Plumbing Permit

NBC FORM NO.
A -06
Republic of the Philippines
Municipality of Malitbog
Province of Southern Leyte
OFFICE OF THE BUILDING OFFICIAL

PLUMBING PERMIT
APPLICATION NO. PP NO BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY

OWNER/APPLICANT
THE 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 ZIP CODE TELEPHONE NO
LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO. _____________________
STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF ________________________________
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________ RAISING________________________________________
DEMOLITION ____________________________________
ERECTION CONVERSION ________________________
ACCESSORY BUILDING/STRUCTURE ________________
ADDITION REPAIR _____________________________ OTHERS (Specify) _________________________________
ALTERATION MOVING _____________________________
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 HEAD SODA FOUNTAIN SINK
WATER METER LABORATORY SINK
GREASE TRAP STERILIZER
BATH TUB OTHERS (Specify)
SLOP SINK __________________________
URINAL __________________________
AIR CONDITIONING UNIT __________________________
WATER TANK/RESERVOIR __________________________
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
(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
NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE “NATIONAL BUILDING CODE”.
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 8
PROGRESS FLOW
IN OUT
PROCESSED BY
DATE TIME DATE TIME
RECEIVING AND RECORDING
PLUMBING
OTHERS (Specify)
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 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
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:

PERMIT ISSUED BY:
BUILDING OFFICIAL
(Signature Over Printed Name)
Date ____________________

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NBC FORM NO.

OFFICE OF THE BUILDING OFFICIAL

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

(Signature Over Printed Name) (Signature Over Printed Name)

RECEIVED BY: DATE:

FIVE (5) SETS OF PLUMBING DOCUMENTS

PLUMBING PLANS AND SPECIFICATIONS COST ESTIMATES

BILL OF MATERIALS OTHERS (Specify)

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

PERMIT ISSUED BY:

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