PERMIT NUMBER:
EMERGENCY
WORK PERMIT MINOR WORKS
MAJOR WORKS
TENANT: UNIT: AUTHORIZED REPRESENTATIVE:
NATURE OF WORK: Note:
HOTWORKS A Fire Extinguisher and pail of water should be placed at
all times beside the MAPP Gas.
OTHER INSTRUCTIONS: (For Admin use only)
SCOPE OF WORK:
1) _______________________________________
2) _______________________________________
3) _______________________________________
4) _______________________________________
5) _______________________________________
NAME OF WORKER(S):
1) _______________________________________
2) _______________________________________
3) _______________________________________
4) _______________________________________
5) _______________________________________
ITEMIZED LIST OF TOOLS AND MATERIALS:
1) _______________________________________
2) _______________________________________
3) _______________________________________
4) _______________________________________
5) _______________________________________
Work duration: From: __________________________ To: __________________________
Total number of days: (Calendar days) __________________________ days
6:00am to 6:00pm
Working hour(s): 6:00pm to 6:00am
Total number of personnel to work for the project: ___________
Requested by: In case of contractor,
Endorsed by:
Name Name
Designation: Designation:
Date: Date:
RECOMMENDING APPROVALS APPROVED BY: FOR RELEASE
Finance/ Actg. Dept. Engineering Dept. Received by:
Civil Electrical
BUILDING ADMINISTRATOR Name
Date: Date: Date: Date: Date:
Note:
This work permit shall be revoked if violations are found on the implementation of the approved plans.
Validity of work permit is dependent to updated account.
2018 Revised WORK PERMIT FORM
REQUIREMENTS: (Checklist)
1. Letter of Request from tenant
2. Specific work/ activities to be performed
3. List of workers with legible photocopy of their company ID’s
4. Itemized list of materials needed.
5. Itemized list of tools and equipments to be allowed entry into the building and work premises.
6. Scope of work-bar/GANTT Chart. (if applicable)
7. Drawing details (Blueprint-signed by owner & license professionals. (if needed)
Mechanical Plan
Architectural Plan
Plumbing Plan
Electrical Plan
Others _____________________
ACKNOWLEDGMENT RECEIPT
I, hereby acknowledge receipt of this duly filled work permit form with complete necessary
requirements and in triplicate copies, this _______ day of _______________, 20____ at _______ am/pm.
____________________________
Admin Staff
REMINDERS:
Please be advised that any application for WORK PERMIT (s) should be submitted to the Office of
the Building Administration three (3) days prior to schedule of work to be done with complete
requirements in order to avoid unnecessary delay in the processing of the said WORK PERMIT (s)
NOTE:
Only WORK PERMIT(s) with complete requirements shall be received or processed by the
Office of the Building Administration starting 8:00 AM until 2:00 PM only.
Application received after said period will be considered as transaction for the following day.
NO EMERGENCY WORK PERMIT SHALL BE ISSUED DURING WEEKEND
Fill out and submit this form with complete requirements in three (3) copies.
NO WORK SHALL BE ALLOWED WITHOUT OFFICIAL WORK PERMIT ISSUED
AND SIGNED BY THE BUILDING ADMINISTRATION.
REMARKS:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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2018 Revised WORK PERMIT FORM
