Republic of the Philippines
Municipality of Kabankalan
Province of Negros Occidental
OFFICE OF THE BUILDING OFFICIAL
PLUMBING PERMIT
APPLICATION NO. PP NO. BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED IN PART BY THE OWNER/APPLICANT)
OWNER/APPLICANT LAST NAME FIRST NAME M.I TIN
FOR CONSTRUCTION OWNED FORM PF OWNERSHIP USE OR CHARACTER IF OCCUPANCY
BY AN ENTERPRISE
ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.
LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DE. NO.
STREET BARANGAY CITY/MUNICIPALITY OF
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION DEMOLITION
ADDITION REPAIR ACCESSORY BUILDING/STRUCTURE
ALTERATION MOVING OTHER (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 LAUNDRY TRAYS
LAVATORY DENTAL CUSPIDOR
KITCHEN SINK DRINKING FOUNTAIN
FAUCET BAR SINK
SHOWER SODA FOUNTAIN SINK
WATER METER LABORATORY SINK
GREASE TRAP STERILIZER
BATH TUB OTHERS (Specify)
SLOP SINK
URINAL
AIR CONDITIONING UNIT
WATER TANK RESERVIOR
TOTAL TOTAL
WATER DISTRIBUTION SYSTEM SEWAGE SYSTEM SEPTIC TANK STORM DRAINAGE SYSTEM
PREPARED BY:
BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF PLUMBING WORKS
Date Date
MASTER PLUMBER MASTER PLUMBER
(Sign and Sealed Over Printed) (Sign and Sealed Over Printed)
Address Address
PRC No. Vality PRC No. Vality
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
CTC No. Date issued Place Issued CTC No. Date issued Place Issued
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
BOX 7
RECEIVED BY: DATE:
FIVE (5) SETS OF PLUMBING DOCUMENTS
PLUMBING PLANS AND SPECIFICATIONS COST ESTIMATES
BILL OF MATERIALS OTHERS (Specify)
BOX 7
PROGRESS FLOW
IN OUT
PROCESSED BY
DATE TIME DATE TIME
RECEIVING AND RECORDING
PLUMBING
OTHERS (Specify)
BOX 8
ACTION TAKEN:
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed plumbing works shall be in accordance with the plumbing plans filed with is 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 Office.
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 stating that the plumbing works of the building 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 building permit.
PERMIT ISSUED BY:
BUILDING OFFICIAL
(Signature Over Printed Name)
Date:
