Republic of the Philippines
City/Municipality of __________________
BAGUIO
Province of __________________________
BENGUET
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 LAST NAME FIRST NAME M.I. TIN
DO NOT FILL-UP (PSA USE ONLY)
MELCHOR HIANO 000-941-771-344
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP
BY AN ENTERPRISE OWNER
ADDRESS: NO., STREET, BARANGAY, CITY / MUNICIPALITY ZIP CODE CONTACT NO.
LOT #52 HONEYMOON (HONEYMOON-HOLY GHOST) BAGUIO CITY BENGUET2600 09357267332
LOCATION OF CONSTRUCTION: LOT NO. _______
71 BLK NO. ________
7 TCT NO. ______________
0182021000066 CURRENT TAX DEC. NO. ____________________
202104004012200
BAGUIO CITY
STREET_____________________
N/A BARANGAY __________________________
QUIRINO HILL, MIDDLE CITY / MUNICIPALITY CITY/MUNICIPALITY
OF_____________________________________
OF
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION ACCESSORY BUILDING/STRUCTURE
ADDITION REPAIR LEGALIZATION OF EXISTING BUILDING
ALTERATION MOVING OTHERS (Specify)
USE OR CHARACTER OF OCCUPANCY
GROUP H : ASSEMBLY (OCCUPANT
GROUP A : RESIDENTIAL (DWELLINGS) GROUP E : COMMERCIAL LOAD LESS THAN 1,000)
SINGLE DUPLEX RESIDENTIAL R-1, R-2 BANK STORE SHOPPING THEATER, AUDITORIUM, CONVENTION HALL,
OTHERS ______________________________________ DRINKING / DINING CENTER / MALL GRANDSTAND/ BLEACHER
GROUP B : RESIDENTIAL ESTABLISHMENT OTHERS ______________________________
HOTEL MOTEL TOWNHOUSE SHOP (i.e. DRESS SHOP, TAILORING,
DORMITORY BOARDINGHOUSE, BARBERSHOP, etc.) GROUP I : ASSEMBLY (OCCUPANT
RESIDENTIAL R-3, R-4, R-5 LODGING HOUSE OTHERS ______________________________
` LOAD 1,000 OR MORE)
COLISEUM, SPORTS COMPLEX,
OTHERS _______________________________________ GROUP F : LIGHT INDUSTRIAL CONVENTION CENTER AND SIMILAR
GROUP C : EDUCATIONAL & RECREATIONAL FACTORY / PLANT (USING INCOMBUSTIBLE/ STRUCTURE
SCHOOL BUILDING SCHOOL AUDITORIUM, NON-EXPLOSIVE MATERIALS OTHERS _______________________
CIVIC CENTER GYMNASIUM OTHERS ______________________________
`
CLUBHOUSE CHURCH, MOSQUE, GROUP J : (J-1) AGRICULTURAL
TEMPLE, CHAPEL GROUP G : MEDIUM INDUSTRIAL BARN, GRANARY, POULTRY HOUSE,
OTHERS _______________ PIGGERY, GRAIN MILL, GRAIN SILO
STORAGE / WAREHOUSE (FOR HAZARDOUS/
GROUP D : INSTITUTIONAL HIGHLY FLAMMABLE MATERIALS OTHERS _______________________
HOSPITAL OR SIMILAR STRUCTURE FACTORY (FOR HAZARDOUS/ HIGHLY GROUP J : (J-2) ACCESSORIES
HOME FOR THE AGED FLAMMABLE MATERIALS PRIVATE CARPORT / GARAGE, TOWER,
GOVERNMENT OFFICE OTHERS _______________________________ SWIMMING POOL, FENCE OVER 1.80m,
STEEL / CONCRETE TANK
OTHERS _______________________________________ OTHERS _______________________
OCCUPANCY CLASSIFIED_____________________________
Residential Apartment TOTAL ESTIMATED COST: P ______________________________________
5120371.79
7
NUMBER OF UNITS__________________________________ 4,514,772.78
BUILDING ____________________________ COST OF EQUIPMENT INSTALLED:
NUMBER OF STOREY________________________________
2 w/ 2 basement w/ roofdeck ELECTRICAL ____________________________
263,197 P ______________________________
TOTAL FLOOR AREA ___________________________
435 SQ. M. MECHANICAL____________________________
N/A P ______________________________
LOT AREA ____________________________________
110 SQ. M ELECTRONICS___________________________
N/A P ______________________________
PLUMBING ___________________________
342,402.01 P ______________________________
JUNE 1, 2022
PROPOSED DATE OF CONSTRUCTION: _______________________________ EXPECTED DATE OF COMPLETION: _______________________________
JANUARY 27, 2023
BOX 2
FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
Address
JERVIN JHAYLEX SALIONG 30-Block 7 N/A Quirino Hill, East
PRC No. 0158366 Validity 05/15/2023
ARCHITECT OR CIVIL ENGINEER
PTR No. 4900621 Date Issued 01/24/2022
(Signed and Sealed Over Printed Name)
Date_____________________________ Issued at BAGUIO CITY TIN 322317337000
BOX 3 BOX 4
APPLICANT: WITH MY CONSENT: LOT OWNER / AUTHORIZED REPRESENTATIVE
MELCHOR HIANO
Date ______________ Date______________
(Signature Over Printed Name) (Signature Over Printed Name)
Address LOT #52 HONEYMOON (HONEYMOON-HOLY GHOST) BAGUIO CITY BENGUET Address
Gov’t Issued ID No. Date Issued Place Issued Gov’t Issued ID 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:
MELCHOR HIANO
______________________________________________________ _____________________ _______________ ___________________________________
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.____________ ________________________________________________________
Book No.____________ NOTARY PUBLIC (Until December _____________ )
Series of ____________
Copy 1: Owner Copy 2: OBO Copy 3: BFP Copy 4: Philippine Statistics Authority
*May require additional requirements
