CHECK LIST FOR BUILDING/STRUCTURE

COMPANY : PT. PLN (Persero) Contractor : PT. Rekadaya Elektrika

PROJECT : PLTU Gorontalo 2 x 25 MW
ANGGREK, GORONTALO UTARA

ITEM NAME :…………………………………………………. FORM No. : /CVL/CL-F/2016

DWG No. :…………………………………………………. SHEET : OF
REV :………………………………………………….
REVIEWED/WITNESSED
ITEM DESCRIPTION PT. RE PT. PLN
DATE SIGN DATE SIGN

1. SURVEYING - LOCATION
- ELEVATION
- PLUMBNESS

2. RE-BAR - DIAMETER BENDING

- LAP LENGTH COLUMN
- LOCATION NUMBER WALL
- SURFACE CLEANING OF REBAR BEAM
- RIGIDITY SLAB

3. FORM WORK - DIMENSION ALIGNMENT

- FORM OIL COATING COLUMN
- STABILITY WALL
- TOP ELEVATION BEAM
- CHAMPER, SPACER SLAB

4. CONCRETE - CLEANING POURING PLACE

- SLUMP TEST COLUMN
- USING VIBRATOR WALL
- REMOVAL OF LEITANCE BEAM
- CURING SLAB
- APPEARANCE OF SURFACE
5. ANCHOR BOLT/BOX - SIZE, TYPE, NUMBER
EMBEDDED STEEL, WATER - LOCATION, ORIENTATION, LEVEL
STOP, PIPE CHASING - STABILITY
- PROTECTION OF ANCHOR BOLT SCREW
6. MISC : OPENING SLEEVE, etc - DIMENSION, LOCATION, ORIENTATION, MATERIAL
REMARK :

Prepared by Prepared by Witnessed by Approved by

PT. SARTONIA AGUNG PT. REKADAYA ELEKTRIKA PT. PLN-PUSMANKON PT. PLN (Persero) upp
(………………………………………) (…………………………………….) (…………………...………………) (……………..……………………….)
 PERMIT CONCRETE POURING
COMPANY : PT. PLN (Persero) FORM No. : __________
PROJECT : PLTU GORONTALO 2 x 25 MW SHEET : __________
ANGGREK, GORONTALO UTARA __________
POUR No. : PLTU / PCP / / / 17 DATE : ____________________
LOCATION : ___________________ QUANTITY : ____________________
STRUCTURE NAME : ___________________ ELEVATION : ____________________
___________________ PLACING TEMP. : ____________________
___________________ REQUIRED CURING : ____________________

DESAIN MIX : C-15 C-25 C-30

CEMENT TYPE : TYPE-I TYPE II TYPE V
SLUMP : _______ CM
REQUIRED FINISH : SMOOTH / ROUGHNESS*)

PT.RE PT.SA
CIVIL : ______________ DATE : ____________________
PIPING : ______________ DATE : ____________________
MECHANICAL : ______________ DATE : ____________________
ELECTRICAL : ______________ DATE : ____________________
SURVEY : ______________ DATE : ____________________

ENGINEERING / QC PRE POUR APPROVALS

PT.RE
ENGINEERING : ______________ DATE : ____________________
QUALITY CONTROL : ______________ DATE : ____________________

WEATHER : SUNNY / CLAUDY / RAIN / DRIZZLE

PLACEMENT STARTED DATE
PLACEMENT COMPLETED DATE
NUMBER OF CYLINDER
CYLINDER CODE
CONCRETE TESTED BY
: _______ TIME : ____________________
: _______ TIME : ____________________
: _______ NOS, ACTUAL SLUMP: ____________
: ______________________
: ______________________

REMARK :
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Prepared by, Reviewed by, Witnessed by, Approved by,
PT.Sartonia Agung PT.Rekadaya Elektrika PT.PLN - PMK PT.PLN-UPP KITRING Gorontalo
(…………………………..) (………………………………..) (………………………..) (………………………………………..)