PT.

GRAMA PRAMESI SIDDHI

BEKASI MIXED USE DEVELOPMENT

REQUEST FOR INSPECTION / TESTING

BID PACKAGE : LOA-A030 CONTRACTOR: PT. NUSA RAYA CIPTA, Tbk

RFIT No: BMD-NRC-RFIT-0 - Rev.No. Date:

DISCIPLINE : INSPECTION DETAILS :

General/Site HVAC Inspection Date :

Civil Drainage System Relevant MS No: BMD-NRC-MS-

Structures Fire Fighting System Relevant ITP No: BMD-NRC-ITP-

Architectural AV and Telecommunications Shop Drawing No./Rev: BMD-SD-

Mechanical Wall and Floor Finishing Inspection Location:

Electrical Landscape Subcont. Name (If any):

Plumbing Other ……………..

Detailed Description of Works to be Inspected:

ISSUANCE :
WE CONFIRM THAT THE WORK TO BE INSPECTED HAS BEEN COORDINATED WITH ALL RELATED DISCPLINES AND SUB-CONTRACTORS:

Related Discipline: Civil/Architect: Structural: Electrical: Mechanical: External Works: QA/QC: HSE:

Signature: _______ _______ _______ _______ _______ _______ _______

Issued By : ……………………………...... (NSC/DC/Subc.)

PM/DPM/SM : Signature : Date:

Q/C STATEMENT :

INSPECTED BY:

Name : ………………...……………(Q/C PT. NRC) Signature : Date:

APPROVED BY QA/QC MANAGER :

Name : Otty SYD Signature : Date:

APPROVED BY QA/QC MANAGER (GPS) :

Name : Makno Basoeki Signature : Date:

IF THERE IS A NCR PLEASE REFER TO NCR NUMBER AND SNAGGING LIST REFF. No. ……………………………………………….

RECEIVED AND INSPECTED BY CM / GPS : Date :

APPROVED APPROVED W/ MINOR COMMENTS REVISE & RESUBMIT REJECTED

Inspector : Initials : Signature : Date :

Const. Manager : Initials : Signature : Date :

Project Manager : Name : Irene S Signature : Date :

RECEIVED BY CONTRACTOR :

Name : Signature : Date :

Submit at least 24 hours before its commencement.