NBC FORM NO.
A -06
Republic of the Philippines
City/ Municipality of CABADBARAN
Province of AGUSAN DEL NORTE
OFFICE OF THE BUILDING OFFICIAL
PLUMBING PERMIT
APPLICATION NO. PP NO BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT LAST
OWNER/APPLICANT
BY THE OWNER/APPLICANT)
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. _____________________
CABADBARAN
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”.
