REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

OFFICE OF THE BUILDING OFFICIAL

CALOOCAN CITY

DISTRICT/CITY MUNICIPALITY
AREA CODE ___________
APPLICATION NO. PERMIT NO.
SANITARY / PLUMBING PERMIT
DATE OF APPLICATION DATE ISSUED
BOX 1 (TO BE ACCOMPLISHED BY SANITARY ENGINEER/MASTER PLUMBER IN PRINT)
NAME OF OWNER/APPLICANT LAST NAME, FIRST NAME, M.I TAX IDENTIFICATION NO.

ADDRESS NO. STREET, BARANGAY, CITY/MUNICIPALITY TELEPHONE NO.

LOCATION OF INSTALLATION
NO. STREET, BARANGAY, CITY/MUNICIPALITY

SCOPE OF WORK
ADDITION OF _______________________________________ OTHER (SPECIFY)
NEW INSTALLATION REPAIR OF REMOVAL _________________________________ _____________OF_____________
REMOVAL OF _______________________________________ _____________OF_____________

USER OR TYPE OF OCCUPANCY

RESIDENTIAL AGRICULTURAL
COMMERCIAL PARKS, PLAZA, MONUMENTS
INDUSTRIAL RECREATIONAL
INSTITUTIONAL OTHER (SPECIFY)

FIXTURES TO BE INSTALLED
QTY. NEW EXISTING KIND OF QTY. NEW EXISTING KIND OF
FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES
WATER CLOSET BIRDETTE
FLOOR DRAIN LAUNDRY TRAYS
LAVATORIES DENTAL CUSPIDOR
KITCHEN SINK GAS HEATER
FAUCET ELECTRIC HEATER
SHOWER HEAD WATER BOILER
WATER METER DRINKING FOUNTAIN
GREASE TRAP BAR SINK
BATH TUBS SODA FOUNTAIN SINK
SLOP SINK LABORATORY SINK
URINAL STERILIZER
AIR CONDITIONING UNIT SWIMMING POOL
WATER TANK/RESERVOIR OTHER (SPECIFY)

TOTAL
WATER DISTRIBUTION SYSTEM SANITARY SEWER SYSTEM STORM DRAINAGE SYSTEM

WATER SUPPLY SYSTEM OF DISPOSAL

SHALLOW WELL WASTE WATER TREATMENT PLANT SURFACE DRAINAGE

DEEP WELL & PUMP SET SEPTIC VAULT/IMHOFF TANK STREET CANAL
CITY/MUNICIPALITY WATER SYSTEM SANITARY SEWER CONNECTION WATER COURSE
OTHER ___________________ SUB-SURFACE SAND FILTER

NUMBER OF STOREYS OF BUILDING TOTAL AREA OF BUILDING/SUBDIVISION

SQ.M.

PROPOSED DATE TOTAL COST

START OF INSTALLATION OF INSTALLATION
EXPECTED DATE OF COMPLETION PREPARED BY

BOX 2 (TO BE ACCOMPLISHED BY THE BUILDINGH OFFICIAL)

ACTION TAKEN:
PERMIT IS HEREBY GRANTED TO INSTALL THE SANITARY /PLUMBING FIXTURE ENUMERATED
HEREIN SUBJECT TO THE FOLLOWING CONDITIONS:

1.THAT THE PROPOSED INSTALLATION SHALL BE IN ACCORDANCE WITH APPROVED

PLANS FILED WITH THISOFFICE AND IN COMFORMITY WIT THE NATIONAL BUIILDING CODE.
2.THAT A DULY LICENSED SANITARY ENGINEER/MASTER PLUMBING BE ENGAGED TO UNDERTAKE
THE INSTALLATION/CONSTRACTION. BUILDING OFFICIAL
3.THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY A SANITARY ENGINEER/MASTER PLUMBER
IN – CHARGE OF INSTALLATION SHALL BE SUBMITTED NOT LATER THAN SEVEN (7) AFTER COMPLETION OF THE INSTALLATION.
4.THAT A CERTIFICATE OF FINAL INSPECTION AND A CERTIFICATE OF OCCUPANCY BE SECURED PRIOR TO THE ACTUAL OCCUPANCY
OF THE BUILDING. DATE

NOTE:
“THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 & 306 OF THE NATIONAL BUILDING CODE”
BOX 3 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION)

BUILDING DOCUMENTS

SANITARY PLUMBING PLANS & SPECIFICATIONS COST ESTIMATE

BILL OF MATERIALS OTHERS (SPECIFY)

BOX 4 (TO BE ACCOMPLISHED BY THE DIVISION/SECTION CONCERNED)

ASSESSED FEES

AMOUNT ASSESSED BY O.R. NUMBER DATE PAID

BOX 5 (BE ACCOMPLISHED BY THE DIVISION CONCERNED)

PROGRESS FLOW

IN OUT

NOTED: ACTION PROCESSED

TIME TIME DATE
CHIEF, PROCESSING DIVISION/SECTION DATE REMARKS BY
RECEIVING AND RECORDING

GEODETIC (LINE and GRADE)

SANITARY

WE HEREBY AFFIX OUR HANDS SIGNIFY CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH

BOX 6 BOX 6

SANITARY ENGINEER/MASTER PLUMBER PRC REG. NO. SIGNATURE

SIGNED AND SEALED PLANS & SPECIFICATION

PRINT NAME APPLICANT

ADDRESS RES. CERT. NO. RES. CERT. NO. PLACE ISSUED

P.T.R. NO DATE ISSUED PLACE ISSUED

SIGNATURE TIN

BOX 7

SANITARY ENGINEER/MASTER PLUMBER PRC REG. NO.

SIGNED AND SEALED PLANS & SPECIFICATION

PRINT NAME

ADDRESS

P.T.R. NO DATE ISSUED PLACE ISSUED

SIGNATURE TIN