NBC FORM NO.
A -06
Republic of the Philippines
City of Malolos
Province of Bulacan
OFFICE OF THE BUILDING OFFICIAL
PLUMBING/SANITARY PERMIT
APPLICATION NO. PLUMBING PERMIT / SANITARY PERMIT NO.
______________________ - P/S ______________________ - P/S
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)
OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY
BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO
LOCATION OF CONSTRUCTION: LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO. _____________________
STREET________________________________________________________________ BARANGAY ______________________________________ CITY OF MALOLOS
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION ________________________
ERECTION CONVERSION ________________________ RAISING________________________________________
DEMOLITION ____________________________________
ADDITION REPAIR _____________________________
ALTERATION MOVING _____________________________ ACCESSORY BUILDING/STRUCTURE ________________
OTHERS (Specify)_________________________________
BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
FIXTURES TO BE INSTALLED INSTALLATION & OPERATION OF :
QTY. NEW EXISTING KIND OF QTY. NEW EXISTING KIND OF WATER SUPPLY : SYSTEM DISPOSAL :
FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES FIXTURES
WATER CLOSET BIDETTE SHALLOW WELL WASTE WATER TREATMENT PLANT
FLOOR DRAIN LAUNDRY TRAYS
DEEP WELL & PUMP SET IMHOFF TANK
LAVATORY DENTAL CUSPIDOR
KITCHEN SINK DRINKING FOUNTAIN CITY WATER SYSTEM SANITARY SEWER CONNECTION
FAUCET BAR SINK
SHOWER HEAD SODA FOUNTAIN SINK
OTHERS (Specify)
__________________ SUB-SURFACE SAND FILTER
WATER METER LABORATORY SINK
GREASE TRAP STERILIZER SURFACE DRAINAGE
BATH TUB OTHERS (Specify)
SLOP SINK __________________ STREET CANAL
URINAL __________________
AIR CONDITIONING UNIT __________________ WATER COURSE
WATER TANK/RESERVOIR __________________
OTHERS (Specify)
TOTAL TOTAL __________________
WATER DISTRIBUTION SEWAGE SYSTEM SEPTIC TANK STORM DRAINAGE SYSTEM
SYSTEM
PREPARED BY: ______________________________________________________________________________________________________________________________
BOX 3 BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS SUPERVISOR / IN-CHARGE OF PLUMBING/SANITARY WORKS
Date_______________ Date_______________
MASTER PLUMBER/SANITARY ENGINEER MASTER PLUMBER/SANITARY ENGINEER
(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)
Address Address
PRC. No Validity PRC. No Validity
PTR. No Date Issued PTR. No Date Issued
Issued at TIN Issued at TIN
BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER
(Signature Over Printed Name) (Signature Over Printed Name)
Date_________________ Date__________________
Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
NOTE: THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 AND 306 OF THE “NATIONAL BUILDING CODE”.
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION
BOX 7
RECEIVED BY: DATE:
FIVE (5) SETS OF PLUMBING/SANITARY DOCUMENTS
PLUMBING/ SANITARY PLANS AND SPECIFICATION COST ESTIMATES
SPECIFICATIONS
BILL OF MATERIALS OTHERS (Specify) ________________________________
BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY
DATE TIME DATE TIME
RECEIVING AND RECORDING
PLUMBING / SANITARY
OTHERS (Specify)
BOX 9
ACTION TAKEN:
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed plumbing/sanitary works shall be in accordance with the plumbing/sanitary
plans filed with this Office and in conformity with the Revised Plumbing Code, Code on
Sanitation of the Philippines, the National Building Code and its IRR.
2. That prior to any commencement of plumbing/sanitary works, a duly accomplished prescribed
“Notice of Construction” shall be submitted to the Office of the Building Official.
3. That upon completion of the plumbing/sanitary works, the licensed supervisor/in-charge shall
submit the entry to the logbook duly signed and sealed to the Building Official including as-
built plans and other documents and shall also accomplish the Certificate of Completion
stating that the plumbing/sanitary works of the building conform to the provision of the Revised
Plumbing Code, Code on Sanitation of the Philippines, the National Building Code and its IRR.
4. That this permit is null and void unless accompanied by the building permit.
RECOMMENDING APPROVAL: APPROVED BY:
ENGR. CECILIA C. SANTOS ENGR. RICASOL P. MILLAN
ENGINEER II CITY ENGINEER
Date ___________________ Date ___________________
