NBC FORM NO.
A-06
                                                                       Republic of the Philippines
                                                              DEPARTMENT OF PUBLIC WORKS & HIGHWAYS
                                                                   OFFICE OF THE BUILDING OFFICIAL
                                                                                     MUNICIPALITY
                                                                              PLUMBING PERMIT
APPLICATION NO.                                                               PP NO.                                                PERMIT NO.
              DATE OF APPLICATION                                                                                                                        DATE ISSUED
  BOX 1 (TO BE ACCOMPLISHED BY SANITARY ENGINEER/MASTER PLUMBER, IN PRINT)
  NAME OF OWNER/APPLICANT                                                      LAST NAME, FIRST NAME,                    M.I.                           TAX ACCT. NO.
  ADDRESS                                                                      No., Street, Barangay, City/Municipality                                 TELEPHONE NO.
  Location of Installation                                                     No., Street, Barangay, City/Municipality
  SCOPE OF WORK
         NEW CONSTRUCTION                                  RENOVATION                                           RISING
         ERECTION                                          CONVERSION                                           DEMOLITION
         ADDITION                                          REPAIR                                               ACCESSORY BUILDING/STRUCTURE
         ALTERATION                                        MOVING                                               OTHERS (specify)
  USE OR TYPE OF OCCUPANCY
          Residential                                                                             Agricultural
          Commercial                                                                              Parks, Plazas, Monuments
          Industrial                                                                              Recreational
          Institutional                                                                           Others (Specify)
  BOX 2 (TO BE ACCOMPLISHED BY THE DESIGNING PROFESSIONAL)
  FIXTURES TO BE INSTALLED
               NEW         EXISTING                         KIND OF                                             NEW             EXISTING                  KIND OF
     QTY.    FIXTURES      FIXTURES                        FIXTURES                            QTY.           FIXTURES          FIXTURES                 FIXTURES
                                                       Water Closet                                                                                      Bidet
                                                       Floor Drain                                                                                       Laundry Trays
                                                       Lavatories                                                                                        Dental Cuspidator
                                                       Kitchen Sink                                                                                      Gas Heater
                                                       Faucet                                                                                            Electric Heater
                                                       Shower Head                                                                                       Water Boiler
                                                       Water Meter                                                                                       Drinking Fountain
                                                       Grease Trap                                                                                       Bar Sink
                                                       Bath Tubs                                                                                         Soda Fountain Sink
                                                       Slop Sink                                                                                         Laboratory Sink
                                                       Urinal                                                                                            Sterilizer
                                                       Airconditioning Unit                                                                              Swimming Pool
                                                       Water Tank/reservoir                                                                              R.C.S. volume
                             TOTAL                                                                                       TOTAL                           Others (Specify)
                Water Distribution                                     Sanitary Sewer System                                       Storage Drainage System
  BOX 3                                                                                           BOX 4
                DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS                                                        SUPERVISOR/IN-CHARGE OF PLUMBING WORKS
                     MASTER PLUMBER                                           Date                                       MASTER PLUMBER                                         Date
              (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)
Address                                                                                         Address
CTC No.                        Date Issued                     Place Issued                     CTC No.                          Date Issued                     Place Issued
  BOX 7 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION )
RECEIVED BY:                                                               DATE:
                                                       THREE (3) SETS OF PLUMBING DOCUMENTS
   Plumbing Plans & Specifications                                           Cost Estimates
   Bill of Materials                                                         Others (Specify)
 BOX 8 (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)
                                                                   ASSESSED FEES
                                      AMOUNT DUE                  ASSESSED BY                   O.R. NUMBER                 DATE PAID
 BOX 9 (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)
                                                                  PROGRESS FLOW
                                                      IN                           OUT
                 NOTE                                                                                      ACTION/REMARKS     PROCESSED BY
                                             TIME           DATE            TIME          DATE
 Chief, Processing Division/Section
 Receiving and Recording
 Geodetic (Line and Grade)
 Plumbing
 BOX 10
 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 :
                                                    ENGR. CIRINIA GRACE L. CATUBIG
                                                                  Officer-In-Charge
 THIS PERMIT MAY BE CANCELLED OR REVOKED PERSUANT TO SECTION. 305 & 306 OF THE "NATIONAL BUILDING CODE".