Republic of the Philippines

MUNICIPALITY OF GENERAL LUNA

Province of Surigao del Norte
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)

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 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
GYMNASIUM OTHERS _______________________
CIVIC CENTER 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,
SWIMMING POOL, FENCE OVER 1.80m,
GOVERNMENT OFFICE OTHERS _______________________________ STEEL / CONCRETE TANK
OTHERS _______________________________________ 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)
Address 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:
______________________________________________________ _____________________ _______________ ___________________________________
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
 BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)

BASIS OF AMOUNT
ASSESSED FEES ACCOUNT ASSESSED BY
ASSESSMENT DUE
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 Unified 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 UNDERTAKE that all information in this application is true and correct based on my personal knowledge and
authentic records submitted to Office of the Building Official, Municipality of Genera Luna. Any false or
misleading information supplied or production of fake / falsified documents shall be grounds for appropriate
legal action against me and automatically revokes the permit. I hereby agree that all personal data (as defined
under the Data Privacy Law of 2012 and its Implementation Rules and Regulations) and account transaction
information or records with the Local Government of General Luna may be processed, profiled or shared to
requesting parties or for the purpose of any court, legal process, examination, inquiry and audit or investigation
of any authority.”
___________________________________________________
SIGNATURE OVER PRINTED NAME OF OWNER/APPLICANT
NBC FORM NO. A - 01

Republic of the Philippines

Municipality of General Luna
Province of Surigao del Norte
OFFICE OF THE BUILDING OFFICIAL

ARCHITECTURAL PERMIT
APPLICATION NO. AP NO. BUILDING PERMIT NO.

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

OWNER / APPLICANT: LAST NAME FIRST NAME MIDDLE NAME TIN

FOR CONSTRUCTION OWNED BY AN ENTERPRISE FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

ADDRRESS: NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION:

LOT NO._______________ BLK. NO.____________ TCT NO.______________________________ TAX DEC. NO.__________________________

STREET____________________ BARANGAY_________________________ GENERAL LUNA, SURIGAO DEL NORTE

SCOPE OF WORK

 NEW CONSTRUCTION  RENOVATION  RAISING

 ERECTION  CONVERSION  ACCESSORY BUILDING/STRUCTURE

 ADDITION  REPAIR  OTHERS (Specify)____________________

 ALTERATION  MOVING

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

ARCHITECTURAL FACILITIES AND OTHER FEATURES PURSUANT TO BATAS PAMBANSA BILANG 344, REQUIRING CERTAIN BUILDINGS,
1 INSTITUTIONS, ESTABLISHMENTS AND UTILITIES TO INSTALL FACILITIES AND OTHER DEVICES.

 STAIRS  RAMPS  DRINKING FOUNTAINS

 WALKWAYS  PARKING AREAS  PUBLIC TELEPHONES
 CORRIDORS  SWITCHES, CONTROLS, BUZZERS  SEATING ACCOMMODATIONS
 DOORS, ENTRANCES & THRESHOLDS  HANDRAILS  OTHERS (Specify)_________________
 WASH ROOMS AND TOILETS  THRESHOLDS

 LIFTS/ELEVATORS  FLOOR FINISHES

2 PERCENTAGE OF SITE OCCUPANCY 3 CONFORMANCE TO FIRE CODE OF THE PHILIPPINES (P.D. 1185)
 PERCENTAGE OF BUILDING FOOTPRINTS ______%  NUMBER AND WIDTH OF EXIT DOORS  FIREWALLS

 PERCENTAGE OF IMPERVIOUS SURFACE AREA _____%  WIDTH OF CORRIDORS  SMOKE DETECTORS

 PERCENTAGE OF UNPAVED SURFACE AREA _______%  DISTANCE TO FIRE EXITS  EMERGENCY LIGHTS

 OTHERS (Specify) _____________________________  ACCESS TO PUBLIC STREET  OTHERS (Specify)

 FIRE FIGHTING AND SAFETY FACILITIES _________________

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF ARCHITECTURAL WORKS

ARCHITECT ARCHITECT
(Signed and Sealed over Printed Name) (Signed and Sealed over Printed Name)

Date_________________ Date_________________

Address Address
PRC NO. Validity PRC NO. Validity
PTR. NO. Date Issued PTR. NO. Date Issued
IAPAO NO. O.R. No. IAPAO NO. O.R. No.
Date Issued TIN Date Issued TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

(Signature over Printed Name) (Signature over Printed Name)

