Republic of the Philippines

Municipality of Governor Generoso

Province of Davao Oriental
OFFICE OF THE BUILDING OFFICIAL
UNIFIED APPLICATION FOR BUILDING PERMIT
SIMPLE COMPLEX*
X NEW RENEWAL AMENDATORY

THIS APPLIES ALSO FOR: X LOCATIONAL CLEARANCE X FIRE SAFETY EVALUATION CLEARANCE
APPLICATION NO. AREA NO.

Box 1 (TO BE ACCOMPLISHED BY THE APPLICANT)

Owner/ Applicant Last Name First Name M.I. TIN
Do not Fill - up (PSA Use Only)
NAKAYAMA MARIA VILLA E.
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP
SOLE PROPRIETORSHIP
BY ENTERPRISES
ADDRESS: NO. STREET BARANGAY CITY/ MUNICIPALITY ZIP CODE CONTACT NO.
PUROK 1 - A NANGAN Governor Generoso 8210
LOCATION OF CONSTRUCTION: LOT NO. Blk. # TAX DEC NO.
STREET BARANGAY NANGAN MUNICIPALITY OF Governor Generoso
SCOPE OF WORKS

x NEW CONSTRUCTION RENOVATION RAISING

ERECTION CONVERSION ACCESSORY BUILDING STRUCTURE
ADDITION REPAIR STRUCTURE
MOVING OTHER
ALTERATION
(Specify)
USE OR CHARACTER OF OCCUPANCY
GROUP A: RESIDENTIAL (DWELLINGS) x GROUP E: COMMERCIAL GROUP H: ASSEMBLY (OCCUPANT

SINGLE DUPLEX RESIDENTIAL R-1, R-2 BANK DUPLEX SHOPPING LOAD LESS THAN 1000 )
THEATER, AUDITORIUM,
OTHERS DRINKING/ DINING CENTER/ MALL
CONVENTION HALL, GRANDSTAND/
ESTABLISHMENT BLEACHER
GROUP B: RESIDENTIAL SHOP (i.e. DRESS SHOP, TAILORING, Others
HOTEL MOTEL TOWNHOUSE BARBERSHOPE, etc.) GROUP I: ASSEMBLY (OCCUPANT
DORMITORY BOARDING HOUSE OTHERS WATER REFILLING STATION LOAD 1000 OR MORE )
COLISEUM, SPORTS COMPLEX,
RESIDENTIAL R-3, R-4, R -5 LODGING HOUSE
CONVENTION CENTER AND SIMILAR
OTHERS GROUP F: LIGHT INDUSTRIAL STRUCTURE

GROUP C: EDUCATIONAL & RECREATIONAL FACTORY/ PLANT (Using Incombustible/

Others
SCHOOL BUILDING SCHOOL AUDITORIUM Non - Explosive Materials GROUP J: (J-1) AGRICULTURAL
BARN, GRANARY, POULTRY HOUSE,
CIVIC CENTER GYMNASIUM OTHERS
CLUBHOUSE CHURCH, MOSQUE GROUP G: MEDIUM INDUSTRIAL PIGGERY, GRAIN MILL, GRAIN SILO
STORAGE/ WAREHOUSE (FOR
OTHERS TEMPLE, CHAPEL Others
HAZARDOUS/ HIGHLY FLAMMABLE
GROUP D: INSTITUTIONAL MATERIALS GROUP J: (J-2) ACCESSORIES
HOSPITAL OR SIMILAR STRUCTURE FACTORY(FOR HAZARDOUS/ PRIVATE CARPORT/ GARAGE,
TOWER, SWIMMING POOL, FENCE
HOME FOR THE AGED HIGHLY FLAMMABLE MATERIALS
OVER 1.80 M., STEEL/ CONCRETE
GOVERNMENT OFFICE OTHERS TANK

OTHERS Others

OCCUPANCY CLASSIFIED COMMERCIAL TOTAL ESTIMATED COST PHP 190,142.40

NUMBER OF UNITS ONE (1) BUILDING COST OF EQUIPMENT INSTALLED:
NUMBER OF STOREY ONE (1) ELECTRICAL P
TOTAL FLOOR AREA 41.00 SQ.M. MECHANICAL P
LOT AREA SQ.M. ELECTRONICS P
PLUMBING P
OTHERS P
PROPOSED DATE OF CONSTRUCTION: 1-Apr-21 EXPECTED DATE OF COMPLETION: 1-May-21

BOX 2
FULL TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS (REPRESENTING THE OWNER)
ADDRESS
DESIDERIO S. SUMAMPONG JR. POBLACION, GOVERNOR GENEROSO, DAVAO ORIENTAL
ARCHITECT OR CIVIL ENGINEER PRC NO. 103042 Validity 07/13/2022
(Signed and Sealed Over Printed Name) PTR NO. Date Issued 09/13/2005
Date: Issued at TIN
BOX 3 BOX 4
APPLICANT WITH MY CONSENT: LOT OWNER/ AUTHORIZED REPRESENTATIVE
Represented by
MARICEL ESPEROS Date Date
(Signature Over Printed Name) (Signature Over Printed Name)
Address Tibanban, Governor Generoso, Davao Oriental 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 )
CITY/ MUNICIPALITY OF ) S.S.

