NBC FORM NO.

B - 01
Republic of the Philippines
Municipality of
Municipality of Roxas
Belison
Province of Oriental
Province Mindoro
of Antique
OFFICE OF THE BUILDING OFFICIAL
APPLICATION FOR BUILDING PERMIT
NEW RENEWAL AMENDATORY
APPLICATION NO. x AREA NO
x
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)
OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN DO NOT FILL-UP (NSO USE ONLY)

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 RAISING
ERECTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ADDITION REPAIR OTHERS (Specify)
1
1 ALTERATION MOVING
1
USE
1 OR CHARACTER OF OCCUPANCY
1 GROUP A : RESIDENTIAL, DWELLINGS GROUP F : INDUSTRIAL OTHERS (Specify) ________________
1
GROUP G : INDUSTRIAL STORAGE AND HAZARDOUS
1 GROUP B : RESIDENTIAL HOTEL, APARTMENT
1 GROUP C : EDUCATIONAL, RECREATIONAL GROUP H : RECREATIONAL, ASSEMBLY OCCUPANT LOAD LESS THAN 1000
1
GROUP I : RECREATIONAL, ASSEMBLY OCCUPANT LOAD 1000 OR MORE
1 GROUP D : INSTITUTIONAL
1 GROUP E : BUSINESS AND MERCANTILE GROUP J : AGRICULTURAL, ACCESSORY

OCCUPANCY CLASSIFIED ________________________________________ TOTAL ESTIMATED COST P_________________________________

NUMBER OF UNITS _______________________________________________
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 ________