Building Permit Form

APPLICANT
PROJECT:
PROPOSED 5-UNITS COMMERCIAL BUILDING
Name of Applicant
>
Last Name
First Name
Middle Name
ROSALYN B. SHIMOKAWA
Address:
Street NO.
Barangay
City / Municipality
Street NO.
Barangay
City / Municipality
>
Location:
> KAUSWAGAN, CAGAYAN DE ORO CITY, NEAR QUADRO OCHO

Tax declaration No.
TCT / OCT No.
DATE and PLACE
>
> 137-2012002460
>
TOTAL BUILDING AREA
Residence Certificate No.
Sq.m
>
Date Issued:
Building
>
Place Issued:
Electrical
Mechanical
>
Plumbing
T.I.N.
Others (Specify)
>
TOTAL COST
Php
Php
Php
Total
Php
LOT OWNER
Name :
Last Name
>
Address:
First Name
Middle Name
Street NO.
Barangay
City / Municipality
> 0
Tax Declaration No.
TCT / OCT No.
DATE and PLACE
> 0
>
>
137-2015003801,-2028,-2029
CDO
> 0
Date Issued:
> 12/30/1899
Place Issued:
> 0
T.I.N.
> 0
Architect
Electrical Engineer
Name:
Name:
> ARCH. HEINRICH S. TY
> ENGR. ANTONIO S. OLANGO
Address:
Address:
> KAUSWAGAN, CDO
> LAPASAN, CAGAYAN DE ORO CITY
PTR NO.
PTR NO.
> 4037160
> 4030066B
TIN:
TIN:
> 920-165-451
> 157 303 184
PRC Reg. NO.
PRC Reg. NO.
> 15013
> 2835
Date Issued:
Date Issued:
> 16-Jan-15
> jan/8/2015
Place Issued:
Place Issued:
> CDO
> CDO
Master Plumber
Mechanical Engineer
Name:
Name:
> MR. REYNALDO DIUPIN C. TY
> ALFREDO T. BUTEN
Address:
Address:
> KAUSWAGAN, CDO
> SCIONS KAUSWAGAN CDOC
PTR NO.
PTR NO.
> 4039435
> 4019193B
TIN:
TIN:
> 114-752-873
> 144-327-259
PRC Reg. NO.
PRC Reg. NO.
> 939
> 3126
Date Issued:
Date Issued:
> 3-Jan-15
> 6-Jan-15
Place Issued:
Place Issued:
> CDO
> CDO
Civil Engineer
Place
Address:
> CITY OF CAGAYAN DE ORO

> CAGAYAN DE ORO CITY
> #8, T-SQUARE BUILDING, SAINT IGNATIUS ST.,
> LAPASAN, CAGAYAN DE ORO
>
Name:
> ENGR. ROMMEL RAFISURA
PTR NO.
> 9504543B
TIN:
> 186 - 383 - 721

PRC Reg. NO.
> 75326
Date Issued:
> 27-Jan-15
Place Issued:
> CDO
Republic of the Philippines

CITY OF CAGAYAN DE ORO
OFFICE OF THE BUILDING OFFICIAL
BUILDING PERMIT
BP NO.
Date
BOX 1 (To be accomplished by designing Architect/Civil Engineer, in print)
Last Name
First Name
M.I.
NAME OF APPLICANT:
Tax Identification Number
For Construction owned
Form of Ownership
0
Main Economic Activity/Kind of Business
by an Enterprise
ADDRESS:
Street no.
LOCATION:
Street no.
Barangay
City/Municipality
Barangay
City/Municipality
0
KAUSWAGAN, CAGAYAN DE ORO CITY, NEAR QUADRO OCHO
SCOPE OF WORK:
[ ] New Constructi [ ] Additi
[ ] Repair [ ] Renovation
[ ] Demolitio [ ] Others (Specify)
USE OR TYPE OF OCCUPANCY:
RESIDENTIAL
[ ] Single
[ ] Duplex
[ ] Rowhouse / Accessories
[ ] Others ( specify 2-storey
)
COMMERCIAL
[ ] Bank
[ ] Stores
[ ] Market
[ ] Gasoline Station
[ ] Hotel/Motel/Restaurants, etc.
[ ] Office, Condominium/Business Office
[ ] Shop (Dress, Tailoring, Barber, and the like)
[ ] Dormitory or othe Lodging House
[ ] Others ( specify )
INDUSTRIAL
[ ] Factory
[ ] Repair Shop, Machine Shop
[ ] Refinery
[ ] Printing Press
[ ] Warehouse
AGRICULTURAL
[ ] Barns, Poultry Houses, etc.
[ ] Grain, Mill
INSTITUTIONAL
[ ] School
[ ] Church and Other Religious Structures
[ ] Hospital or Similar Structures
[ ] Welfare and Charitable Structures
[ ] Theater, Auditorium, Stadium, Court
STREET FURNITURE, LANDSCAPING & SIGNBOARD

[ ] Parks, Plazas, Monuments, Pools, Plant Boxes, etc.
[ ] Outdoor Ads, Signboards, etc.
[ ] Fence (Enclosure)
[ ] Sidewalks, Promenades, Terraces, Lampposts, Electric Pole OTHER CONSTRUCTION
Telephone Poles, etc.
[ ] Specify
BOX 2 (To be accomplished by the Receiving and Recording Section)
BUILDING DOCUMENTS (Five sets each)
[
[
[
[
[
] Perspective
] Architectural Plans
] Structural Plans
] Sanitary/Plumbing Plans
] Electrical Plans
[
[
[
[
[
] Mechanical Plans
Others (Specify)
] Specifications
] Bill of Materials and Cost Estimate
] Soil Analysis
] Structural Analysis
BOX 3 (To be accomplished by the Building Official)

ACTION TAKEN:
PERMIT is hereby GRANTED subject to the following conditions:
APPROVED:
1. That the proposed construction/addition/repair/renovation/demolition/installation, etc.
shall be in conformity with the National Building (PD 1096) and its corresponding
implementing rules and regulations;
2. That a duly licensed Architect/Civil Engineer/Structural Designer has been engaged to
Prepare plans and specifications and to undertake the supervision/inspection of
the construction of the project;

