CONCRETE POURING PERMIT
Name of Project/Location
Contractor
Part of Structure to be Poured Estimated Volume:
Station Limits/Section
Date of Pouring Time of Pouring
Requested by:
JONATHAN B. ZABALA
Project in- charge
(Contractor)
CHECKLIST
Concrete Vibrator Field Density Test
Protective Covering materials Beam/cylinder
Warning Signs/Barricade Flagmen Curing Materials
Concete Saw Slump cone
Concrete Block Spacers Plumbness
Quality of Materials Used ( Result of Design/Trial
Finishing Tools/Equipment (Screeder, Broom, etc.) mix, Test Reports, etc.)
Line and Grade allignment (Form setting, elevations,
etc.)
Required construction equipment
Rebars sizes, spacing, number
Rebars installation requirements
CHECKED BY:
Materials Engineer ENGR. CHARITO B. OLASO Date
(Name/Signature)
Remarks/Recommendations
Project Inspector ENGR. NILO H. MENDOZA Date
(Name/Signature)
Remarks/Recommendations
REQUEST: APPROVED DISAPPROVED
Remarks/Recommendations
NOTED:
EDGAR D. AGANA, MPA
Provincial Engineer
CONTRACTOR'S NAME/LOGO
WORK REQUEST
NO. _______
Date:
NAME OF PROJECT:
LOCATION:
CONTRACTOR:
WORK TO BE PERFORMED:
SCHEDULE AND DATE:
STATION LIMIT:
REQUESTED BY:
NAME OF REP./ ENGR
(Designation)
(Contractor)
WORK REQUEST APPROVED: REMARKS:
LGU
(Designation)
Project In-charge
NOTED:
CHARITO B. OLASO
Engineer-IV EDGAR D. AGANA, MPA
Chief, Quality Assurance Section Provincial Engineer
CONTRACTOR'S NAME/LOGO
CONCRETE POURING PERMIT
Name of Project/Location
Contractor
Part of Structure to be Poured Estimated Volume:
Station Limits/Section
Date of Pouring Time of Pouring
Requested by:
NAME OF REP./ ENGR
(Designation)
(Contractor)
CHECKLIST
Concrete Vibrator Field Density Test
Protective Covering materials Beam/cylinder
Warning Signs/Barricade Flagmen Curing Materials
Concete Saw Slump cone
Concrete Block Spacers Plumbness
Quality of Materials Used ( Result of Design/Trial
Finishing Tools/Equipment (Screeder, Broom, etc.) mix, Test Reports, etc.)
Line and Grade allignment (Form setting, elevations,
etc.)
Required construction equipment
Rebars sizes, spacing, number
Rebars installation requirements
CHECKED BY:
Materials Engineer ENGR. CHARITO B. OLASO Date
(Name/Signature)
Remarks/Recommendations
Project Inspector LGU ENGR Date
(Name/Signature)
Remarks/Recommendations
REQUEST: APPROVED DISAPPROVED
Remarks/Recommendations
NOTED:
EDGAR D. AGANA, MPA
Provincial Engineer