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Building Ancillary Permit

TIEZA application form for building ancillary permit

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Tourism Infrastructure and Enterprise Zone Authority

Office of the Building Official

MECHANICAL PERMIT
APPLICATION NO.

BUILDING PERMIT NO.

MP NO

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

LAST NAME

FOR CONSTRUCTION OWNED

FIRST NAME
FORM OF OWNERSHIP

M.I.

TIN

USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE
ADDRESS:

NO.,

STREET,

LOCATION OF CONSTRUCTION:

BARANGAY,

CITY/MUNICIPALITY

ZIP CODE

TELEPHONE NO

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

STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF________________________________

SCOPE OF WORK
NEW CONSTRUCTION
ERECTION
ADDITION
ALTERATION

RENOVATION ________________________
CONVERSION ________________________
REPAIR _____________________________
MOVING _____________________________

RAISING_______________________________________
DEMOLITION ___________________________________
ACCESSORY BUILDING/STRUCTURE ______________
OTHERS (Specify) _______________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
INSTALLATION AND OPERATION OF:
BOILER

CENTRAL AIRCONDITIONING

DUMBWAITER

PRESSURE VESSEL

MECHANICAL VENTILLATION

PUMPS

INTERNAL COMBUSTION ENGINE

ESCALATOR

REFRIGERATION AND ICE MAKING

MOVING SIDEWALK

COMPRESSED AIR, VACUUM, INSTITUTIONAL
and/or INDUSTRIAL GAS

WINDOW TYPE AIRCONDITIONING

FREIGHT ELEVATOR

PACKAGED/ SPLIT TYPE AIRCONDITIONING

PASSENGER ELEVATOR

PNEUMATIC TUBES, CONVEYORS
and/or MONORAILS

OTHERS (Specify) _____________________

CABLE CAR

FUNICULAR

PREPARED BY _____________________________________________________________________________________________________________
BOX 3

BOX 4

DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS

SUPERVISOR / IN-CHARGE OF MECHANICAL WORKS
PROFESSIONAL MECHANICAL ENGINEER

PROFESSIONAL MECHANICAL ENGINEER
(Signed and Sealed Over Printed Name)

MECHANICAL ENGINEER

(Signed and/or Sealed Over Printed Name)

Date________________________

Date___________________

Address

Address
PRC. No

Validity

PRC. No

Validity

PTR. No

Date Issued

PTR. No

Date Issued

Issued at

TIN

Issued at

TIN

BOX 5

BOX 6

BUILDING OWNER

WITH MY CONSENT: LOT OWNER

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

(Signature Over Printed Name)
Date__________________
Address

Date Issued

Place Issued

C.T.C. No.

Date Issued

Place Issued

TO BE ACCOMPLISHED BY THE PERMITS AND LICENSES DIVISION
BOX 7
RECEIVED BY:

DATE:

FIVE (5) SETS 20”X30” & ONE (1) A3 OF MECHANICAL DOCUMENTS
MECHANICAL PLANS AND SPECIFICATIONS

COST ESTIMATES

BILL OF MATERIALS

OTHERS (Specify) ____________________________________

BOX 8
PROGRESS FLOW
IN
DATE

OUT
TIME

DATE

TIME

PROCESSED BY:

MECHANICAL
OTHERS (Specify)

BOX 9

ACTION TAKEN:
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed mechanical works shall be in accordance with the mechanical plans filed with this Office and in conformity
with the latest Philippine Mechanical Code, the National Building Code and its IRR.
2. That prior to any mechanical installation, a duly accomplished prescribed “NOTICE OF CONSTRUCTION” shall be
submitted to the Office of the Building Official.
3. That upon completion of the mechanical works, the licensed supervisor/in-charge shall submit the entry to the logbook duly
signed and sealed to the building official including as-built plans and other documents and shall also accomplish the
certificate of completion stating that the mechanical works conform to the provision of the Philippine Mechanical Code, the
National Building Code and its IRR.
4. That this permit is null and void unless accompanied by the building permit.
5. That a Certificate of Operation shall be issued for the continuous use of mechanical installations.

PERMIT ISSUED BY:

BUILDING OFFICIAL
(Signature Over Printed Name)
Date ______________________
 
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