Excavation Permit Application Form For Utilities - Department Of The Building Official
ADVERTISEMENT
1Republika ng Pilipinas
Quezon City
DEPARTMENT OF THE BUILDING OFFICIAL
EXCAVATION PERMIT APPLICATION FORM
(FOR UTILITIES)
(Print the required data, legibly, on all appropriate boxes.)
PROJECT NAME:_________________________________________________________________________
APPLICATION CONTROL NUMBER
DATE OF APPLICATION
BOX 1 (TO BE ACCOMPLISHED BY THE APPLICANT)
NAME OF APPLICANT (LAST NAME, FIRST NAME, M.I.)
T.I.N.
ADDRESS (NO., STREET NAME, BARANGAY, CITY)
TELEPHONE NO.
LOCATION OF EXCAVATION (NO., STREET NAME, BARANGAY, CITY)
TYPE OF WORK
( ) BY CONTRACT
( ) INDIVIDUAL
( ) BY ADMINISTRATION
_________________________
( ) OTHERS (SPECIFY) ________________________________
UTILITY PROVIDER:
SCOPE OF WORK: INSTALLATION, REPAIR OR IMPROVEMENT OF:
( ) WATER
( ) GAS PIPES/SYSTEM
( ) DRAINAGE PIPES/SYSTEM
( ) SEWER PIPES/SYSTEM
( ) TELEPHONE LINES
( ) CABLE CONDUITS / POWER LINES & OTHER COMMUNICATION FACILITIES
( ) OTHERS (SPECIFY)_________________________________________________________________________________
PROJECT DURATION __________________________________
SCHEDULED START OF WORK
EXPECTED DATE OF COMPLETION_________________
(DATE OF RECEIPT OF EXCAVATION PERMIT)
CORPORATE SECRETARY'S CERTIFICATION OF A BOARD
SUPPORTING DOCUMENTS:
RESOLUTION AUTHORIZING THE SIGNATORY / IES
SCHEDULE OF ACTIVITIES
CLEARANCES
NUMBER / BARANGAY NAME
DATE ISSUED
BARANGAY CLEARANCE
HOMEOWNERS ASSOCIATION CLEARANCE (if applicable)
EXCAVATION CLEARANCE (from the QC Engineering Dep't.)
INSPECTION REPORT (from the QC Engineering Dep't.)
OWNER / AUTHORIZED REPRESENTATIVE:
CONTRACTOR / AUTHORIZED REPRESENTATIVE:
(SIGNATURE OVER PRINTED NAME)
(SIGNATURE OVER PRINTED NAME)
AGE:__________ GENDER:______________________
AGE:__________ GENDER:______________________
CIVIL STATUS:_________________________________
CIVIL STATUS:________________________________
CELLPHONE No.:_______________________________
CELLPHONE No.:_______________________________
ADDRESS:____________________________________
ADDRESS:____________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Official Form 103a - Application Form For Individuals To Pay The Filing Fee In Installments
Financial
Form 945-x - Instructions For Adjusted Annual Return Of Withheld Federal Income Tax Or Claim For Refund - Department Of The Treasury - 2011
Financial
Related Categories
Parent category: Legal