PLUMBING PERMIT

sanitary / plumbing permit date of application date issued ... grease trap bar sink ... deep well & pump set septic vault/imhoff tank street canal...

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Form No. 77-001-S

REPUBLIC OF THE PHILIPPINES PROVINCE OF PANGASINAN CITY OF ALAMINOS OFFICE OF THE BUILDING OFFICIAL 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.

ADDRESS:

NO., STREET, BARANGAY, CITY/MUNICIPALITY

LOCATION OF INSTALLATION

NO., STREET, BARANGAY, CITY/MUNICIPALITY

SCOPE OF WORK :

TAX ACCT. NO. TELEPHONE NO.

ADDITION OF

NEW INSTALLATION

OTHERS (SPECIFY)

REPAIR OF

OF

REMOVAL OF

OF

USE OR TYPE OF OCCUPANCY RESIDENTIAL

AGRICULTURAL

COMMERCIAL

PARKS, PLAZAS, MONUMENTS

INDUSTRIAL

RECREATIONAL

INSTITUTIONAL

OTHERS (SPECIFY)

FIXTURES TO BE INSTALLED NEW EXISTING QTY. FIXTURES FIXTURES

KINDS OF FIXTURES

QTY.

NEW FIXTURES

EXISTING FIXTURES

KINDS OF FIXTURES

WATER CLOSET

BIDETTE

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

OTHERS (SPECIFY)

TOTAL WATER DISTRIBUTION SYSTEM

TOTAL SANITARY SEWER SYSTEM

STORM DRAINAGE SYSTEM

WATER SUPPLY SHALLOW WELL

WASTE WATER TREATMENT PLANT

SURFACE DRAINAGE

DEEP WELL & PUMP SET

SEPTIC VAULT/IMHOFF TANK

STREET CANAL

CITY/MUNICIPAL WATER SYSTEM

SANITARY SEWER CONNECTION

WATER COURSE

OTHERS

SUB-SURFACE SAND FILTER

NUMBER OF STOREYS OF BUILDING TOTAL AREA OF BUILDING/SUBDIVIISION PROPOSED DATE START OF INSTALLATION EXPECTED DATE OF COMPLETION

TOTAL COST OF INSTALLATION P PREPARED BY:

BOX 2 ( TO BE ACCOMPLISHED BY BUILDING 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

SQ.M.

APPROVED PLANS FILE WITH THIS OFFICE AND CONFORMITY WITH THE NATIONAL BUILDING CODE. 2. THAT A DULY LICENSED SANITARY ENGINEER/MASTER PLUMBER BE ENGAGED TO UNDERTAKE THE INSTALLATION/CONSTRUCTION. 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) DAYS 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. NOTE:

ENGR. VICENTE B. BILLON, JR. BUILDING OFFICIAL

DATE

THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 & 306 OF THE "NATIONAL BUILDING CODE".