCT NO. _______________ CURRENT TAX DEC. NO. _________________
STREET _____________ BARANGAY _________________________ MUNICIPALITY OF ___________________________________________________
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION __________________ RAISING_______________________________________
ERECTION _______________ CONVERSION __________________ ACCESSORY BLDG./STRUCTURE _________________
ADDITION ________________ REPAIR _______________________ LEGALIZATION OF EXISTING BUILDING_____________________
ALTERATION _____________ MOVING _______________________ OTHERS (Specify)_______________________________________
USE OR CHARACTER OF OCCUPANCY
GROUP A : RESIDENTIAL (DWELLINGS) GROUP E : BUSINESS MERCANTILE GROUP H: ASSEMBLY (OCCUPANT
SIMPLE DUPLEX RESIDENTIAL R-1,R-2 BANK STORE SHOPPING LOAD LESS THAN 1,000)
OTHERS_____________________________________ DRINKING/DINING CENTER/MALL ESTABLISHMENT THEATER, AUDITORIUM, CONVENTION HALL,
GROUP B : RESIDENTIAL HOTEL, APARTMENT SHOP(i.e. DRESS SHOP, TAILORING, BARBER SHOP, GRANDSTAND/BLEACHER
HOTEL MOTEL TOWNHOUSE etc.) OTHERS________________________
DORMITORY BOARDING HOUSE OTHERS________________________ GROUP I: ASSEMBLY (OCCUPANT
RESIDENTIAL, R-3, R-4, R-5 LODGING HOUSE GROUP F: LIGHT INDUSTRIAL LOAD 1,000 OR MORE)
OTHERS _______________________________ FACTORY/PLANT(USING INCOMBUSTIBLE/ COLISEUM, SPORTS COMPLEX, COVENTION
GROUP C : EDUCATIONAL & RECREATIONAL NON-EXPLOSIVE MATERIALS CENTER AND SIMILAR STRUCTURE
SCHOOL BUILDING SCHOOL AUDITORIUM, OTHERS________________________ OTHERS__________________________
CIVIC CENTER GYMNASIUM GROUP G: MEDIUM INDUSTRIAL GROUP J: (J-1) AGRICULTURAL
CLUBHOUSE CHURCH, MOSQUE, STORAGE/WAREHOUSE (FOR HAZARDOUS/ BARN, GRANARY, POULTRY HOUSE,
OTHERS ____________ TEMPLE,CHAPEL HIGHLY FLAMMABLE MATERIALS) PIGGERY,GRAIN MILL, GRAIN SILO
GROUP D : INSTITUTIONAL FACTORY (FOR HAZARDOUS/HIGHLY OTHERS__________________________
HOSPITAL OR SIMILAR STRUCTURE FLAMMABLE MATERIALS) GROUP J: (J-1) AGRICULTURAL
HOME FOR THE AGED OTHERS_________________________________ PRIVATE CARPORT/GARAGE, TOWER,
OTHERS_________________________________ SWIMMING POOL. FENCE OVER 1.80 M,
STEEL/CONCRETE TANK
OTHERS__________________________
OCCUPANCY CLASSIFIED ____________________________ TOTAL ESTIMATED COST P ________________________________________________________
NUMBER OF UNITS __________________________________ BUILDING_____________________________ COST OF EQUIPMENT INSTALLED
NUMBER OF STOREY_________________________________ ELECTRICAL__________________________ P_____________________________
TOTAL FLOOR AREA ___________________________ SQ.M. MECHANICAL__________________________ P_____________________________
LOT AREA_____________________________________SQ.M. ELECTRONICS_________________________ P_____________________________
PLUMBING____________________________ P_____________________________
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

_____________________________________________ 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 )
CITY / MUNICIPALITY OF _________________ ) S.S

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 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. ________________ NOTARY PUBLIC (Until December _________)
Book No. ________________
Series of ________________
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