Republic of the Philippines
National Irrigation Administration
CAMARINES SUR IMO DISTRICT OFFICE III (THIRIS)
DATE:
CONCRETE POURING PERMIT
Name of Project :
Location :
Contractor :
Part of Structure to Estimated Volume, (cu.m.)
be ,,poured
:
Station Limits/ Section :
Date of Pouring : Time of Pouring
Requested by:
(Name & Signature of Contractor/Project Engr.)
CHECKLIST
Falsework/ Formworks adequacy Field Density Test
Protective Covering Materials Beam/ Cylinder Molds
Warning Signs/ Barricades/ Flagmen Curing Materials
Slump Cone Concrete Saw
Concrete Block Spacers Plumbness
Rebars sizes, spacing and number Concrete Vibrator
Line and Grade alignment (form
Lighting System
setting, ,,,,,,elevations, etc)
Required Construction equipment Electrical Layout (roughing-ins/embedment)
Rebars installation requirements Plumbing Layout (Roughing - ins/ embedments)
Quality of Materials Used (Result of
Finishing Tools/ Equipment (Screeder, broom, ,,,,etc)
Design/ ,,,,,,Trial,Mix, Test Reports, etc)
Checked by:
Materials Engineer/
Date
Project ,,,In-Charge
(Name and Signature)
REMARKS/ ,,,RECOMMENDA
TIONS
In-house Inspectorate ,,,Team
Date
Leader
(Name and Signature)
REMARKS/ ,,,RECOMMENDA
TIONS
Request : Approved Disapproved
REMARKS/ ,,,,RECOMMEND
ATIONS
MARY JANE C. MIRABUENO
Acting Head, NIA-THIRIS
Date: 30/12/1899