REPAIR PERMIT

Republic of the Philippines ... PLUMBING ELECTRONICS INTERIORS OTHERS (Specify) ... CITY/MUNICIPALITY ZIP CODE TELEPHONE NO...

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NBC ACCESSORY FORM NO. 08 - B

Republic of the Philippines City/Municipality of ________________ Province of _________________________

OFFICE OF THE BUILDING OFFICIAL

REPAIR PERMIT BUILDING PERMIT NO.

RP NO

APPLICATION NO.

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

LAST NAME

FIRST NAME

FOR CONSTRUCTION OWNED BY AN ENTERPRISE ADDRESS:

NO.,

FORM OF OWNERSHIP

STREET,

LOCATION OF REPAIR WORKS:

BARANGAY,

MIDDLE NAME

TIN

USE OR CHARACTER OF OCCUPANCY

CITY/MUNICIPALITY

ZIP CODE

TELEPHONE NO

LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO.___________________

STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF ______________________________

SCOPE OF WORK ARCHITECTURAL STRUCTURAL ELECTRICAL

ELECTRONICS INTERIORS OTHERS (Specify) ______________________________ ______________________________________________

MECHANICAL SANITARY PLUMBING

BOX 2 FULL-TIME INSPECTOR AND SUPERVISOR OF REPAIR WORKS Tel. No.

Address PRC. No

Validity

ARCHITECT OR CIVIL ENGINEER

PTR. No

Date Issued

(Seal and Signature Over Printed Name) Date__________________________

Issued at

TIN

BOX 3 (TO BE ACCOMPLISHED BY THE APPLICANT) I HEREBY CERTIFY TO THE FOLLOWING: 1. That the undersigned is the bonafide owner/authorized representative of the buildings/structure to be repaired. 2. The building/structure is leased/not leased to other party and is not involved in any court litigation. 3. The repair to be done is in the form of remedial works on damaged and/or deteriorated portions of the subject building/structure in order to restore to their original condition only and not to add, to alter and/or renovate said building/structure or any part thereof. 4. The proposed repair works are not intended to harass and/or eject lawful tenants or occupants of the subject building. 5. The estimated total cost of repair works is P_______________________ WITH MY CONSENT: LOT OWNER

APPLICANT:

(Signature Over Printed Name) Date_________________

(Signature Over Printed Name) Date_________________ Address C.T.C. No.

Address Date Issued

Place Issued

C.T.C. No.

Date Issued

Place Issued

BOX 4 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 Inspector and Supervisor of Repair Works)

whose signatures appear herein above, 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. WITHNESS MY HAND AND SEAL on the date and place above written. Doc. No. Page No. Book No. Series No.

_______________ _______________ _______________ _______________

NOTARY PUBLIC (Until December______________________)

FEE PAID DATE PAID

OFFICIAL RECEIPT NO. DATE ISSUED

BOX 5 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN: PERMIT IS HEREBY ISSUED/GRANTED SUBJECT TO THE FOLLOWING CONDITIONS: 1.

That the proposed repair works shall be in conformity with the provisions of the “National Building Code” (PD 1096) and its Implementing Rules and Regulations.

2.

That the other provisions, existing laws, decrees, rules and regulations shall be complied with.

3.

That a duly licensed architect/civil engineer has been engaged to undertake the supervision of the repair work.

4.

That the owner and contractor shall be jointly responsible for the safety, protection, security and convenience of the general public and his/her personnel, third parties, the works, equipment and the like.

5.

That this permit shall not serve as exemption from securing permits/written clearances from various government authorities exercising regulatory function affecting buildings and other related structures.

6.

That a previous building permit/certificate of occupancy shall have been secured prior to the repair works.

PERMIT ISSUED:

BUILDING OFFICIAL (Signature Over Printed Name) Date____________________