NBC FORM NO.
A -06
Republic of the Philippines
CITY OF MATI
Province of Davao Oriental
OFFICE OF THE BUILDING OFFICIAL
PLUMBING PERMIT
APPLICATION NO. PP NO BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)
OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN
EYOG MARICHEL U.
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.
STREET Purok Omar, Bangunay BARANGAY Bobon CITY OF Mati, Davao Oriental
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION DEMOLITION
ADDITION REPAIR ACCESSORYBUILDING/STRUCTURE
ALTERATION MOVING OTHERS (Specify)
BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
QTY. NEW EXISTING KIND OF QTY. NEW EXISTING KIND OF
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
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
Mrs. Marichel U. Eyog
(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
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATIONDIVISION BOX 7
RECEIVED BY: DATE:
FIVE (5) SETS OF PLUMBING DOCUMENTS
PLUMBING PLANS AND SPECIFICATIONS COST ESTIMATES
BILL OF MATERIALS OTHERS (Specify)
BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY
DATE TIME DATE TIME
RECEIVING AND RECORDING
PLUMBING
OTHERS (Specify)
BOX 9
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. ZENAIDA M. LOON, EnP, MPA
City Building Official
(Signature over Printed Name)
Date: ___________________