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 ENGINER Gov't Issued ID No. Date Issued Place Issued
whose signatures appear hereinabove, known to me be the same person who executed this standard prescribed form and acknowledge 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. __________________

Series of ___________________ NOTARY PUBLIC (Until December)

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)

ASSESSED FEES ACCOUNT BASIS OF AMOUNT DUE ASSESSED BY

ASSESSMENT

FOR ZONING (ZONING ADMINISTRATOR):

LOCATIONAL / ZONING OF LAND

FOR BUILDING / STRUCTURE (OBO):

FILING FEE
BUILDING 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

HOT WORKS
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 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 have read this form, understood its contents and consent to the processing of my personal data. I understand that my consent does not
preclude 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

 Republic of the Philippines
MUNICIPALITY OF GOVERNOR GENEROSO
PROVINCE OF DAVAO ORIENTAL

OFFICE OF THE BUILDING OFFICIAL

FENCING PERMIT
APPLICATION NO. FP NO. BUILDING PERMIT NO.

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

OWNER/APPLICANT LAST NAME FIRST NAME M.I TIN NO

FORM OF OWNERSHIP
FOR CONSTRUCTION OWNED
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 REPAIR OTHERS(SPECIFY)

ERECTION DEMOLITION

ADDITION

BOX 2 BOX 3
DESIGN, PROFESSIONAL, PLANS AND SPECIFICATIONS FULL-TIME INSPECTOR AND SUPERVISOR OF CONSTRUCTION WORKS

DATE DATE
ARCHITECT OR CIVIL ENGINEER ARCHITECT OR CIVIL ENGINEER
SIGNED AND SEALED OVER PRINTED NAME SIGNED AND SEALED OVER PRINTED NAME
ADDRESS ADDRESS
PRC NO VALIDITY PRC NO VALIDITY
PTR NO DATE ISSUED PTR NO DATE ISSUED
ISSUED AT TIN ISSUED AT TIN
BOX 4 (TO BE ACCOMPLISHED BY THE APPLICANT)
APPLICANT: WITH 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

BOX 5
REPUBLIC OF THE PHILIPPINES ) S.S
CITY MUNICIPALITY OF )
BEFORE ME, at the City/Municipality of on, personally,
appeared the following

APPLICANT CTC NO DATE ISSUED PLACE ISSUED

LICENSED ARCHITECT OR CIVIL ENGINEER CTC NO DATE ISSUED PLACE ISSUED

(FULL TIME INSPECTORAND SUPERVISOR OF FENCING WORK

whose signature appear herein above, known to me to be the same persons who executed this standard prescribed form and acknowledge 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. NOTARY TO THE PUBLIC ( Until December: )
BOOK NO.
SERIES NO.
BOX 6 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

MEASUREMENTS: Length in Meters Height in Meters

TYPE OF FENCING: Indigenous Materials RC Steel Matting
RC (Reinforced Concrete) RC Barbed Wire
RC and Conc. Hollow Blocks Others (Specify)
RC and Bricks
RC and Interlink/ Cyclone Wire

BOX 7(TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)

PROGRESS FLOW
IN OUT
Processed By
Date Time Date Time
LINE AND GRADE (GEODETIC)
CIVIL/ STRUCTURAL
ELECTRICAL
OTHERS (Specify)
ASSESSED FEES
Amount Due O.R. Number Date Paid Processed BY
LINE AND GRADE (GEODETIC)
FENCING
ELECTRICAL (if Any)
OTHERS (Specify)
Total
BOX 8 (TO BE ACCOMPLISHED BY BUILDING OFFICIAL)
ACTION TAKEN:

PERMIT IS HEREBY ISSUED/ GRANTED SUBJECT TO THE FOLLOWING CONDITIONS:

