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Application Form Scaffolding Permit

This document is a scaffolding permit application from the Office of the Building Official of a city or municipality in the Philippines. It contains information about the owner/applicant, location of construction, scope of work requiring scaffolding, design professional and inspector details, consent from the lot owner, fees paid, and conditions of the permit including responsibility for safety and not obstructing passage or utilities. The building official has issued a permit to erect scaffolding for a specified period at the listed premises.

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Irfan Maulana
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344 views

Application Form Scaffolding Permit

This document is a scaffolding permit application from the Office of the Building Official of a city or municipality in the Philippines. It contains information about the owner/applicant, location of construction, scope of work requiring scaffolding, design professional and inspector details, consent from the lot owner, fees paid, and conditions of the permit including responsibility for safety and not obstructing passage or utilities. The building official has issued a permit to erect scaffolding for a specified period at the listed premises.

Uploaded by

Irfan Maulana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NBC FORM NO.

B - 06

Republic of the Philippines


City/Municipality of ________________
Province of _________________________

OFFICE OF THE BUILDING OFFICIAL

SCAFFOLDING 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 M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY


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 RENOVATION ________________________ RAISING _____________________________________
ERECTION CONVERSION ________________________ DEMOLITION __________________________________
ADDITION REPAIR _____________________________ ACCESSORY BUILDING/STRUCTURE _____________
ALTERATION MOVING _____________________________ OTHERS (Specify) ______________________________

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 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 BOX 5
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

BOX 6

APPLICANT
(Signature Over Printed Name)
Date___________________
CTC NO. DATE ISSUED PLACE ISSUED

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

FEE PAID OFFICIAL RECEIPT NO.


DATE PAID DATE ISSUED

BOX 8 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN:

Permit is hereby issued/granted to __________________________________________________________


with postal address at __________________________________________________________________________
to erect a SCAFFOLDING for ____________________________________________________________________
with a frontage of ________________________ ( ) lineal meters at the premises of _______________________
for the period of ________( ) days inclusive from _________________, ____ to _________________, ____
pursuant to pertinent provisions of the “National Building Code” (PD 1096) and its Implementing Rules and
Regulations and to the following conditions:

1. 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.
2. That the scaffolding shall not be erected on the roadway area nor shall it obstruct the free passage of
pedestrians.
3. That surface drains and other utility fixtures or lines shall not be obstructed.
4. 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.

PERMIT ISSUED BY:

BUILDING OFFICIAL
(Signature Over Printed Name)
Date_____________________

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