Republic of the Philippines

Municipality of Tantangan
Province of South Cotabato

UNIFIED APPLICATION FORM FOR BUILDING PERMIT

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

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)

OWNER / APPLICANT LASTNAME FIRST NAME M.I. TIN DO NOT FILL-UP(PSA USE ONLY)

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE CONTACT NO.

LOCATION OF CONSTRUCTION: LOT NO._________BLK NO.__________TCT NO.________________CURRENT TAX DEC. NO.__________________

STREET_____________________BARANGAY______________________________CITY / MUNICIPALITY OF __________________________________
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION _______________________ RAISING ____________________________________
ERECTION ____________________ CONVERSATIONACCESORY __________ BUILDING/STRUCTURE _______________________
ADDITION _____________________ REPAIR ____________________________ LEGALIZATION OF EXISTING BUILDING _________
ALTERATION __________________ MOVING ___________________________ OTHERS (Specify) ____________________________
USE OR CHARACTER OF OCCUPANCY
GROUP A : RESIDENTIAL (DWELLINGS) GROUP E : COMMERCIAL GROUP H : ASSEMBLY (OCCUPANT
SINGLE DUPLEX RESIDENTIAL R-1, R-2 BANK STORE SHOPPING LOAD LESS THAN 1,000)
OTHERS ______________________________________ DRINKING / DINING CENTER / MALL THEATER, AUDITORIUM, CONVENTION HALL,
GROUP B. RESIDENTIAL ESTABLISHMENT GRANDSTAND/ BLEACHER
HOTEL MOTEL TOWNHOUSE SHOP (i.e. DRESS SHOP, TAILORING OTHERS_____ __________________________
DORMITORY BOARDING HOUSE, BARBERSHOP, etc.) GROUP I : ASSEMBLY (OCCUPANT
RESIDENTIAL R-3, R-4, R-5 LODGING HOUSE OTHERS____________________________ LOAD 1,000 OR MORE)
OTHERS _________________________________________ GROUP F : LIGHT INDUSTRIAL COLISEUM, SPORTS COMPLEX,
GROUP C : EDUCATIONAL & RECREATIONAL FACTORY / PLANT (USING INCOMBUSTIBLE/ CONVENTION CENTER AND SIMILAR
SCHOOL BUILDING SCHOOL AUDITORIUM, NON-EXPLOSIVE MATERIALS STRUCTURE
CIVIC CENTER GYMNASIUM OTHERS ______________________ _________ OTHERS _______________________________
CLUBHOUSE CHURCH, MOSQUE GROUP G : MEDIUM INDUSTRIAL GROUP J : (J-1) AGRICULTURE
OTHERS __________________ TEMPLE, CHAPEL STORAGE / WAREHOUSE (FOR HAZARDOUS/ BARN, GRANARY, POULTRY HOUSE
GROUP D. INSTITUTIONAL HIGHLY FLAMMABLE MATERIALS PIGGERY, GRAIN MILL, GRAIN SILO
HOSPITAL OR SIMILAR STRUCTURE FACTORY ( FOR HAZARDOUS/H IGHLY OTHERS________________________
HOME FOR THE AGED FLAMMABLE MATERIALS GROUP J : (J-2) ACCESORIES
GOVERNMENT OFFICE OTHERS __________________ _____________ PRIVATE CARPORT / GARAGE, TOWER,
OTHERS ________________________________________ SWIMMING POOL, FENCE OVER 1.80m,
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
_________________________________________________________
PRC No. Validity
ARCHITECT OR CIVIL ENGINEER
(Signed and Sealed Over Printed Name) PTR No. Date Issued
Date______________________________ Issued at TIN

BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER / AUTHORIZED REPRESENTATIVE

____________________________________________Date ___________ _______________________________________________Date __________

(Signature Over Printed Name) (Signature Over Printed Name)
Gov’t Issued ID__________________Date issued_________Place Issued_________ Gov’t Issued ID__________________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
thefollowing:
______________________________________ ____________________ _________________ ________________________________
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.______________
PageNo.______________ ___________________________________________________________________
Book No._____________ NOTARY PUBLIC (Until December ___________________________)
Series of _____________
BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
ASSESSED FEES ACCOUNT BASIS OF ASSESSMENT AMOUNT DUE ASSESSED BY

FOR ZONING (ZONING ADMINITRATOR):

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 asfull-time Inspector/supervisor of the construction works, by filling of the necessary
data/information required thereat.

2. The fully accomplised prescribe 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 prelude 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