Date_______________ Date_______________

Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHE BY THE PROCESSING AND EVALUATION DIVISION

BOX 7
RECEIVED BY: DATE:

FOUR (4) SETS OF ARCHITECTURAL DOCUMENTS

 VICINITY MAP/ LOCATIONAL PLAN WITHIN A TWO-KILOMETER RADIUS DETAILS OF RAMPS, PARKING FOR THE DISABLED,

 SITE DEVELOPMENT PLAN STAIRS, FIRE ESCAPES, CABINETS AND PARTITIONS

 PERSPECTIVE  SCHEDULE OF DOORS AND WINDOWS

 FLOOR PLANS  SCHEDULE OF FINISHES FOR FLOORS, CEILING AND WALLS

 ELEVATIONS, AT LEAST FOUR (4)  ARCHITECTURAL INTERIOR

 SECTIONS, AT LEAST TWO (2)  SPECIFICATIONS

 CEILING PLANS SHOWING LIGHTING FIXTURES AND DIFFUSERS  COST ESTIMATES

 OTHERS (Specify)______________________

BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME
ARCHITECTURAL DRAWINGS
SPECIFICATIONS
OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1 That under Article 1723 of the Civil Code of the Philippines, the Architect (and Engineer) who drew up the plans and
specifications for the building/structure is responsible for the damages if within fifteen (15) years from the completion of
the building/structure, the same should collapse due to defect in the plans or specifications or defects in the ground.
The Engineer or Architect who supervises the construction shall be solidarily liable with the contractor should the edifice
collapse due to defect in the construction or the use of inferior materials.
2 That the proposed architectural works shall be in accordance with the architectural plans filed with this office and in
conformity with the latest Architectural Code of the Philippines, the National Building Code and its IRR.
3 That prior to any construction activity, a duly accomplished prescribed "NOTICE OF CONSTRUCTION" shall be
submitted to the Office of the Building Official.
4 That upon completion of the construction, the licensed full-time inspector and supervisor/in-charge of construction
works shall submit the entry to the logbook duly signed and sealed to the Building Official including As-Built plans and
other documents and shall also accomplish the Certificate of Completion stating that the architectural works conform to
the provision of the Architectural Code of the Philippines, the National Building Code and its IRR.

5 That this permit is null and void unless accompanied by the Building Permit.

PERMIT ISSUED BY:

ENGR. JERSON E. GALVEZ

BUILDING OFFICIAL
(Signature over Printed Name)
Date__________________

NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE "NATIONAL BUILDING CODE".
NBC FORM NO. A - 02

Republic of the Philippines

Municipality of General Luna
Province of Surigao del Norte
OFFICE OF THE BUILDING OFFICIAL

CIVIL/STRUCTURAL PERMIT
APPLICATION NO. C/SP NO. BUILDING PERMIT NO.

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

OWNER / APPLICANT: LAST NAME FIRST NAME MIDDLE NAME TIN

FOR CONSTRUCTION OWNED BY AN ENTERPRISE FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

ADDRRESS: NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION:

LOT NO._______________ BLK. NO.____________ TCT NO.______________________________ TAX DEC. NO.__________________________

STREET____________________ BARANGAY_________________________ GENERAL LUNA, SURIGAO DEL NORTE

SCOPE OF WORK

 NEW CONSTRUCTION  RENOVATION  RAISING

 ERECTION  CONVERSION  ACCESSORY BUILDING/STRUCTURE

 ADDITION  REPAIR  OTHERS (Specify)____________________

 ALTERATION  MOVING

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

NATURE OF CIVIL / STRUCTURAL WORKS:

 STAKING  ERECTION/LIFTING  PRE-STRESS WORKS

 EXCAVATION  CONCRETE FRAMING  MATERIAL TESTING

 SOIL STABILIZATION  STRUCTURAL STEEL FRAMING  STEEL TOWERS

 PILING WORKS  SLABS  TANKS

 FOUNDATION  WALLS  OTHERS (Specify)_________________

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF CIVIL/STRUCTURAL WORKS

CIVIL/STRUCTURAL ENGINEER CIVIL/STRUCTURAL ENGINEER

(Signed and Sealed over Printed Name) (Signed and Sealed over Printed Name)

Date_________________ Date_________________

Address Address
PRC NO. Validity PRC NO. Validity
PTR. NO. Date Issued PTR. NO. Date Issued
Issued at: TIN Issued at: TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

(Signature over Printed Name) (Signature over Printed Name)

Date_______________ Date_______________

Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHE BY THE PROCESSING AND EVALUATION DIVISION

BOX 7
RECEIVED BY: DATE:

FOUR (4) SETS OF CIVIL/STRUCTURAL DOCUMENTS

 CIVIL/STRUCTURAL DESIGNS COMPUTATIONS, PLANS AND SPECIFICATIONS  COST ESTIMATES

 BILL OF MATERIALS  OTHERS (Specify)______________________

BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME
CIVIL/STRUCTURAL
SPECIFICATIONS
OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1 That under Article 1723 of the Civil Code of the Philippines, the Engineer (or Architect) who drew up the plans and
specifications of the building/structure is responsible for the damage if within fifteen (15) years from the completion of
the building/structure, the same should collapse due to the defect in the plans or specifications or defects in the ground.
The Engineer or Architect who supervises the construction shall be solidarily liable with the contractor should the edifice
collapse due to defect in the construction or the use of inferior materials.
2 That the proposed civil/structural works shall be in accordance with the civil/structural plans filed with this Office and in
conformity with the latest National Structural Code of the Philippines, the National Building Code and its IRR.

3 That prior to any construction activity, a duly accomplished prescribed "NOTICE OF CONSTRUCTION" shall be
submitted to the Office of the Building Official.
4 That upon completion of the construction, the licensed full-time inspector and supervisor/in-charge of construction
works shall submit the entry to the logbook duly signed and sealed to the Building Official including As-Built plans and
other documents, and shall also accomplish the Certificate of Completion stating that the civil/structural works conform
to the provision of the National Structural Code of the Philippines, the National Building Code and its IRR.

5 That this permit is null and void unless accompanied by the Building Permit.

PERMIT ISSUED BY:

ENGR. JERSON E. GALVEZ

BUILDING OFFICIAL
(Signature over Printed Name)
Date__________________

NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE "NATIONAL BUILDING CODE".
NBC FORM NO. A - 03

Republic of the Philippines

Municipality of General Luna
Province of Surigao del Norte
OFFICE OF THE BUILDING OFFICIAL

ELECTRICAL PERMIT
APPLICATION NO. EP NO. BUILDING PERMIT NO.

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

OWNER / APPLICANT: LAST NAME FIRST NAME MIDDLE NAME TIN

FOR CONSTRUCTION OWNED BY AN ENTERPRISE FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

ADDRRESS: NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION:

LOT NO._______________ BLK. NO.____________ TCT NO.______________________________ TAX DEC. NO.__________________________

STREET____________________ BARANGAY_________________________ GENERAL LUNA, SURIGAO DEL NORTE

SCOPE OF WORK

 NEW INSTALLATION  RECONNECTION OF SERVICE ENTRANCE  RELOCATION OF SERVICE ENTRANCE

 ANNUAL INSPECTION  SEPARATION OF SERVICE ENTRANCE  OTHERS (Specify)____________________

 TEMPORARY  UPGRADING OF SERVICE ENTRANCE

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

NUMBER OF OUTLETS AND EQUIPMENT TO BE INSTALLED

 LIGHTS ______________  SWITCHES ______________  CONV. OUTLETS _________________

 BELL SYSTEM _____________  ELECTRIC RANGE _____ K.W.______  WATER HEATER _________________

 AIRCONDITIONING SYSTEM ___________  TELEPHONE _______________  MOTORS __________________

 OTHERS (Specify)_____________________________
SUMMARY OF ELECTRICAL LOADS/CAPACITIES APPLIED FOR

TOTAL CONNECTED LOAD TOTAL TRANSFORMER CAPACITY TOTAL GENERATOR/UPS CAPACITY

___________KVA _____________KVA _____________KVA

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF ELECTRICAL WORKS

PROFESSIONAL ELECTRICAL ENGINEER PROFESSIONAL ELECTRICAL ENGINEER / ELECTRICAL

(Signed and Sealed over Printed Name) ENGINEER / MASTER ELECTRICIAN
Date_________________ (Signed and Sealed over Printed Name)

Date_________________

Address Address
PRC NO. Validity PRC NO. Validity
PTR. NO. Date Issued PTR. NO. Date Issued
Issued at: TIN Issued at: TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

(Signature over Printed Name) (Signature over Printed Name)

Date_______________ Date_______________

Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHE BY THE PROCESSING AND EVALUATION DIVISION

BOX 7
RECEIVED BY: DATE:

FOUR (4) SETS OF ELECTRICAL DOCUMENTS

 ELECTRICAL PLANS AND SPECIFICATIONS  EXPECTED DATE OF COMPLETION/INSTALLATION/CONSTRUCTION

 SPECIAL FIXTURES AND EQUIPMENTS  OTHERS (Specify)______________________

 PROPOSED STARTING DATE OF INSTALLATION/CONSTRUCTION

BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME
ELECTRICAL
SPECIFICATIONS
OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1 That the proposed electrical works shall be in accordance with the electrical plans filed with this Office and in
conformity with the provisions of the latest Philippine Electrical Code, the National Building Code and its
Implementing Rules and Regulations.
2 That prior to any construction activity, a duly accomplished prescribed "NOTICE OF CONSTRUCTION" shall be
submitted to the Office of the Building Official.
3 That for installed electrical capacity of 200 amperes and above at 230 Volts nominal and above, a specialty electrical
contractor duly licensed by the Philippine Contractors Accreditation Board (PCAB) shall be required.

4 That a duly licensed electrical practitioner shall be in-charge of the installation, and that upon completion of the
electrical works, he/she shall submit the entry to the logbook duly signed and sealed to the Office of the Building
Official including As-Built plans and other documents. He/She shall also accomplish the Certificate of Completion
stating that the electrical works conform to the provisions of the Philippine Electrical Code, the National Building
Code and its IRR.
5 That this permit is null and void unless accompanied by the Building Permit except for projects involving purely
electrical works in which case only the building permit number of the existing building/structure shall be required.

6 That a Certificate of Final Electrical Inspection (CFEI) and Certificate of Occupancy shall be secured first prior to the
actual occupancy of the building.
7 That this permit shall be posted at the door of site of work.

PERMIT ISSUED BY:

ENGR. JERSON E. GALVEZ

BUILDING OFFICIAL
(Signature over Printed Name)
Date__________________

NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE "NATIONAL BUILDING CODE".
NBC FORM NO. A - 05

Republic of the Philippines

Municipality of General Luna
Province of Surigao del Norte
OFFICE OF THE BUILDING OFFICIAL

SANITARY PERMIT
APPLICATION NO. SP NO. BUILDING PERMIT NO.

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

OWNER / APPLICANT: LAST NAME FIRST NAME MIDDLE NAME TIN

FOR CONSTRUCTION OWNED BY AN ENTERPRISE FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

ADDRRESS: NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION:

LOT NO._______________ BLK. NO.____________ TCT NO.______________________________ TAX DEC. NO.__________________________

STREET____________________ BARANGAY_________________________ GENERAL LUNA, SURIGAO DEL NORTE

SCOPE OF WORK
 NEW CONSTRUCTION  RENOVATION  RAISING

 ERECTION  CONVERSION  ACCESSORY BUILDING/STRUCTURE

 ADDITION  REPAIR  OTHERS (Specify)____________________

 ALTERATION  MOVING

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

INSTALLATION AND OPERATIONS OF:

WATER SUPPLY SYSTEM OF DISPOSAL:

 SHALLOW WELL  WASTE WATER TREATMENT PLANT  SURFACE DRAINAGE

 DEEP WELL AND PUMP SET  IMHOFF TANK/SEPTIC TANK  STREET CANAL

 MUNICIPAL WATER SYSTEM  SANITARY SEWER CONNECTION  WATER COURSE

 OTHERS (Specify)_________________  SUB-SURFACES AND FILTER  OTHERS (Specify)____________

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF PLUMBING WORKS

SANITARY ENGINEER SANITARY ENGINEER

(Signed and Sealed over Printed Name) (Signed and Sealed over Printed Name)

Date_________________ Date_________________

Address Address
PRC NO. Validity PRC NO. Validity
PTR. NO. Date Issued PTR. NO. Date Issued
Issued at: TIN Issued at: TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

(Signature over Printed Name) (Signature over Printed Name)

Date_______________ Date_______________

Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHE BY THE PROCESSING AND EVALUATION DIVISION

BOX 7
RECEIVED BY: DATE:

FOUR (4) SETS OF SANITARY DOCUMENTS

 SANITARY PLANS AND SPECIFICATIONS  OTHERS (Specify)______________________

 BILL OF MATERIALS

BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME

RECEIVING AND RECORDING

SANITARY

OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1 That the proposed sanitary works shall be in accordance with the sanitary plans filed with this Office and in
conformity with the latest Code on Sanitation of the Philippines, the National Building Code and its IRR.
2 That prior to any construction activity, a duly accomplished prescribed "NOTICE OF CONSTRUCTION" shall be
submitted to the Office of the Building Official.
3 That upon completion of the sanitary works, the licensed full-time inspector and supervisor/in-charge of construction
works shall submit the entry to the logbook duly signed and sealed to the Building Official including As-Built plans
and other documents, and shall also accomplish the Certificate of Completion stating that the sanitary works conform
to the provisions of the Code on Sanitation of the Philippines, the National Building Code and its IRR.