1 That under Article 1723 of the Civil Code of the Philippines, the Engineer or Architect who drew up the plans and
specification is liable for damages of within fifteen (15 years from completion of the structure, it should collapse due to
defects in the ground. The Engineer or Architect who supervise 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 Construction/ Section/ Addition, etc. shall be conformity with the provisions of the " National Building
Code" (PD 1096) and it's Implementing Rules and Regulations.
a. That prior to commencement of the proposed projects and construction an actual relocation survey shall be
conducted by responsible licensed Geodetic Engineer.
b. That before the commencing the excavation the person making or causing the excavation to be made shall verify
in writing the owner of adjoining building not less than ten (10) days before such excavation is to be made and
show how the adjoining building should be protected.
c. That the owner of the fence shall engage the services of responsible licensed Architect or Civil Engineer to
undertake the full time inspection and suspension of the construction work.
d. That there shall be kept at the jobsite at all times a logbook wherein the actual progress of construction including
test conducted, weather condition and other pertinent data are to be recorded, same shall be made available for
scrutiny and comments by the OBO representative during the conduct of his/ her inspection pursuant to Section
207 of the National Building Code.

PERMIT ISSUED BY:

ROLAN M. AGUANTA, CE
Engineer I/OIC - ME
Building Official
 Republic of the Philippines
MUNICIPALITY OF GOVERNOR GENEROSO
PROVINCE OF DAVAO ORIENTAL

OFFICE OF THE BUILDING OFFICIAL

PERMIT FOR TEMPORARY SERVICE CONNECTION
CONTROL NO. PTSC NO.
0 0 0 - 0 0 0 - 0 1

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

OWNER/APPLICANT LAST NAME FIRSFIRST NAME M.I TIN NO

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

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

PURPOSE
FOR CONSTRUCTION FOR TESTING OTHERS

SUMMARY OF ELECTRICAL LOADS/ CAPACITIES APPLIED FOR

TOTAL CONNECTED LOAD TOTAL TRANSFORMER CAPACITY TOTAL GENERATORS CAPACITY

BOX 2 TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL

DESIGN, PROFESSIONAL, PLANS AND SPECIFICATIONS

ADDRESS
PROFESSIONAL ELECTRICAL ENGINEER PRC NO VALIDITY
SIGNED AND SEALED OVER PRINTED NAME PTR NO DATE ISSUED
Date : ISSUED AT TIN

BOX 3
SUPERVISOR/ INCHARGE OF ELECTRICAL WORKS

PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN

Date
SIGNED AND SEALED OVER PRINTED NAME

PRC NO VALIDITY
PTR NO DATE ISSUED
ISSUED AT TIN

ADDRESS
BOX 4 TO BE ACCOMPLISHED BY THE OWNER/ APPLICANT
OWNER/ APPLICANT ADDRESS:

CTC NO:

Signature Over Printed Name DATE ISSUED:

Date : PLACE ISSUED:
NBC FORM NO. B - 10
Republic of the Philippines
MUNICIPALITY OF GOVERNOR GENEROSO
PROVINCE OF DAVAO ORIENTAL
OFFICE OF THE BUILDING OFFICIAL

CERTIFICATE OF COMPLETION

DATE

This is to certify that the building/ structure covered by Building Permit No. Issued on has been
constructed and completed under our supervision, conforms with the plans and specifications submitted and on file with the Office of the Building
Official, and complies with the provisions of the provisions of the National Building Code and Accessibility Law (BP Bldg. 344).

NAME OF OWNER
(Last Name) (Given Name) (M.I)

ADDRESS OF OWNER ZIP CODE 8210 TEL. NO.

LOCATION OF CONSTRUCTION: LOT NO. BLK NO. BRGY. MUNICIPALITY OF GOVERNOR GENEROSO

USE OR CHARACTER OF OCCUPANCY GROUP

PLANNED ACTUAL
DATE OF START OF CONSTRUCTION
DATE OF COMPLETION
TOTAL FLOOR AREA (Square Meters)
NO. OF STOREY(S)
NO. OF UNITS
SUMMARY OF ACTUAL COST
1 TOTAL COST OF MATERIALS Php
1.1 Cement (Bag)
1.2 Lumber (bdft.)
1.3 Reinforcing Bar (kg)
1.4 GI Sheet (sheet)
1.5 Prefab Structural Steel (kg)
1.6 Other Materials
2 TOTAL COST OF DIRECT LABOR Php
This includes compensation whether by safety or contract for project architect/ engineer down to laborers
3 TOTAL COST OF EQUIPMENT UTILIZATION Php
4 OTHER COST
This includes professional services fee, permits and others fees
TOTAL COST OF BUILDING/ STRUCTURE Php
FULL - TIME SUPERVISOR OR INSPECTOR OF CONSTRUCTION IF CONSTRUCTION WAS UNDERTAKEN BY CONTRACT
Contractor PCAB Lic. No.
Validity
ARCHITECT OR CIVIL ENGINEER TIN
(Signed and Sealed Over Printed Name) Address Tel. No.
Date

PRC No. Validity

PTR No. Date Issued
Issued at TIN AUTHORIZED MANAGING OFFICER Date
CTC No. Date Issued Issued at (Signature Over Printed Name)
CTC No. Date Issued Issued at
Conformed: CTC No.

