NBC FORM NO.

A -06
Republic of the Philippines
City/Municipality of Lubang
Province of Occidental Mindoro

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
MENDOZA MARK LANCELOT

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO
GEN.A.LUNA MALIIG LUBANG 5109

LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO. _____________________
STREET____GEN.A.LUNA________ BARANGAY _____________MALIIG________________________ CITY/ MUNICIPALITY OF _______LUBANG_________________

SCOPE OF WORK RAISING________________________________________

DEMOLITION ____________________________________
NEW CONSTRUCTION RENOVATION ________________________
ACCESSORY BUILDING/STRUCTURE ________________
ERECTION CONVERSION ________________________
OTHERS (Specify)_________________________________
ADDITION REPAIR _____________________________
ALTERATION MOVING _____________________________

BOX 2 (TOTO
FIXTURES BE BE
ACCOMPLISHED
INSTALLED BY THE DESIGN PROFESSIONAL)
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

MARK LANCELOT MENDOZA MARK LANCELOT MENDOZA

(Signature Over Printed Name) (Signature Over Printed Name)
Date_________________ Date__________________
BRGY. MALIIG, LUBANG, OCCIDENTAL MINDORO BRGY. MALIIG, LUBANG, OCCIDENTAL MINDORO
PERMIT
Address IS HEREBY ISSUED SUBJECT TO THEAddress FOLLOWING:
11034171
C.T.C. No. 01-03-2022
Date Issued Place
ArawIssued
at Bituin C.T.C. No.
11034171 Date Issued
01-03-2022 Place
Araw Issued
at Bituin
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 BE ACCOMPLISHED to PROCESSING
BY THE the logbookAND
dulyEVALUATION
signed and sealed to the building official including as-
DIVISION
BOX 7 built plans and other documents and shall also accomplish the Certificate of Completion

RECEIVEDstating
BY: that the plumbing works of the building
DATE: conform to the provision of the Revised
NOTE:Plumbing
THIS PERMIT MAYCode, theORNational
BE CANCELLED
FIVEBuilding
(5) SETS OFCode
REVOKED PURSUANT TO SECTIONS 305 ANDand
306 OFits IRR. BUILDING CODE”.
THE “NATIONAL
PLUMBING DOCUMENTS
BUILDING OFFICIAL
4. PLUMBING
That thisPLANS permit is null and void unless
AND SPECIFICATIONS (Signatureaccompanied
Over Printed Name) byCOST the ESTIMATES
building permit. PROCESSED BY
PERMIT
OTHERS
RECEIVING
PLUMBING ISSUED BY: Date ____________________ OTHERS (Specify)
TIME________________________________
BOX 98BILL
ACTION (Specify)
AND
OF MATERIALS
RECORDING
TAKEN: DATE IN
PROGRESS TIME
FLOW DATE OUT