PROJECT MANILA

: NEW OFFICE ANNEX

FORM NO. :
F-YLFCCS-QC-10-031
REQUEST FOR DEMOLITION
CONTRACTOR : _____________________________________________________________________________________________________________

NAME/POSITION : ________________________________________________________________
REQUEST NO. :_________________________

DATE PREPARED : ________________________________________________________________

SIGNATURE : __________________________

DEFINABLE FEATURE OF WORK : ___________________________________________________________________________________________

STRUCTURE: LEVEL: GRIDLINE / LOCATION:

AREA (Pls. enclose key plan) : INSPECTION TYPE: INSPECTION DATE/TIME: INSPECTION CLOSE OUT DATE:
Preliminary
Final (INSPECTION)

NOTE : ALL SIGNATORIES SHOULD PRINT THEIR NAME AND SIGN TO IDENTIFY EACH SPECIMEN

The A&E Representatives certify to the CMG Representative that inspections were conducted by the subcontractor and verified by te CONTRACTOR'S-Project Engineers, and that the
(Pass/Fail) recommendations reflect the findings from those inspections.

Prepared By Checked By Inspected By REMARKS

TRADE
CONTRACTOR'S OPERATION CONTRACTOR'S QC ENGINEER YLFCCS REPRESENTATIVE (YLFCCS TO FILL UP)

ARCHITECTURAL

CIVIL/STRUCTURAL

ELECTRICAL

TELECOM

FDAS

BMS

MECHANICAL

SANITARY/PLUMBING

FIRE PROTECTION

SAFETY

OTHERS

ATTACHMENTS: Keyplan Inspection Checklist Test Reports (IF APPLICABLE) Material/s Inspection (IF APPLICABLE)

REMARKS / COMMENTS: ACTION

For Follow-up

Proceed to Succeeding Work

Do Not Proceed

Others _________________

CHECKED BY : APPROVED BY:

CONTRACTOR'S PROJECT/SITE ENGINEER YLFCCS REPRESENTATIVE

RECOMMENDING APPROVAL: NOTED BY:

CONTRACTOR'S QC ENGINEER YLFCCS - Project Manager

NOTED : THIS FORM MUST BE SUBMITTED TO THE CMGSI TEAM, DULY ACCOMPLISHED AND SIGNED BY THE CORRESPONDING CONTRACTOR'S PERSONNEL-IN-
CHARGE AT LEAST 24 HOURS BEFORE THE ACTUAL INSPECTION AND/OR INSTALLATION.