Annex 52

PAG-UN BUILDERS & SUPPLY

Paguntalan St., Miag-ao,Iloilo
Tele/Fax No. (033) 315-9774
Cellular No.0917-318-7023
Email Add: pag_unbuilders_supply@yahoo.com

CONCRETE POURING PERMIT (CPR)

CPR Number : 1
Name of Contract :
Date Prepared: 20-Jun-23
Location: Qui-anan, San joaquin, Iloilo
Contractor PAG-UN BUILDERS
Part of Structure to be poured : Column Footing Volume (m³) 2.70 cu.m.
Station Limit(s)/Section
Date of Pouring 23-Jun-23 Time of Pouring: 8:00 AM

Requested by: Received by:

Signature Signature
Name PAG-UN BUILDERS Name
Title Contractor Title
Date Date

CHECKLIST
Yes No Yes No

Concrete Vibrator Field Density Tests

Protective Covering Materials Beam/Cylinder Moulds
Warning Signs/Barricades/Flagmen Curing Materials
Concrete Saw Slump Core
Finish Tool/Equipment Quality of Materials Used (Design Mix, Test Reports, etc.)
Line & Grade Alignment (Forms, Elev., etc.) Lighting System
Required Construction Equipment Elect'l. Lay-out (Roughing-ins/Embedments)
Re-bar Sizes, Spacing and Number Plumbing Lay-out (Roughing-ins/Embedments)
Re-bar Installation Requirements Falsework/Formworks Adequacy
Plumbness Others

Checked by:

Inspector Date
(Name and Signature)
Remarks/Recommendations:

Project Engineer/Inspector Date

(Name and Signature)
Remarks/Recommendations:

Request: APPROVED DISAPPROVED

Remarks/Recommendations:

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