Republic of the Philippines
Quezon City
DEPARTMENT OF ENGINEERING
INDUSTRIAL SAFETY DIVISION
Tel. No. 925-6045 loc 314
APPLICATION NO.
PERMIT NO.
MECHANICAL PERMIT
DATE OF APPLICATION
DATE ISSUED
BOX 1 (PLEASE PRINT)
NAME OF OWNER/APPLICANT:
LAST NAME,FIRST NAME, MIDDLE INITIAL
TAX I.D. NO.
ADDRESS:
NO., STREET,BARANGAY , CITY/MUNICIPALITY
TELEPHONE NO.
LOCATION OF INSTALLATION:
NO., STREET,BARANGAY , CITY/MUNICIPALITY
SCOPE OF WORK:
NEW INSTALLATION:
ADDITION OF
BUILDING PERMIT NO.
REMOVAL OF
CERTIFICATE OF OCCUPANCY NO.
OTHERS (SPECIFY)
USE OR TYPE OF OCCUPANCY
RESIDENTIAL
AGRICULTURAL
COMMERCIAL
LANDSCAPING
INDUSTRIAL
OTHERS (SPECIFY).
INSTITUTIONAL
INSTALLATION AND OPERATION OF
BOILER
CENTRAL AIR-CONDITIONING
DUMBWAITER
PRESSURE VESSELS
MECHANICAL VENTILATION
PUMPS
INTERNAL COMBUSTION ENGINE
ESCALATOR
COMPRESSED AIR, VACUUM,
INSTITUTIONAL and/or INDUSTRIAL GAS
REFRIGERATION & ICE-MAKING
MOVING SIDEWALK
WINDOW TYPE AIR-CONDITION
FREIGHT ELEVATOR
PNEUMATIC TUBES,CONVEYORS
PACKAGE AIR-CON UNIT
PASSENGER ELEVATOR
And/or MONORAILS
OTHERS (SPECIFY)
PROPOSED DATE
OF INSTALLATION
EXPECTED DATE
OF COMPLETION
TOTAL INSTALLATION COST
PREPARED BY
BOX 2 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)
ACTION TAKEN
PERMIT IS HEREBY GRANTED TO INSTALL THE MECHANICAL EQUIPMENT ENUMERATED HEREIN SUBJECT TO THE FOLLOWING CONDITIONS:
1. THAT THE PROPOSED INSTALLATION SHALL BE IN ACCORDANCE
WITH APPROVED PLANS FILED WITH THIS OFFICE AND IN CONFORMITY WITH THE NATIONAL BUILDING CODE.
2. THAT A DULY LICENSED PROFESSIONAL MECHANICAL ENGINEER
BE ENGAGED TO UNDERTAKE THE INSTALLATION/CONSTRUCTION
3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY THE PROFESSIONAL MECHANICAL ENGINEER IN-CHARGE OF INSTALLATION SHALL BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS
AFTER COMPLETION OF THE INSTALLATION.
4. THAT A CERTIFICATE OF FINAL INSPECTION AND A CERTIFICATE
OF OCCUPANCY BE SECURED PRIOR TO THE ACTUAL OCCUPANCY
OF THE BUILDING.
ENGR. JOSELITO C. ARCANIA
Chief, Industrial Safety Division
ENGR. ISAGANI R. VERZOSA JR.
Local Building Official
www.quezoncity.gov.ph
OFFICE OF THE BUILDING OFFICIAL
5. THAT AN ANNUAL CERTIFICATE OF INSPECTION SHALL BE SECURED FOR THE CONTINUOUS OPERATION OF THE MECHANICAL
EQUIPMENT INSTALLED.
NOTE:
THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 & 306 OF THE NATIONAL BUILDING CODE.
BOX 3
(TO BE ACCOMPLISHED BY THE RECEIVING AND RECORDING SECTION)
BUILDING DOCUMENTS
(FIVE (5) SETS EACH)
BOX 4
MECHANICAL PLANS & SPECIFICATIONS
BILL OF MATERIALS
COST ESTIMATES
OTHERS (SPECIFY)
(TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)
ASSESSED FEES
AMOUNT DUE
ASSESSED BY
O.R. NUMBER
DATE PAID
MECHANICAL
REVIEWED:
Asst. Chief of Division
BOX 5
(TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)
PROGRESS FLOW
NOTED
OUT
IN
CHIEF, PROCESSING DIVISION/SECTION
DATE
TIME
DATE
TIME
ACTION/REMARKS
PROCESSED BY
WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH
BOX 8
BOX 6
PROF. MECH. ENGINEER
PRC REG. NO.
SIGNATURE
SIGNED AND SEALED PLANS & SPECIFICATIONS
PRINT NAME
APPLICANT
ADDRESS
P.T.R. NO.
RES. CERT. NO.
DATE ISSUED
SIGNATURE
DATE ISSUED
PLACE ISSUED
TIN
BOX 7
PROF. MECH. ENGINEER
PRC REG. NO.
IN-CHARGE OF INSTALLATION
PRINT NAME
ADDRESS
P.T.R. NO.
SIGNATURE
DATE ISSUED
PLACE ISSUED
TIN
www.quezoncity.gov.ph
OFFICE OF THE BUILDING OFFICIAL
PLACE ISSUED