Date Date Issued

OWNER/ APPLICANT Place Issued
(Signature Over Printed Name)

REPUBLIC OF THE PHILIPPINES )

S.S.
CITY/ MUNICIPALITY OF )

BEFORE ME, at the City/ Municipality of on personally appear

the persons whose signatures appear herein at the front and back of this page, know to me to be the same persons who's executed this standard
prescribed form and acknowledged to me that the same is their free and voluntarily 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 )
Seried of
 DESIGN PROFESSIONALS, PLANS ANS SPECIFICATION
ARCHITECTURAL CIVIL/ STRUCTURAL

Date
(Signature Over Printed Name) Date
Address (Signature Over Printed Name)
PRC No. Validity Address
IAPOA NO. OR NO. Date Issued PRC No. Validity
PTR No. Date Issued PTR No. Date Issued
Issued at TIN Issued at TIN

ELECTRICAL MECHANICAL

Date Date
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
PRC No. Validity PRC No. Validity
PTR No. Date Issued PTR No. Date Issued
Issued at TIN Issued at TIN

SANITARY PLUMBING

Date Date
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
PRC No. Validity PRC No. Validity
PTR No. Date Issued PTR No. Date Issued
Issued at TIN Issued at TIN

ELECTRONICS INTERIOR DESIGN

Date Date
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
PRC No. Validity PRC No. Validity
PTR No. Date Issued PTR No. Date Issued
Issued at TIN Issued at TIN
SUPERVISOR OF SPECIALTY WORKS
ELECTRICAL WORKS MECHANICAL WORKS

Date Date
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
PRC No. Validity PRC No. Validity
PTR No. Date Issued PTR No. Date Issued
Issued at TIN Issued at TIN

SANITARY WORKS PLUMBING WORKS

Date Date
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
PRC No. Validity PRC No. Validity
PTR No. Date Issued PTR No. Date Issued
Issued at TIN Issued at TIN

ELECTRONICS WORK INTERIOR DESIGN WORKS

Date Date
(Signature Over Printed Name) (Signature Over Printed Name)
Address Address
PRC No. Validity PRC No. Validity
PTR No. Date Issued PTR No. Date Issued
Issued at TIN Issued at TIN
NBC FORM NO. B - 09
Republic of the Philippines
MUNICIPALITY OF GOVERNOR GENEROSO
PROVINCE OF DAVAO ORIENTAL
OFFICE OF THE BUILDING OFFICIAL

NOTICE OF VIOLATION
First Notice Second Notice Third & Last Notice

Thursday, August 19, 2021

DATE

Manuel Roxas, GGDO.

SIR/ MADAM:

Please be informed that an inspection conducted by this office on August 18, 2021 of your building/ Fence
structure/ construction and premises located at Manuel Roxas, Governor Generoso, Davao Oriental
reveals the following violation/s of the National Building Code (PD 1096) and it's Implementing Rules and Regulations:

SECTION 301 BUILDING PERMIT

No persons, firm or corporation, including any agency or instrumentality of the government shall erect, construct, alter, repair, move, convert
X
or demolish any building/ structure or cause the same to be done without first obtaining a building permit therefore from the office of the

Building Official assigned in the place where the subject building/ structure is located or the building work is to be done.

SECTION 309 CERTIFICATE OF OCCUPANCY

Failure to post or display the Certificate of Occupancy at a conspicuous place on the premises of the building.

RULE II ADMINISTRATIVE SANCTIONS

Non - compliance with work stoppage order for alteration/ addition/ conversion/ repair without permit.
Use or occupancy without Certificate of Occupancy
Change in existing use or occupancy without Certificate of Change of Occupancy.
Unauthorized change in type of construction from more fire - resistive to less fire - resistive.
Non - compliance with order to abate or demolish.
Non - compliance with work stoppage order for construction without permit.

NO FENCING PERMIT
x Stop immediately all illegal activities in this premises/ area.

You or your representative shall contact the Office within three (3) days from receipt hereof. Failure to do so shall cause
the Office to institute appropriate action against you.

Your cooperation on this matter is highly appreciated.

ROLAN M. AGUANTA, CE
Engineer I/OIC - ME
Building Official
Date August 19, 2021

Served by: KENT IAN NIÑO A. REYES

Date: Thursday, August 19, 2021
Received by:
Date: