Annex J

Concrete Pouring Permit

2020 LGSF-SALINTUBIG

Republic of the Philippines

Province of Zamboanga Sibugay
Municipality of Talusan

CONCRETE POURING PERMIT

Date _____________

PROJECT TITLE REHAB/IMPVT OF LGU WATER SYSTEM

PROJECT LOCATION
CONTRACTOR
CONTRACTOR’S ADDRESS
CONTRACTOR’S PCAB LICENSE
NO.
PART OF STRUCTURE TO BE
POURED
STATION LIMITS/SECTION
DATE OF POURING
POBLACION, TALUSAN, ZAMBOANGA SIBUGAY
GENETIAN BUILDER’S & ENT.
NESORICOM, BRGY TIGUMA, PAGADIAN CITY
18052
ESTIMATED VOLUME
(m3)
TIME OF POURING

Requested by:

Contractor: GENEO SOPHINE C. DY

_______________________________
Name & Signature

AUDIT ITEM Y N COMMENT/S

I. PRELIMINARY
 DESCRIPTION
 CURING METHOD
STREAM, WATER, FOG, OTHER
 FIELD DENSITY TEST
 REQUIRED CONSTRUCTION
EQUIPMENT
II. FORMWORK AND FALSEWORK
 FORMWORKS DIMENSION IN
ACCORDANCE TO THE APPROVED
DESIGN
 FORMS ARE CLEAN, SMOOTH AND
WATERTIGHT AND FREE OF
DELETERIOUS/ EXTRANEOUS/
FOREIGN MATERIALS
 LINE AND GRADE ALIGNMENT (FORM
SETTING, ELEVATIONS, ETC)
 PLUMBNESS
III. REINFORCING STEEL
 STEEL LOCATED/FIXED IN
ACCORDANCE WITH THE APPROVED
DRAWING
 REBARS SIZES, SPACING, AND
NUMBER ARE IN ACCORDANCE TO THE
APPROVED DESIGN
 RENFORCING ARE CLEAN AND FREE OF
DELETERIOUS MATERIALS
 ALL SPLICES TO REINFORCEMENT AT
APPROVED LOCATIONS
 ALL WELDS IN ACCORDANCE TO THE
APPROVED PLANS
IV. CONCRETE INCLUSIONS
 EMBEDDED DOWELS, BOLTS,
CONDUITS AND DUCTS
 CORED HOLES, WEEPHOLES, BLOCK
OUTS, ETC
 CONCRETE BLOCK SPACERS
 PLUMBING LAYOUT
 ELECTRICAL LAYOUT
 LIGHTNING SYSTEM
V. CONCRETE DELIVERY
 NUMBER OF BATCHES
 Annex J
Concrete Pouring Permit
2020 LGSF-SALINTUBIG

 BATCH TIME ( FROM DELIVERY

DOCKET)
 ARRIVAL TIME AT SITE
 FINISH TIME
VI. CONCRETE TESTING
 NUMBER OF CYLINDERS TAKEN
 TARGET SLUMP
 TARGET STRENGTH
 QUALITY OF MATERIALS USED
(RESULT OF DESIGN/TRIAL MIX/ TEST
REPORTS, ETC)
VII. CONCRETE PLACEMENT
 WARNING SIGNS/BARRICADES/
FLAGMEN
 CONCRETE VIBRATOR
 APPROVED VIBRATION METHOD
 PLACEMENT METHOD (PUMP, TREMIE,
CHUTE, OTHERS)
 SUFFICIENT PERSONNEL FOR
FINISHING
 FINISHING TOOLS/EQUIPMENT
(SCREEDER, BROOM, ETC)
 REINFORCEMENT COVER MAINTAINED
DURING POURING
 FORMWORK STABLE DURING PLACING
AND VIBRATION
 CONCRETE PLACED AND COMPACTED
WITHIN THE ALLOWABLE TEMP. VS
TIME
 PROVISION FOR CLOSURE OF
ACCESS/OPENINGS
 CONCRETE SAW
 CONCRETE FINISHED IS WITHIN THE
APPROVED TOLERANCE
AUDIT RESULT AND COMMENTS

CONTRACTOR’S MATERIAL ENGINEER: SIGNATURE: DATE:

AUDIT RESULT AND COMMENTS

PROJECT INSPECTOR (LGU): SIGNATURE: DATE:

REQUEST APPROVED  DISAPPROVED


REMARKS/
RECOMMENDATIO
NS

MUNICIPAL ENGINEER
Accreditation No.