3. That a certification of completion duly signed and sealed by the designing Archit
Civil Engineer and the Architect/Civil Engineer In-Charge of Construction shall be
submitted not later than seven (7) days after completion of the project.
4. That a Certificate of Occupancy shall be secured prior to actual Occupancy of the
Building
0
Building Official
Date
NOTE: This permit may be canceled or revoked pursuant to Section 305 & 306 of the National Building Code
REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE CITY BUILDING OFFICIAL

CAGAYAN DE ORO CITY
DISTRICT / CITY / MUNICIPALITY
AREA CODE __9000____
APPLICATION NO.
PERMIT NUMBER
DATE ISSUED
PAID UNDER OR No.
AMOUNT
DATE
DATE FILED
APPLICATION FOR ELECTRICAL PERMIT

( To be Accomplished by the Office Concerned )
BOX 1
NAME OF
LAST NAME
OWNER / APLLICANT:
ADDRESS:
NO.
FIRST NAME
MIDDLE NAME
TIN
STREET
BARANGAY
CITY/MUNICIPALITY
STREET
BARANGAY
CITY/MUNICIPALITY
0
LOCATION OF
NO.
INSTALLATION:
BOX 2
ASSESSED FEES
AMOUNT DUE
ASSESSED BY
O.R. NUMBER
DATE PAID
REVIEWED BY:
CHIEF,PROCESSING DIV/SEC.
BOX 3
PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING DEVICES AND EQUIPMENT ENUMERATED IN THE APPLICATION
SUBJECT TO THE FOLLOWING CONDITIONS:

1. THAT THE PROPOSED INSTALLATION BE IN ACCORDANCE WITH THE APPROVED PLANS FILED WITH THE OFFICE AND
IN CONFORMITY WITH THE PROVISIONS OF THE LATEST EDITION OF THE PHILIPPINE ELECTRICAL CODE;
2. THAT A DULY LICENSED ELECTRICAL PRACTITIONER BE IN-CHARGE OF THE INSTALLATION/CONSTRUCTION;

3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY THE ELECTRICAL PRACTITIONER IN-CHARGE OF THE INSTALLATION BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION;
4. THAT A CERTIFICATE OF FINAL ELECTRICAL INSPECTION BE SECURED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING
5. THIS PERMIT SHALL BE POSTED AT THE DOOR ON SITE OF WORK.
APPROVED:
ELECTRICAL ENGINEER OF THE BUILDING OFFICE
DATE
(Signature Over Printed Name)
PRC REG. NO. & VALIDITY

NOTED:
0
BUILDING OFFICIAL
DATE
(Signature Over Printed Name)

Note 1.
Note 2.
This permit may be cancelled or revoked pursuant to Sections 305 & 306 of the National Building Code.
Alterations on this form are not allowed.
ID
NG DIV/SEC.
APPLICATION
HE BUILDING

SANITARY / PLUMBING PERMIT

Applicant No.
Permit Number
Date of Application
BOX 1 (To be accomplished by Sanitary Engineer/Master Plumber, in print)
NAME OF APPLICANT
Last Name
First Name
M.I.
ADDRESS
No.
Street
Barangay/City Municipality
Telephone Number
0
LOCATION OF INSTALLATION :
No.
Street
Barangay/City Municipality
Telephone Number

SCOPE OF WORK
New Installation
Addition of
Removal of
Repair of
Others
TYPE OR USE OF OCCUPANC :
Residential
Commercial
Industrial
Institutional
Agricultural
Parks/Plazas
Recreational
Others
FIXTURES TO BE INSTALLED:
QTY.
5
New
Fixtures
x
10
Floor Drain
Laundry Trays
Lavatories
Dental Cuspidor
Kitchen Sink
Gas Heater
Faucet
Electric Heater
Shower Head
Water Boiler
Water Meter
Drinking Fountain
Grease Trap
Bar Sink
Bath Tabs
Soda Fountain Sink
Slop Sink
Laboratory Sink
Urinal
Sterilizer
Air Conditioning
Swimming Pool
Water Tank/Reservoir
Others (Specify)
10
5
Existing Kind of
Fixtures Fixtures
Water Closet
x
x
QTY.
5
New
Fixtures
x
TOTAL
x
Water Distribution System
Sanitary Sewer System

System of Disposal
Shallow Well
Waste Water Treatment Plan

x
City/Municipal Water System
Others
Number of Storeys of Building
Proposed Date Start of Installation
Expected Date of Completion
Kind of
Fixtures
Bidette
TOTAL
Water Supply
Deep Well & Pump Set
Existing
Fixtures
Septic Vault/IMHOFF Tank
Storm Drainage System

Surface Drainage
Street Canal
Water Course
Sanitary Water Connection

1
Feb-16
Mar-17
0
Total Area of Building/Subdivi
Total Cost of Installation
Prepared by MR. REYNALDO DIUPIN C. TY
sq.m.
BOX 2 (To be accomplished by Building Official)

Action Taken:
PERMIT is hereby GRANTED to install the Sanitary/Plumbing Fixtures enumerated herein subject to the ff. condition:
1.
That the proposed installation shall be in accordance with approved
plans filed with this Office and in accordance with the conformity with
the National Building Code;
2.
3.
4.
NOTE:
That a duly licensed Sanitary Engineer/Master Plumber be in-charge

of the installation/construction;
That a Certificate of Completion duly signed by the Sanitary Engine
Master Plumber in-charge of the installation be submitted not later
than seven (7) days after the completion of the installation;
That a Certificate of Final Inspection and Certificate of Occupancy
be secured prior to the actual occupancy of the building.
0
City Building Official
Date
This permit may be canceled or revoked pursuant to Section 306 of the National Building Code.
Cuspidor
g Fountain
untain Sink
Specify)
inage System
sq.m.
to the ff. condition:

DEPARTMENT OF PUBLIC WORKS, TRANSPORTATION AND COMMUNICATIONS

CAGAYAN DE ORO CITY
AREA CODE 9000
APPLICATION NO.
PERMIT NO.
MECHANICAL PERMIT
DATE OF APPLICATION
DATE ISSUED
BOX 1 (TO BE ACCOMPLISHED BY PROFESSIONAL MECHANICAL ENGINEER, IN PRINT)

NAME OF
LAST NAME
FIRST NAME
M.I.
TAX ACCOUNT NO.
OWNER / APLLICANT:
ADDRESS:
NO., STREET, BARANGAY, CITY/MUNICIPALITY
TELEPHONE NO.
0
LOCATION OF INSTALLATION: NO., STREET, BARANGAY, CITY/MUNICIPALITY

