MPW FORM NO.

77-009-B

Republic of the Philippines

Province of Bohol
OFFICE OF THE BUILDING OFFICIAL

APPLICATION NO. ______________________________________ PERMIT NO.

__________________ DISTRICT /CITY/MUNICIPALITY _____________________
AREA CODE__________________

______________________ FENCING PERMIT __________________

DATE OF APPLICATION DATE ISSUED

BOX 1: (TO BE ACCOMPLISHED BY APPLICANT IN PRINT)

LAST NAME FIRST NAME MI TAX ACCT. NO.
NAME OF APPLICANT

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP

BY AN ENTERPRISE

ADDRESS NO. STREET BARANGAY CITY /MUNICIPALITY TEL NO.

LOCATION OF AREA NO. STREET BARANGAY CITY /MUNICIPALITY TEL NO.

TO BE FENCED
SCOPE OF WORK ( ) ADDITION ( ) RENOVATION
( ) NEW FENCE ( ) REPAIR ( ) OTHER (SPECIFY)

BOX 2: (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION )

ACCOMPANYING DOCUMENTS:
( ) XEROX COPY OF T.C.T.
( ) XEROX COPY OF LOT/SITE PLAN
( ) XEROX COPY OF LATEST LAND TAX RECEIPT
( ) XEROX COPY OF CONTRACT OF LEASE (IF NOT OWNED BY APPLICANT)
( ) OTHERS CLEARANCES (SPECIFY)

BOX 3: (TO BE ACCOMPLISHED BY DESIGNING ARCHITECT/CIVIL ENGINEER/CONTRACTOR IN

PRINT)
LENGTH IN METERS HEIGHT IN METERS
MEASUREMENTS
TYPE OF FENCING ( ) INDIGENOUS MATERIALS ( ) R.C. & INTERLINK/CYCLONE WIRE
( ) R.C. (REINFORCED CONCRETE) ( ) R.C. & STEEL MATTING
( ) R.C. & CONC. HOLLOW BLOCKS ( ) R.C. & BARBED WIRE & OTHER WIRE
( ) R.C. & BRICKS ( ) OTHERS (SPECIFY)

BOX 4 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN

PERMIT IS HEREBY GRANTED SUBJECT TO THE FOLLOWING CONDITIONS:

1. THAT THE PROPSED CONSTRUCTION/ADDITION/REPAIR/RENOVATION SHALL BE IN CONFORMITY WITH

NATIONAL BUILDING CODE (P.D. 1096) AND ITS CORRESPONDING IMPLEMENTING RULES AND
REGULATIONS.

2. THAT THE REQUIRED PERMIT SHALL BE OBSERVED.

_____________________________
BUIDING OFFICIAL

___________________________
DATE
NOTE:
THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE
NATIONAL BUILDING CODE.
BOX 5 ( TO BE ACCOMPLISHED BY THE DIVISION CONCERNED)

ASSESSED FEES
AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

( ) LINE & GRADE

( ) FENCING

( ) ELECTRICAL (IF ANY)

REVIEWED :
CHIEF PROCESSING DIVSION
TOTAL

BOX 6 ( TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)

PROGRESS FLOW

NOTED: IN OUT ACTION PROCESSE

CHIEF PROCESSING DIVISION TIME DATE TIME DATE REMARKS D BY
RECEIVING/RECORDING
GEODETIC (LINE CONFORMITY)
STRUCTURAL
ELECTRICAL
CASHIER

WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SET
FORTH.

BOX 7: BOX 9:

ARCHITECT / CIVIL ENGINEER PRC REG. NO. APPLICANT

SIGNED & SEALED PLANS & PRINT NAME:
SPECIFICATIONS
PRINT NAME SIGNATURE

ADDRESS RES. CERT. DATE ISSUED PLACE OF

NO. ISSUE
P.T.R. NO. DATE ISSUED PLACE OF ISSUE

SIGNATURE TAN

BOX 8 : BOX 10 :

PRC REG. NO. CONSENT OF LAND OWNER

ARCHITECT / CIVIL ENGINEER PRINT NAME OF LAND OWNER:
IN CHARGE OF CONSTRUCTION

PRINT NAME: ADDRESS:

ADDRESS: OCT / TCT NO. TAX DECLARATION NO.

P.T.R. NO. DATE ISSUED PLACE OF ISSUE RES. CERT. NO. DATE ISSUED PLACE
ISSUED

SIGNATURE TAN SIGNATURE TAN