REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

METROPOLITAN MANILA AUTHORITY
OFFICE OF THE BUILDING OFFICIAL

CITY OF LAS PIÑAS

AREA CODE _________

PLUMBING PERMIT
APPLICATION NO. SP NO. BUILDING PERMIT NO.

DATE OF APPLICATION:
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 □ ADDITION OF _____________________ OTHERS (Specify)

□ NEW INSTALLATION □ REPAIR OF _______________________ □ __________ of __________
□ REMOVAL OF _____________________ □ __________ of __________

USE OR TYPE OF OCCUPANCY

□ RESIDENTIAL _____________ □ AGRICULTURAL _____________
□ COMMERCIAL ____________ □ PARKS, PLAZAS, MONUMENTS _____________
□ INDUSTRIAL ______________ □ RECREATIONAL _____________
□ INSTITUTIONAL ___________ □ OTHERS (Specify) _____________

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
______ □ □ □ LAVATORIES ______ □ □ □ DENTAL CRUSPIDOR
______ □ □ □ KITCHEN SINK ______ □ □ □ GAS HEATER
______ □ □ □ FAUCET ______ □ □ □ ELECTRIC HEATER
______ □ □ □ SHOWER HEAD ______ □ □ □ WATER BOILER
______ □ □ □ WATER METER ______ □ □ □ DRINKING FOUNTAIN
______ □ □ □ GREASE TRAP ______ □ □ □ BAR SINK
______ □ □ □ BATH THUBS ______ □ □ □ SODA FOUNTAIN SINK
______ □ □ □ SLOP SINK ______ □ □ □ LABORATORY SINK
______ □ □ □ URINAL ______ □ □ □ STERILIZER
______ □ □ □ AIR CONDITIONING UNIT ______ □ □ □ SWIMMING POOL
______ □ □ □ WATER TANK/RESERVOIR ______ □ □ □ OTHERS (Specify) ____
___________ TOTAL ___________ TOTAL _________________

□ WATER DISTRIBUTION SYSTEM □ SANITARY SEWER SYSTEM □ STORM DRAINAGE SYSTEM

WATER SUPPLY: SYSTEM OF DISPOSAL:
□ SHALLOW WELL □ WASTE WATER TREATMENT PLANT □ SURFACE DRAINAGE
□ DEEP WELL & PUMP SET □ SEPTIC VAULT/IMHOFF TANK □ STREET CANAL
□ CITY/MUNICIPALITY □ SANITARY SEWER CONNECTION □ WATER COURSE
□ OTHERS ______________ □ SUB-SURFACE

NUMBER OF STOREY’S OF BUILDING TOTAL AREA OF BUILDING/SUBDIVISION

PROPOSED DATE _______________________ _______________________________
START OF INSTALLATION _________________ TOTAL COST OF INSTALLATION
EXPECTED DATE OF COMPLETION __________ PREPARED BY: ___________________

BOX 2 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN:
PERMIT IS HEREBY GRANTED TO INSTALL THE SANITARY/PLUMBING
FIXTURES ENUMERATED HEREIN SUBJECT TO THE FOLLOWING CONDITIONS:
1. THAT THE PROPOSED INSTALLATION SHALL BE IN ACCORDANCE WITH APROVED PLANS FILED WITH THIS OFFICE
AND IN CONFROMITY WITH THE “NATIONAL BUILDING CODE.”
2. THAT DULY LICENSED SANITARY ENGINEER/MASTER PLUMBER BE ENGAGED/MASTER PLUMBER IN-CHARGE OF
INSTALLATION SHALL BE SUBMITTED NOT LATER THAN (7) DAYS AFTER COMPLETION OF THE INSTALLATION. ENGR. ROSABELLA A. BANTOG
3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY A SANITARY ENGINEER/MASTER PLUMBER IN-CHARGE OF BUILDING OFFICIAL
INSTALLATION SHALL SUBMITTED NOT LATER (7) DAYS AFTER COMPLETION OF THE INSTALLATION.
4. THAT A CERTIFICATE OF FINAL INSPECTION AND CERTIFICATE OF OCCUPANCY BE SECURED PRIOR TO THE ACTUAL _____________________________
OCCUPANCY OF THE BUILDING. DATE

NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 & 306 OF THE “NATIONAL BUILDING CODE”
BOX 3 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION)
BUILDING DOCUMENTS

□ SANITARY PLUMBING PLANS & SPECIFICATIONS □ COST ESTIMATES

□ BILL OF MATERIALS □ OTHERS (Specify)

BOX 4 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERENED)

ASSESSED FEES

AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

BOX 5 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)

PROGRESS FLOW

NOTED: IN OUT ACTION/REMARKS PROCESSED BY:

CHIEF, PROCESSING DIVISION/SECTION TIME DATE TIME DATE

RECEIVING AND RECORDING

GEODETIC (LINE and GRADE)

SANITARY

WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFROMITY TO THE INFORMATION ABOVE SETFORTH

BOX 6 BOX 7
MASTER PLUMBER SIGNED AND SEALED PRC. REG. NO. SIGNATURE
PLAN & SPECIFICATIONS

PRINT NAME
APPLICANT
ADDRESS
RES CERT. NO. DATE ISSUED PLACE ISSUED
P.T.R. NO. DATE ISSUED PLACE ISSUED

SIGNATURE TIN

BOX 8
SUPERVISOR / IN-CHARGE OF PLUMBING PRC. REG. NO.
WORKS

PRINT NAME

ADDRESS

P.T.R. NO. DATE ISSUED PLACE ISSUED

SIGNATURE TIN