REPUBLIC OF THE PHILIPPINES

PROVINCE OF BOHOL
MUNICIPALITY OF CORELLA
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. T.A.ACCT.NO.

Address: No., Street, Barangay / Municipality Tel. No.

Location of Installation: No., Street, Barangay / Municipality

SCOPE OF WORK
[ ] ADDITION OF____________________________ OTHERS (SPECIFY)
[ ] NEW INSTALLATION [ ] 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 Kind of New Existing Kind of
QTY. Fixtures Fixtures Fixtures QTY. Fixtures Fixtures Fixtures
_____ [ ] [ ] [ ] Water Closet _____ [ ] [ ] [ ] Bidette
_____ [ ] [ ] [ ] Floor drain _____ [ ] [ ] [ ] Laundry trays
_____ [ ] [ ] [ ] Lavatories _____ [ ] [ ] [ ] Dental cuspitor
_____ [ ] [ ] [ ] Kitchen sink _____ [ ] [ ] [ ] Gas heater
_____ [ ] [ ] [ ] Faucet _____ [ ] [ ] [ ] Electric heater
_____ [ ] [ ] [ ] Shower head _____ [ ] [ ] [ ] Water boiler
_____ [ ] [ ] [ ] Water meter _____ [ ] [ ] [ ] Drinking fountain
_____ [ ] [ ] [ ] Grease trap _____ [ ] [ ] [ ] Bar sink
_____ [ ] [ ] [ ] Bath tube _____ [ ] [ ] [ ] Soda fountain sink
_____ [ ] [ ] [ ] Stop sink _____ [ ] [ ] [ ] Laboratory sink
_____ [ ] [ ] [ ] Urinal _____ [ ] [ ] [ ] Sterilizer
_____ [ ] [ ] [ ] Air conditioning unit _____ [ ] [ ] [ ] Swimming pool
_____ [ ] [ ] [ ] Water tank/reservoir _____ [ ] [ ] [ ] Others (Specify)
__________________ Total __________________ 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 [ ] Street Canal
[ ] City / Municipal Water System [ ] Sanitary Sewer Connection [ ] Water Course
[ ] Others ___________________ [ ] Sub surface Sand Filter

No. of Storeys Building Total Area of Building / Subdivision

________________________ ___________________________ Sq. M.
Proposed Date Total Cost
Start of Installation____________________________ of Installation P_______________________
Expected Date
Of completion _______________________________ 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 approved plans filed with this office
and in 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 charged 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 Building Official
occupancy of the Building.
_______________________
Date
NOTE:
THIS PERMIT MAYBE REVOKED OR CANCELLED PURSUANT TO SECTION 305 & 306 OF THE NATIONAL BUILDING CODE.
BOX 3 (TO BE ACCOMPLISHED BY THE RECEIVING & RECORDING SECTION)

BUILDING DOCUMENTS
[ ] SANINTARY PLUMBING & PLANS SPECIFICATIONS [ ] COST ESTIMATES
[ ] BILL OF MATERIALS [ ] OTHERS (Specify)

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

ASSESSED FEES

AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

BOX 5: (TO BE ACCOMPLISHED BY THE DIVISION / SECTION CONCERNED)

PROGRESS FLOW

NOTED: IN OUT
CHIEF PROCESSING DIVISION/SECTION Actions / Remarks Processed by
TIME DATE TIME DATE

RECEIVING & RECORDING

GEODETIC (LINE & GRADE)

SANITARY

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

BOX 6:
SANITARY ENGINEER / PRC REG.NO. SIGNATURE
MASTER PLUMBER SIGNED AND
SEALED PLANS & SPECIFICATIONS
PRINT NAME ____________________________________

ADDRESS APPLICANT

P.T.R. NO. Date Issued Place Issued Res. Cert. No. Date Issued Place Issued

SIGNATURE TAN

BOX 7
SANITARY ENGINEER / MASTER PLUMBER PRC REG.NO.
(IN-CHARGE OF CONSTRUCTION)

PRINT NAME

ADDRESS

P.T.R. NO. DATE ISSUED PLACE ISSUED

SIGNATURE TAN