4 That this permit is null and void unless accompanied by the Building Permit.

PERMIT ISSUED BY:

ENGR. JERSON E. GALVEZ

BUILDING OFFICIAL
(Signature over Printed Name)
Date__________________

NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE "NATIONAL BUILDING CODE".
NBC FORM NO. A - 06

Republic of the Philippines

Municipality of General Luna
Province of Surigao del Norte
OFFICE OF THE BUILDING OFFICIAL

PLUMBING PERMIT
APPLICATION NO. PP NO. BUILDING PERMIT NO.

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

OWNER / APPLICANT: LAST NAME FIRST NAME MIDDLE NAME TIN

FOR CONSTRUCTION OWNED BY AN ENTERPRISE FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

ADDRRESS: NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION:

LOT NO._______________ BLK. NO.____________ TCT NO.______________________________ TAX DEC. NO.__________________________

STREET____________________ BARANGAY_________________________ GENERAL LUNA, SURIGAO DEL NORTE

SCOPE OF WORK
 NEW CONSTRUCTION  ADDITION  REPAIR

 REMOVAL  OTHERS (Specify)____________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

FIXTURES TO BE INSTALLED
QTY. NEW EXISTING KIND OF FIXTURES QTY. NEW EXISTING KIND OF FIXTURES

___________    WATER CLOSET ___________    WATER TANK/RESERVOIR

___________    FLOOR DRAIN ___________    BIDETTE

___________    LAVATORIES ___________    LAUNDRY TRAYS

___________    KITCHEN SINK ___________    DENTAL CUSPIDOR
___________    FAUCET ___________    DRINKING FOUNTAIN
___________    SHOWER HEAD ___________    BAR SINK
___________    WATER METER ___________    SODA FOUNTAIN SINK

___________    GREASE TRAP ___________    LABORATORY SINK

___________    BATH TUB ___________    STERILIZER

___________    SLOP SINK ___________    OTHERS (Specify) _________

___________    URINAL ___________

___________    AIR CONDITIONING UNIT

________________ TOTAL ________________ TOTAL

 WATER DISTRIBUTION SYSTEM  SEWAGE SYSTEM  SEPTIC TANK  STORM DRAINAGE SYSTEM

PREPARED BY: _____________________________________________________________________________

BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF PLUMBING WORKS

MASTER PLUMBER MASTER PLUMBER

(Signed and Sealed over Printed Name) (Signed and Sealed over Printed Name)
Date_________________ Date_________________

Address Address
PRC NO. Validity PRC NO. Validity
PTR. NO. Date Issued PTR. NO. Date Issued
Issued at: TIN Issued at: TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

(Signature over Printed Name) (Signature over Printed Name)

Date_______________ Date_______________

Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHE BY THE PROCESSING AND EVALUATION DIVISION

BOX 7
RECEIVED BY: DATE:

FOUR (4) SETS OF PLUMBING DOCUMENTS

 PLUMBING PLANS AND SPECIFICATIONS  COST ESTIMATES

 BILL OF MATERIALS  OTHERS (Specify)______________________

BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME

RECEIVING AND RECORDING

PLUMBING

OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1 That the proposed plumbing works shall be in accordance with the sanitary plans filed with this Office and in conformity
with the Revised Plumbing Code of the Philippines, the National Building Code and its Implementing Rules and
Regulations.
2 That prior to any plumbing works, a duly accomplished prescribed "NOTICE OF CONSTRUCTION" shall be submitted
to the Office of the Building Official.
3 That upon completion of the plumbing works, the licensed full-time inspector and supervisor/in-charge of construction
works shall submit the entry to the logbook duly signed and sealed to the Building Official including As-Built plans and
other documents, and shall also accomplish the Certificate of Completion stating that the plumbing works of the
building conform to the provisions of the Revised Plumbing Code of the Philippines, the National Building Code and its
Implementing Rules and Regulations.
4 That this permit is null and void unless accompanied by the Building Permit.

PERMIT ISSUED BY:

ENGR. JERSON E. GALVEZ

BUILDING OFFICIAL
(Signature over Printed Name)
Date__________________

NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE "NATIONAL BUILDING CODE".