Date :________________________

CONCRETE POURING PERMIT

Name of
Project/Location
Contractor
Part of structure to
be poured
Sta.limits/Section
Date of Pouring
Construction & Installation Juagdan Water Works
System Level I & II
Ferac Builders
Estimated Volume
Time of Pouring
Requested by:

Contractor: _________________________
(Name and Signature)
CHECKLIST
Concrete Vibrator Field Density Test
Protective Covering Materials Beam/Cylinder Molds
Warning Signs/Barricades/Flagmen Curing Materials
Concrete Saw Slump Cone
Concrete Block Spacer Plumbness
Finishing Tools/Equipment(screeder, Quality of Materials Used (Result of
broom, etc.) Design/Trial Mix, Test Reports, etc.)
Line and Grade alignment (from Lighting System
setting, elevations, etc.)
Required construction equipment Electrical Lay-out (Roughing-
ins/embedments)
Rebars installation requirements Falsework/formworks adequacy
Checked by:
Project
Implementation Date
Team Head (Name and Signature)
Remarks/
Recommendations

Project Inspector
(KC-TF or M.E) Date
(Name and Signature)
Remarks/
Recommendations

Request: Approved Disapproved

BSPMC Chair
Date
(Name and Signature)
Remarks/
Recommendations