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Subdivision and Memorial Parks Site Inspection Report/ Fact Sheet
HLURB report form for subdivision and memorial parks site inspection
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: PRLD.0006-A.02
Housing and Land Use Regulatory Board
Expanded National Capital Region Field Office
6th Floor, Sunnymede IT Center,
1614 Quezon Avenue, South Triangle, Quezon City
SITE INSPECTION REPORT/FACT SHEET FOR SUBDIVISION
AND MEMORIAL PARKS
DATE
PROJECT NAME: ____________________________ DOCKET NO.: __________ DEVELOPMENT PERMIT ISSUED: _________
LOCATION: _______________________________________________________ DEVELOPMENT PERMIT NO.: _____________
OWNER/DEVELOPER: ______________________________________________ LICENSE TO SELL ISSUED: ______________
ADDRESS/TEL. NO.: ________________________________________________ LICENSE TO SELL NO.: __________________
LAND AREA: __________ NO. OF SALEABLE LOTS/UNITS: ________________ CERT. OF REGISTRATION ISSUED: _______
PROJECT TYPE: PD 957 [ ] BP 200 [ ] OTHERS (SPECIFY):______________ CERT. OF REGISTRATION NO.: __________
LATEST DATE OF INSPECTION: ______ CONDUCTED BY: _________________ TARGET COMPLETION DATE: ___________
PURPOSE OF INSPECTION: __________________________________________ LAST REPORTED STATUS OF
DEVELOPMENT: ______________________
DATE OF INSPECTION: _____________ CONDUCTED BY: _______________________________________________________
DEVELOPMENT DESCRIPTION
AS PER APPROVED PLANS
1. ROAD WORKS
A. Clearing and Grubbing
B. Road Excavation
C. Filling and Compaction
D. Sub-base/Base Coarse
E. Concrete Pavement
F. Curbs and Gutters
G. Sidewalks
2. DRAINAGE & SEWERAGE
SYSTEM
A. Underground
RCP Line
NRCP Line
Cross Drain
Manholes/Catch Basin
B. Open Canal
3. WATER DISTRIBUTION
SYSTEM
A. Centralized
Water Lines
Fire Hydrants
Elevated Water Tank with
pump
B. Local Water Utilities System
4. ELECTRICAL DISTRIBUTION
SYSTEM
5. RIPRAP/RETAINING WALL
6. BRIDGE/BOX CULVERT
7. OPEN SPACE
8. AMENITIES
OVERALL:
TOTAL
COST
PER ITEM
%
ACCOMPLISHMENT
COST OF
ACCOMPLISMENT
REMAINING
DEVELOPMENT
COST
REMARKS/
EVALUATION
- 2-
EVALUATION/RECOMMENDATION:
Prepared by:
Computation:
PROJECT ENGINEER
Inspector
Date:
VERIFICATION
I, _________________________________, of legal age, after having sworn, depose and say that I have
read and accomplished this form and contents herein are true and correct.
Name, Signature and Seal of the Project
Engineer/Architect
PRC No.:
PTR No.:
Date & Place Issued:
Date & Place Issued:
SUSCRIBED AND SWORN to before me in this ________ day of ______________________ affiant
exhibiting to me his/her ________________________________________ No. ____________________,
issued at ______________________ on _________________________ .
NOTARY PUBLIC
Doc. No.:
Book No.:
Page No.:
Series of
