NBC FORM NO.
A- 06
Republic of the Philippines
Municipality of Marcos
Province of Ilocos Norte
OFFICE OF THE BUILDING OFFICIAL
PLUMBING PERMIT
APPLICATION NO. PP NO. BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED 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 ZIPCODE TELEPHONE NUMBER
MARCOS, ILOCOS NORTE 2907
LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DEC. NO.
STREET BARANGAY CITY/MINICIPALITY OF MARCOS, ILOCOS NORTE
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION_____________________ RAISING___________________________________
ERECTION CONVERSION_____________________ DEMOLITION_______________________________
ADDITION REPAIR__________________________ ACCESSORY BUILDING/STRUCTURE_____________
ALTERATION MOVING_________________________ OTHERS (Specify) ___________________________
____________________________________________
BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
FIXTURES TO BE INSTALLED
QTY. NEW EXISTING KIND OF QTY. NEW EXISTING KIND OF
FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES
_______________ WATER CLOSET _______________ BIDETTE
_______________ FLOOR DRAIN _______________ LAUNDY TRAYS
_______________ LAVATORY _______________ DENTAL CUSPIDOR
_______________ KITCHEN SINK _______________ DRINKING FOUNTAIN
_______________ FAUCET _______________ BAR SINK
_______________ SHOWER HEAD _______________ SODA FOUNTAIN SINK
_______________ WATER METER _______________ LABORATORY SINK
_______________ GREASE TRAP _______________ STERILIZER
_______________ BATH TUB _______________ OTHERS (Specify)
_______________ URINAL _______________
_______________ SLOP SINK
URINAL _______________
_______________ AIR CONDITIONING UNIT _______________
_______________ WATER TANK RESERVOIR _______________
______________________ TOTAL ______________________ TOTAL
WATER DISTRIBUTION SYSTEM SEWAGE SYSTEM SEPTIC TANK STORM DRAINAGE SYSTEM
PREPARED: _______________________________________________________________________________________________________
BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS DESIGN SUPERVISOR / IN-CAHRGE OF PLUMBING WORKS
_____________________________________ Date _________________ _____________________________________ Date _________________
MASTER PLUMBER MASTER PLUMBER
(Signed and Sealed Over 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 5 BOX 6
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
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
RECEIVED BY: DATE
FIVE (5) SETS OF PLUMBING DOCUMENTS
PLUMBING PLANS AND SPECIFICATIONS COST ESTIMATES
BILL OF MATERIALS OTHERS (Specify)
BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY
DATE TIME DATE TIME
RECEIVED AND RECORDING
PLUMBING
OTHERS (Specify)
BOX 9
ACTION TAKEN:
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed plumbing works shall be in accordance with the plumbing plans field with this Office and in conformity with
the Revised Plumbing Code of the Philippines the National Building Code and its IRR.
2. That prior to any commencement of plumbing works, a duly accomplished prescribed "Notice of Construction" shall be
submitted to the Office of the Building Official.
3. That upon completion of the plumbing 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 starting that the plumbing works conform to the provision of the Revised Plumbing Code,
the National Building Code and its IRR.
4. That this permit is null and void unless accompanied by the buiding permit.
PERMIT ISSUED BY:
ENGR. MARIELLE MENOR
ACTING BUILDING OFFICIAL
(Signature Over Printed Name)
Date ______________________________