SCOPE OF WORK:
NEW INSTALLATION
ADDITION OF
BUILDING PERMIT NO.
REMOVAL OF
CERTIFICATE OF OCCUPANCY N
OTHERS (SPECIFY)
USE OR TYPE OF OCCUPANCY

RESIDENTIAL
AGRICULTURAL
COMMERCIAL
LANDSCAPING
INDUSTRIAL
OTHERS (SPECIFY)
INSTITUTIONAL
INSTALLATION AND OPERATION
BOILER
CENTRAL AIR CONDITIONING
DUMBWAITER
PRESSURE VESSELS
MECHANICAL VENTILATION
PUMPS
INTERNAL COMBUSTION ENGINE
ESCALATOR
COMPRESSED AIR, VACUUM
REFRIGERATION & ICE MAKING
MOVING SIDEWAK
INSTITUTIONAL AND/OR
WINDOW TYPE AIRCONDITION
FREIGHT ELEVATOR
INDUSTRIAL GAS
PACKAGE AIR CONDITIONING UNIT
PASSENGER ELEVATOR
OTHERS (SPECIFY
PROPOSED DATE OF INSTALLATION
TOTAL INSTALLATION COST
PNEUMATIC TUBES, CONVEYORS
AND/OR MONORAILS
EXPECTED DATE OF COMPLETIO
Feb-16
-
PREPARED BY:
Mar-17
ALFREDO T. BUTEN
BOX 2 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN
PERMIT IS HEREBY GRANTED TO INSTALL THE MECHANICAL EQUIPMENT
ENUMERATED HEREIN SUBJECT TO THE FOLLOWING CONDITIONS:
1. That the proposed installation shall be in accordance with the approved
plans filed with this office in conformity with the "National Building Code"
2. That a duly licensed professional mechanical engineer be engaged to
undertake the installation/construction.
3. That a certificate of completion duly signed by a professional mechanical
engineer in-charge of installation shall be submitted not later than seven
(7) days after completion of the installation.
4. That certificate of final inspection and certificate of occupancy be secured prior to the actual occupancy of the building.
5. That an annual certificate shall be secured for the continuous operation

of the mechanical equipment installed.
0
CITY BUILDING OFFICIAL
NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 & 306 OF THE "NATIONAL BUILDING CODE."
AIR, VACUUM
ES, CONVEYORS


Application No.
PERMIT NO.
FENCING PERMIT
Date of Application
Date Issued
BOX 1 (To be accomplished by Applicant, in print)

Last Name
First Name
NAME OF APPLICANT
M.I.
For construction
Form of Ownership
by an Enterprise
ADDRESS
No.
Street
Barangay
City/Municipality
LOCATION
No.
Street
0
Barangay
City/Municipality
Tel. No.

SCOPE OF WORK
X New Fence
others
Additional
Renovation
Repair
Others (Specify)

ACCOMPANYING DOCUMENTS
Xerox copy of T.C.T.
Xerox copy of Lot/Site Plan
Xerox copy of Contract of Lease (If not owned by applicant)

Xerox copy of Latest Tax Receipt
Other Clearance (Specify)
BOX 3 (To be accomplished by Designing Architect/Civil Engineer/Contractor, in print)
MEASUREMENTS:
LENGTH, in meters
HEIGHT, in meters
Type of fencing:
Indigenous Materials
R.C. & Interlink/Cyclone Wire
R.C. (Reinforced Concrete)
R.C. & Barbed Wire & Other Wires
R.C. & Bricks
Others (Specify)

ACTION TAKEN:
1. That the proposed construction/addition/repair/renovation shall be in conformity with the National Building Code
(P.D. 1096) and its corresponding implementing rules and regulations;
2. That the required setback shall be observed.
0
NOTE: This permit may be cancelled or revoked pursuant to Section 305 & 306 of the National Building Code.


Application No.
PERMIT NO.
FENCING PERMIT
Date of Application
Date Issued
BOX 1 (To be accomplished by Applicant, in print)

Last Name
NAME OF APPLICANT
First Name
M.I.
For construction
by an Enterprise
ADDRESS
Form of Ownership
No.
Street
Barangay
City/Municipality
Tel. No.
0
LOCATION
No.
Street
Barangay
City/Municipality

SCOPE OF WORK
x
New Fence
Additional
Renovation
Repair
Others (Specify)

ACCOMPANYING DOCUMENTS
Xerox copy of T.C.T.
Xerox copy of Lot/Site Plan
Xerox copy of Contract of Lease (If not owned by applicant)
Xerox copy of Latest Tax Receipt
Other Clearance (Specify)

BOX 3 (To be accomplished by Designing Architect/Civil Engineer/Contractor, in print)
MEASUREMENTS:
LENGTH, in meter
HEIGHT, in mete
Type of fencing:
Indigenous Materials
R.C. & Interlink/Cyclone Wire
R.C. (Reinforced Concrete)
R.C. & Steel Matting
R.C. & Concrete Hollow Blocks
R.C. & Barbed Wire & Other Wires
R.C. & Bricks
Others (Specify)

ACTION TAKEN:
1. That the proposed construction/addition/repair/renovation
shall be in conformity with the National Building Code
(P.D. 1096) and its corresponding implementing rules
and regulations;
2. That the required setback shall be observed.
NOTE:
ENGR. ISIDRO P. OBLIGADO

Officer-in-Charge
This permit may be cancelled or revoked pursuant to Section
of the National Building Code.
/Kind of Business

SIGN PERMIT
APPLICATION NO.
SP NO.
Date
BOX 1 (To be accomplished by designing Architect/Civil Engineer, in print)
NAME OF APPLICANT
Last Name
First Name
M.I.
For Construction owned
Form of Ownership
by an Enterprise
ADDRESS:
No.
Street
Barangay
City/Municipality
No.
Street
Barangay
City/Municipality
0
LOCATION:

SCOPE OF WORK:
[
New Construction
Addition
Repair
[X]
TYPE OF SIGN
Renovation
Demolition
Others (Specify)
MAKE (Display Surface)
Wall
Projecting
[X]
Roof (maximum of 6.0 meters)
Cloth/Canvas
Self Supporting (above 6.0 meters)
G.I. Sheets
Others (Specify)
Others (Specify)
TEMPORARY SIGN (Designing Arch./CE not necessary)
Neon
Panaflex
TYPE OF SIGN STRUCTURE
Streamer
Wooden
Posters
Steel
Others (Specify)
Others (Specify)

LOT OR INSTALLATION SITE DOCUMENTS
SIGN PLANS AND DOCUMENTS
(Three sets each)
(Five sets each)
Lot Title
Perspective, Site Development Location Plan
Mechanical Plan
Lease/Rental Contract
Architectural Plans
Specifications
Lot/Building Owner's Authority
Structural Plans
Bill of Materials & Cost Estimate
Others (Specify)
Electrical Plans
Structural Analysis & Computations
CLEARED AS TO ZONING REQUIREMENTS:
CLEARED AS TO TOURISM:
City Zoning Officer
City Tourism Officer
BOX 3 (To be accompanied by the Building Official)

ACTION TAKEN:
1.
APPROVED:
That the signage shall be installed in conformity with Chapter 20 of P.D. 1096 and
Rule V of its implementing Rules and Regulations.
2.
In case of Electric or neon signs, a corresponding electrical permit thereof shall

be secured.
3.
This permit must be kept in the premises of the establishment wherein the sign is
installed for inspection purposes.
Date
NOTE:
THIS SIGN PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTION 305 & 306 OF THE NATIONAL BUILDING CODE
(P.D. 1096) AND WHEN PUBLIC INTERESTSO DEMANDS.
BOX 4 (To be accomplished by Designing Architect/Civil Engineer in print)

COST OF EQPT. Number of Storeys: [
TOTAL ESTIMATED COST
Building
Electrical
Mechanica
Plumbing
Php
TOTAL COST
Php
] Without Roofdeck
Total Area
sq.m.
###
Proposed Date of Constructi
Feb-16
Expected Date of Completio
Mar-17
Material of Construction
[ ] Steel [ ] Concrete
[ ] Wood[ X ] Mixed
Others (Specify)
] With
Php
Total
BOX 5 (To be accomplished by the Division/Section Concerned)
ASSESSMENT
CATEGORY
AMOUNT DUE
ASSESSED FEES
O.R. NUMBER
DATE PAID
Land Use/ Zoning

Line and Grade
Building
Plumbing
Electrical
Mechanical
Others
Reviewed by:
TOTALS
Chief, Processing Division/Section

BOX 6 (T0 be accomplished by the Division/Section Concerned)
PROGRESS
NOTED:
Chief, Processing Div./Se
IN
TIME
DATE
FLOW
OUT
TIME
DATE
ACTION /
REMARKS
PROCESSED BY
RECEIVING & RECORDING

LAND USE & ZONING
LINE & GRADE
ARCHITECTURAL
STRUCTURAL
SANITARY
ELECTRICAL
MECHANICAL
We hereby affix our hands signifying our conformity to the information herein set forth.
BOX 7 (To be accomplished by the designer)
ARCHITECT/CIVIL ENGINEER
BOX 10 (To be accomplished by the Structural Designer)
P.R.C. No.
(Signed & Sealed Plans /Specifications)

Name :
15013
4037160.00
Signature
(Signed & Sealed Struct'l Design Analysis & Com
Name :
ARCH. HEINRICH S. TY
Address : KAUSWAGAN, CDO

PTR No.
Date Issued
CIVIL ENGINEER / STRUCTURAL ENGINEER P.R.C. No.
Place Issued
16-Jan-15
CDO
T.I.N.
75326
ENGR. ROMMEL RAFISURA
Address : LAPASAN, CAGAYAN DE ORO

PTR No.
Date Issued
Place Issued
9504543B
Signature
T.I.N.
CDO
27-Jan-15
920-165-451
186 - 383 - 721
BOX 8 (To be accomplished by the Construction In-Charge)
BOX 11 (To be accomplished by the Lot Owner)
TCT / OCT No.
(In-Charge of Construction)
Name :
P.R.C. No.
15013
Name :
Address : KAUSWAGAN, CDO

PTR No.
Date Issued
4037160
16-Jan-15
Place Issued
CDO
Tax Declaration No.
137-2015003801,-2028,-2029
Address :
Date Issued
12/30/1899
Place Issued
0.00
Signature
T.I.N.
Signature
T.I.N.
920-165-451
BOX 9 (To be accomplished by the Applicant)
Signature
APPLICANT
0.00
Res. Certificate No.
Date Issued
Place Issue
thout Roofdeck
ATE PAID
OCESSED BY
75326
ace Issued
CDO
186 - 383 - 721
WA
0.00
0.00

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

CAGAYAN DE ORO CITY
AREA CODE : _______
APPLICATION NO.
PERMIT NUMBER
Date of Proposed Start of Application
Date of Completion
APPLICATION FOR ELECTRICAL PERMIT

(Accomplish in print and in duplicate)
BOX 1 (TO BE ACCOMPLISHED BY THE DULY QUALIFIED ELECTRICAL PRACTITIONER)

NAME OF OWNER/APPLICANT:LAST NAME
FIRST NAME
MIDDLE NAME
TIN
ADDRESS
NO.
STREET
BARANGAY
0
TEL/FAX NO.
CITY/MUNICIPALITY
0
LOCATION OF
NO.
STREET
BARANGAY
CITY/MUNICIPALITY
INSTALLATION
SCOPE OF WORK
x NEW INSTALLATION
ANNUAL INSPECTION
ADDITION OF
REPAIR OF
REMOVAL OF
OTHERS (SPECIFY)
RENOVATION
TYPE OF OCCUPANCY OR USE

A. RESIDENTIAL
E. BUSINESS & MERCANTILE
B. RESIDENTIAL, HOTEL, APARTMENT
F. INDUSTRIAL
C. EDUCATION & RECREATION
G. STORAGE & HAZARDOUS
D. INSTITUTIONAL
H. ASSEMBLY OTHER THAN GROUP 1
NUMBER OF OUTLETS
### LIGHT
35 CONVENIENCE/RECEPTACLE
SPO,AIRCON
I. ASSEMBLY OCCUPANT LOAD 1000 OR MORE
J. ACCESSORY
X K. OTHERS (SPECIFY)
COMMERCIAL
NO. OF EQUIPMENT/WIRING DEVICES:

SPO,COOKING UNIT
TOGGLE SWITCH
FA DETECTORS
SPO,WATER HEATER
BELL/BUZZER
OTHERS (see attached list)
SPO,WATER PUMP
PUSH BUTTON
BOX 2 (PROFESSIONAL ELECTRICAL ENGINEER WHO SIGNED AND SEALED PLANS AND SPECIFICATIONS)
NAME
ADDRESS
PTR NO.
ENGR. ANTONIO S. OLANGO

LAPASAN, CAGAYAN DE ORO CITY
2729689
DATE ISSUED jan/8/2015
SIGNATURE
DATE SIGNED
PRC REG. NO. 2835
VALIDITY
TEL./FAX NO.
PLACE ISSUED
CDO
157 303 184
TIN
TPBOX 3 (ELECTRICAL CONTRACTOR - 200 AMPERE MAIN AND ABOVE)

NAME
PBAC LIC. NO.
(SPECIALTY ELECTRICAL)
VALIDITY
ADDRESS
TEL./FAX NO.
BOX 4 (PERSON-IN-CHARGE OF INSTALLATION)

PROFESSIONAL ELECTRICAL ENGINEER
NAME
ADDRESS
PTR NO.
REGISTERED ELECTRICAL ENGINEER
ENGR. ANTONIO S. OLANGO

LAPASAN, CAGAYAN DE ORO CITY
2729689
DATE ISSUED jan/8/2015
SIGNATURE
DATE SIGNED
REGISTERED MASTER ELECTRICIAN

(Not exceeding 600 Volts & 500 kVA)
PRC REG. NO. 2835
VALIDITY
TEL./FAX NO.
PLACE ISSUED
TIN
CDO
157 303 184
BOX 5 9OWNER/AUTHORIZED REPRESENTATIVE)

NAME
SIGNATURE
TIN
CTC NO.
DATE ISSUED
BOX 6 (TO BE RECEIVED BY RECEIVING/RECORDING SECTION)
PLACE ISSUED
137-2015003801,-2028,-2029
December 30, 1899
0
RECEIVED BY:
ELECTRICAL PLANS & SPECIFICATIONS (5 SETS)
DATE RECEIVED:
Signature Over Printed Name
AD 1000 OR MORE
RS (see attached list)
BOX 3 (To be accompanied by the Receiving and Recording Section)

SANITARY DOCUMENTS
Sanitary Plumbing Plans and Specifications
Cost Estimates
Bill of Materials
Others (Specify)

ASSESSED FEES
Amount Due
Assessed by
O.R. Number
Date Paid
BOX 5 (To be accomplished by Division/Sectioned Concerned)

PROGRESS
NOTED:
IN
Chief Processing Div./Sect.
TIME
FLOW
OUT
DATE
TIME
DATE
ACTION/
REMARKS
PROCESSED
BY
RECEIVING and RECORDING

GEODETIC (line and Grade)
SANITARY
We hereby affix our hands signifying our conformity to the information above set forth.
BOX 6
SANITARY ENGINEER/PLUMBER
BOX 8
PRC Reg. No.
939
Signed & Sealed Plans & Specific

Print Name
Signature
MR. REYNALDO DIUPIN C. TY

Address
KAUSWAGAN, CDO
PTR No.
Date Issued
4039435
01/03/15
Signature
Applicant
Place Issued
CDO
114-752-873
BOX 7
SANITARY ENGINEER/PLUMBER
PRC Reg. No.
939
Signed & Sealed Supervision in-Cha

Print Name
MR. REYNALDO DIUPIN C. TY

Address
KAUSWAGAN, CDO
PTR No.
4039435
Signature
Com. Tax Cert. No.
Date Issued
Place Issued
30-Dec-99
TIN No.
Date Issued
01/03/15
Place Issued
CDO
TIN No.
114-752-873
Date Paid
ROCESSED
BY
AWA
Place Issued
BOX 3 (TO BE ACCOMPLISHED BY THE RECEIVING AND RECORDING SECTION)

BUILDING DOCUMENTS
(FIVE (5) SETS EACH)
MECHANICAL PLANS & SPECIFICATIONS
BILL OF MATERIALS
COST ESTIMATES
OTHERS (SPECIFY)
BOX 4 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)

ASSESSES
MECHANICAL
AMOUNT DUE
FEE
ASSESSED BY
O.R. NUMBER
DATE PAID
REVIEWED BY:
CHIEF,PROCESSING DIV/SEC
BOX 5 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)
NOTED
IN
PROGRESS FLOW
OUT
TIME
Chief,Processing Div./Sec.
DATE
TIME
DATE
ACTION / REMARKS
PROCESSED BY

MECHANICAL
We hereby affix our hands signifying our conformity in the information herein written above set forth.
BOX 6
PROF. MECHANICAL ENGINEER
BOX 8
PRC REG. NO.
Signed and sealed plans/specifications

Print Name
3126
Signature
ALFREDO T. BUTEN
Address
PTR No.
4019193B
Signature
APPLICANT
SCIONS KAUSWAGAN CDOC
Date Issued
Place Issued
1/6/2015
CDO
BOX 7
PROF. MECHANICAL ENGINEER
PRC REG. NO.
Signed and sealed plans/specifications

Print Name
3126
ALFREDO T. BUTEN
Address
4019193B
Signature
Date Issued
Place Issued
30-Dec-99
TIN
144-327-259
PTR No.
Com. Tax Cert. No.
SCIONS KAUSWAGAN CDOC

Date Issued
Place Issued
1/6/2015
CDO
TIN
144-327-259
ATE PAID
CESSED BY
n above set forth.
KAWA
Place Issued
BOX 4 (To be accomplished by the Designing Architect/Civil Engineer print)

COST OF EQUIPMENT INSTALLED

_______ sq.m.
Total surface Area
Proposed Date of Construction ________________

Expected Date of Completion _________________

PROGRESS
NOTED:
IN
Chief, Processing Div./Section
TIME
FLOW
ACTIONS/REMARKS
OUT
DATE
TIME
PROCESSED
BY
DATE
RECEIVING & RECORDING

LAND USE AND ZONING
ARCHITECTURAL
STRUCTURAL
SANITARY
ELECTRICAL
MECHANICAL
BOX 6 (To be accomplished by the Designer)
PRC No.
Signed and Sealed Plans & Specifications
BOX 9 (To be accomplished by the applicant)

CIVIL ENGINEER/STRUCTURAL ENGINEER
15013
Print Name
75326
Print Name
ROMMEL D. RAFISURA
ADDRESS
ADDRESS
KAUSWAGAN, CDO
PTR NO.
LAPASAN, CDOC
DATE ISSUED
PLACE ISSUED
16-Jan-15
CDO
4037160
SIGNATURE
TIN
PTR No.
DATE ISSUED
9504543B
SIGNATURE
PLACE ISSUED
1/27/2015
CDO
TIN
186 - 383 - 721
920-165-451
BOX 7 (To be accomplished by Constrution in-charge)
BOX 8 (To be accomplished by Lot Owner)
TCT/OCT NO.
137-2015003801,-2028,-2029
PRC No.
15013
Signed and Sealed Plans & Specifications
Print Name
TAX Dec. No.

0
Print Name
ADDRESS
ADDRESS
KAUSWAGAN, CDO
PTR NO.
PRC No.
Signed and Sealed Struct'l Design Analysis & com
DATE ISSUED
PLACE ISSUED
16-Jan-15
CDO
4037160
SIGNATURE
TIN
RES.CERT.NO.
0
DATE ISSUED
P-ISSUED
12/30/1899
SIGNATURE
30-Dec-99
TIN
###
920-165-451
BOX 9 (TO BE ACCOMPLISHED THE APPLICANT)
SIGNATURE
APPLICANT
RES.CERT.NO.
0
DATE ISSUED
12/30/1899
PLACE ISSUED
0

ASSESSED
CATEGORY
AMOUNT DUE
FEES
ASSESSED BY
O.R. NUMBER
DATE PAID
LINE and GRADE

FENCING
ELECTRICAL (If any)
Others
TOTALS
Received By:
Chief, Processing Division/Section

PROGRESS
NOTED:
IN
Chief, Processing Div./Section
TIME
DATE
FLOW
ACTIONS/REMARKS
OUT
(OK/Lacking Reqmt.)
TIME
DATE
PROCESSED
BY

GEODETIC (Line and Grade)
STRUCTURAL
ELECTRICAL
CASHIER

ARCHITECT/CEVIL ENGINEER
BOX 9 (To be accomplished by the applicant)

PRC No.
15013
Signed and Sealed Plans & Specification

Print Name
Signature
Address
APPLICANT
KAUSWAGAN, CDO
PTR No.
Date Issued
Place Issued
4037160
16-Jan-15
CDO
Signature
Com. Tax Cert. No.
Date Issued
Place Issued
12/30/1899
TIN
920-165-451
BOX 8 (To be accomplished by construction in-charge)
ARCHITECT/CEVIL ENGINEER
PRC No.
15013
Signed and Sealed Plans & Specification

Print Name
BOX 10 (CONSENT OF LOT OWNER)

TCT/OCT No.
Tax Declaration No.
137-2015003801,-2028,-2029
Address
Address
KAUSWAGAN, CDO
PTR No.
4037160
Signature
Print Name
Date Issued
Place Issued
16-Jan-15
CDO
TIN
Res. Certificate
Date Issued
12/30/1899
Signature
920-165-451
Place Issued
0
TIN
PAID
ED
Issued
Issued
BOX 4 (To be accomplished by Designing Architect/Civil Engineer, in print)
COST OF EQUIPMENT INSTALLED

Total Surface Area
MP
Proposed Date of Construction

Expected Date of Completion
P

PROGRESS FLOW
NOTED:
IN
OUT
ACTION/
Chief,Processing Div/Sect.
TIME
DATE
TIME
DATE
PROCESSED BY:
REMARKS

LAND USE and ZONING
LINE and GRADE
ARCHITECTURAL
STRUCTURAL
SANITARY
ELECTRICAL
MECHANICAL
We hereby affix our hands signifying our conformity to the information herein set forth.

BOX 9 (To be accomplished by the Structural Designer)
PRC No.
CIVIL ENGINEER/STRUCTURAL ENGR.
15013
(Signed & Sealed Plans/Specifications)
PRC No.
15013
(Signed & Sealed Structl Design Analysis & Comp)
Print name
Print Name
Address
Address
KAUSWAGAN, CDO
PTR No.
Date Issued
4037160
KAUSWAGAN, CDO
Place Issued
1/16/2015
Signature
PTR No.
CDO
Date Issued
4037160
TIN
Place Issued
1/16/2015
Signature
CDO
TIN
920-165-451
920-165-451
BOX 7 (To be accomplished by the Construction In-Charge)
BOX 10 (To be accomplished by the Lot Owner)
TCT/OCT No.
PRC No.
15013
In-Charge of Construction
Tax Declaration No.
137-2015003801,-2028,-2029
Print name
Print Name
Address
Address
KAUSWAGAN, CDO
PTR No.
4037160
Date Issued
Place Issued
1/16/2015
Signature
0
CDO
TIN
Date Issued
Place Issued
12/30/1899
Signature
0
TIN
920-165-451
0
BOX 8 (To be accomplished by the Applicant)
Signature
APPLICANT
Date Issued
December 30, 1899
Place Issued
T-SQUARE BUILDING, 2ND FLOOR, SAINT IGNATIUS ST., KAUSWAGAN, CDO
Project
Owner
Location
: PROPOSED 5-UNITS COMMERCIAL BUILDING

: ROSALYN B. SHIMOKAWA
: KAUSWAGAN, CAGAYAN DE ORO CITY, NEAR QUADRO OCHO
SPECIFICATIONS
1. GENERAL:
These specifications are intended to cover all labor and materials required for the construction
of this building as shown and describe in these specifications. This entire work is to be finished in
every part with a first class job to the owner of his Architect.
(a)The contractor shall check the dimensions on the plans. He will not be allowed any extra in case any
discrepancy should be discovered during the progress of the work. Should the contractor deviate from
the intent of the plans and specifications without the consent of the owner or his Architect. He shall be
subjected to liquidate damages.
(b)The owner shall have the right to alter, add or omit any part of the plan. The bill for all extras must be
submitted to the owner or his Architect in writing before the final acceptance of the building. A third
person maybe employed if the owner and the contractor may not agree to the extra price of the
alterations, additions or deductions due to omissions.
(c)All permits required by law will be paid by the owner. The deposit for electric meters if so required will be
paid by the owner. The contractor will pay for the deposit for the temporary installations of water meter
and light meter.
(d)The contractor shall be held responsible for any liabilities under the Workmens Compensation Act. He shall
be responsible for all the direct accidents on the job and for all injuries to person and damages of
materials when cause by him or his workmen.
(e)The contractor must employ and select the experienced foreman on the job, who can understand and
speak English or Visayan dialect and acceptable to the owner or his Architect.
(f)Before commencing the work, the contractor shall clear the site from obstructions, and provide the
necessary enclosures. After the construction is finished, the contractor shall have the building cleaned
and ready for occupancy. It is understood that all tiles, floor, walls, gutter, glasses, etc. must be properly
cleaned. The ground around the building shall be properly graded and all rubbish and superfluous
building materials must be removed from the lot.
A.Type of Building: This building shall be constructed in concrete and wooden framework as indicated in the
plans and walled with 6 thick cement hollow blocks.
2. CONCRETE AND MASONRY WORKS: All structural framework of the building except roof frame shall be
reinforced concrete as follows:
a. Foundations, footings
b. Columns, beams and slabs
c. Lintels
d. Parapets
e. Septic Vault
f. Ground floor slab
Class
Class
Class
Class
Class
Class
A mix
A mix
A mix
A mix
B mix
A mix
3. FORMS: Forms shall conform to the shape, lines and dimensions or the finished concrete as called for on the
plans. Lumber used in forms for exposed surfaces shall be dressed to a uniform thickness and shall be
free from loose knots or other defects. Joints in form shall be either horizontal or vertical. For unexposed
surfaces and rough work, undress lumber may be used.
Lumber forms once used shall be ridden of nails and their surfaces to be in contact with concrete shall be
thoroughly cleaned and wetted before being used again. Forms shall be substantially and sufficiently tight to prevent
leakage of mortar and shall be properly braced or tied together so as to maintain correct position and shape.
4. MASONRY FINISHES: All cement finishes unless indicated shall be plain cement plaster finish.
All interior shall be plastered with cement, toweled smooth.
5. FLOOR FINISHES: Floor finish shall be plain cement unless specified in the plans.
6. FLOORING AND WALLING: Use Plain cement except those specified in the plans.
7. CEILING: Ceiling boards of the interior shall be 3.5MM thick hardiflex boards or Gypsum boards except those
specified in the plans. Use 2"x1" metal furring fo ceiing framing (FOR CR'S ONLY)
8. FINISHING HARDWARES: All finishing hardwires such as hinges, door locks, etc.,
shall be approved by the owner.
9. PAINTING: All paints to be used shall be BOYSEN/ DAVIES / RAIN & SHINE brand.
Masonry and other concrete or hollow block walls shall be painted with two (2) coats latex-based paint.
All exterior walls and woodwork shall be painted with two coats of exterior gloss oil paint.
All exterior walls and partitions shall be semi-gloss interior enamel painted made in two (2) coats.
Areas of hollow block walls shall be washed with a solution of zinc sulfate and rinsed with clear water before a
stucco concrete primer and sealer is applied. After the sealer follows the finishing coat which is semi-gloss
interior enamel.
All interior ceilings shall be finished with flat wall enamel paint applied in two (2) COATS.
All built-in closets and cabinets shall be painted with sprayer. The surface shall be puttied and prepared with a
primer surface before any coat of paint is applied.
All doors and stone cut ceiling shall be finished with a dead flat or gloss lacquer paint. Doors shall be uniformly
stained with a wood stain before the finishing lacquer is applied.
All knots, etc. shall be patched puttied before sandpapering it. It shall be well sandpapered before painting it.
No painting or lacquering shall be allowed at rainy days especially in the exterior parts of the house.
(CR PAINTINGS ONLY)
10. ELECTRICAL: All electrical wiring connections and installations shall be done on rigid metal conduits unless
specified in the plans.
All switches and convenient wall outlets shall be quietmatic or National brand.
Provide a safety circuit breaker at the main entrance switch. (General Electric brand)
All electrical wirings and connections shall be in accordance and in conformity with the National Electrical Code
and of the Local Electrical Regulations.
All electrical wires must be Far East or Phelp Dodge brand.
NOTE:
This specification cover two (2) pages.
PREPARED BY:
ARCHITECT
PRC:
15013
PTR NO:
4037160
DATE:
TIN:
16-Jan-15
920-165-451
OWNER
AN, CDO
r the construction
be finished in
a in case any
actor deviate from
hitect. He shall be
extras must be
building. A third
price of the
so required will be
ons of water meter
nsation Act. He shall

d damages of
nderstand and
d provide the
e building cleaned
tc. must be properly
d superfluous
as indicated in the
rame shall be
called for on the

kness and shall be
rtical. For unexposed
with concrete shall be

ently tight to prevent
n and shape.
ards except those
latex-based paint.
paint.
two (2) coats.
ar water before a
is semi-gloss
d prepared with a
shall be uniformly
efore painting it.

house.
l conduits unless
nal Electrical Code
LYN B. SHIMOKAWA
OWNER
#8, T-SQUARE BUILDING, SAINT IGNATIUS ST., KAUSWAGAN, CDO
Project
: PROPOSED 5-UNITS COMMERCIAL BUILDING
Owner
: ROSALYN B. SHIMOKAWA
Location
: KAUSWAGAN, CAGAYAN DE ORO CITY, NEAR QUADRO OCHO
SPECIFICATIONS
1. GENERAL:
These specifications are intended to cover all labor and materials required for the construction
of this building as shown and describe in these specifications. This entire work is to be finished in
every part with a first class job to the owner of his Architect.
(a)The contractor shall check the dimensions on the plans. He will not be allowed any extra in case any
discrepancy should be discovered during the progress of the work. Should the contractor deviate from
the intent of the plans and specifications without the consent of the owner or his Architect. He shall be
subjected to liquidate damages.
(b)The owner shall have the right to alter, add or omit any part of the plan. The bill for all extras must be
submitted to the owner or his Architect in writing before the final acceptance of the building. A third
person maybe employed if the owner and the contractor may not agree to the extra price of the
alterations, additions or deductions due to omissions.
(c)All permits required by law will be paid by the owner. The deposit for electric meters if so required will be
paid by the owner. The contractor will pay for the deposit for the temporary installations of water meter
and light meter.
(d)The contractor shall be held responsible for any liabilities under the Workmens Compensation Act. He shall
be responsible for all the direct accidents on the job and for all injuries to person and damages of
materials when cause by him or his workmen.
(e)The contractor must employ and select the experienced foreman on the job, who can understand and
speak English or Visayan dialect and acceptable to the owner or his Architect.
(f)Before commencing the work, the contractor shall clear the site from obstructions, and provide the
necessary enclosures. After the construction is finished, the contractor shall have the building cleaned
and ready for occupancy. It is understood that all tiles, floor, walls, gutter, glasses, etc. must be properly
cleaned. The ground around the building shall be properly graded and all rubbish and superfluous
building materials must be removed from the lot.
A.Type of Building: This building shall be constructed in concrete and wooden framework as indicated in the
plans and walled with 6 thick cement hollow blocks.
2. STORE FRONT: Shall be 12mm thick, TEMPERED,CLEAR, FRAMELESS GLASS with butt joints & Glazing shall
be from floor to ceiling. Store front openings shall be one eight tenth meters (1.80m)
Doors - shall swing in but must be DOUBLE ACTION for emergency purposes
3. MASONRY FINISHES: All cement finishes unless indicated shall be plain cement plaster finish.
All interior shall be plastered with cement, troweled smooth.
4. FLOOR FINISHES: Floor finish shall be plain cement unless specified in the plans.
5. WALLING: Use Hardiflex or gypsum board with metal furring or specified in the plans.
6. CEILING: Ceiling boards of the interior shall be hardiflex or gypsum board w/ metal furring
Ceiling framing shall be already ready for the prepared of PDAS and sprinkler installation and construction.
Service manhole shall be providedper serviceable area with min. dimension of 600 mm x 600mm.
Metal hangers & supports should have 2 coats of rust-protective paint
7. FINISHING HARDWARES: All finishing hardwares such as hinges, cabinets, pulls and catches, door locks, etc.,
shall be approved by the owner.
8. PAINTING: All paints to be used shall be davies brand or other brand.
All exterior walls and partitions shall be semi-gloss interior enamel painted made in two (2) coats.
All interior ceilings shall be finished with flat wall latex paint applied in two (2) COATS.
All built-in closets and cabinets shall be painted with sprayer. The surface shall be puttied and prepared with a
primer surfacer before any coat of paint is applied.
All doors and stone cut ceiling shall be finished with a dead flat or gloss lacquer paint. Doors shall be uniformly
stained with a wood stain before the finishing lacquer is applied.
All knots, etc. shall be patched puttied before sandpapering it. It shall be well sandpapered before painting it.
All wooden floors shall be machine sanded and finish with a Boysen sanding sealer, applied in two (2) coats
with a sprayer.
No painting or lacquering shall be allowed at rainy days especially in the exterior parts of the house.
The roof shall be painted with 2 coats of roofing paint. (Acrylic roof paint)
11. ELECTRICAL: All electrical wiring connections and installations shall be done on rigid metal conduits unless
specified in the plans.
All switches and convenient wall outlets shall be quietmatic or National brand.
Provide a safety circuit breaker at the main entrance switch. (General Electric brand)
All electrical wirings and connections shall be in accordance and in conformity with the National Electrical Code
and of the Local Electrical Regulations.
All electrical wires must be Far East or Phelp Dodge brand.
12. SIGNAGE: Customized letters fabricated from bras, stainles steel. G.I. Sheet are allowed. Dimensional letter
hard-lit or indirectly lit with light emitting diodes (LED')
Exit Signs The mechanct as required by code, shall install exit Signs within the merchant space
NOTE:
This specification cover one (1) pages.
PREPARED BY:
COMFORME BY:
ARCHITECT
OWNER
PRC:
15013
PTR:
4037160
DATE:
TIN:
16-Jan-15
920-165-451

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APPLICANT

PROPOSED 5-UNITS COMMERCIAL BUILDING

> KAUSWAGAN, CAGAYAN DE ORO CITY, NEAR QUADRO OCHO

TCT / OCT No.

DATE and PLACE

TOTAL BUILDING AREA

Residence Certificate No.

TCT / OCT No.

DATE and PLACE

Residence Certificate No.

> ARCH. HEINRICH S. TY

> ENGR. ANTONIO S. OLANGO

> KAUSWAGAN, CDO

> LAPASAN, CAGAYAN DE ORO CITY

> 157 303 184

PRC Reg. NO.

PRC Reg. NO.

> MR. REYNALDO DIUPIN C. TY

> ALFREDO T. BUTEN

> KAUSWAGAN, CDO

> SCIONS KAUSWAGAN CDOC

PRC Reg. NO.

PRC Reg. NO.

> CITY OF CAGAYAN DE ORO

> LAPASAN, CAGAYAN DE ORO

> ENGR. ROMMEL RAFISURA

> 186 - 383 - 721

Republic of the Philippines

OFFICE OF THE BUILDING OFFICIAL

Tax Identification Number

[ ] New Constructi [ ] Additi

[ ] Demolitio [ ] Others (Specify)

USE OR TYPE OF OCCUPANCY:

STREET FURNITURE, LANDSCAPING & SIGNBOARD

BOX 3 (To be accomplished by the Building Official)

the construction of the project;

REPUBLIC OF THE PHILIPPINES

OFFICE OF THE CITY BUILDING OFFICIAL

APPLICATION FOR ELECTRICAL PERMIT

KAUSWAGAN, CAGAYAN DE ORO CITY, NEAR QUADRO OCHO

SUBJECT TO THE FOLLOWING CONDITIONS:

2. THAT A DULY LICENSED ELECTRICAL PRACTITIONER BE IN-CHARGE OF THE INSTALLATION/CONSTRUCTION;

ELECTRICAL ENGINEER OF THE BUILDING OFFICE

(Signature Over Printed Name)

PRC REG. NO. & VALIDITY

(Signature Over Printed Name)

Republic of the Philippines

OFFICE OF THE BUILDING OFFICIAL

SANITARY / PLUMBING PERMIT

Tax Identification Number

KAUSWAGAN, CAGAYAN DE ORO CITY, NEAR QUADRO OCHO

TYPE OR USE OF OCCUPANC :

Soda Fountain Sink

Water Distribution System

Sanitary Sewer System

Waste Water Treatment Plan

City/Municipal Water System

Septic Vault/IMHOFF Tank

Storm Drainage System

Sanitary Water Connection

BOX 2 (To be accomplished by Building Official)

That a duly licensed Sanitary Engineer/Master Plumber be in-charge

to the ff. condition: