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Sanitary/Plumbing Permit
TIEZA application form for sanitary/plumbing permit
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: NBC FORM NO. A - 04
Tourism Infrastructure and Enterprise Zone Authority
Office of the Building Official
MECHANICAL PERMIT
APPLICATION NO.
BUILDING PERMIT NO.
MP NO
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)
OWNER/APPLICANT
LAST NAME
FOR CONSTRUCTION OWNED
FIRST NAME
FORM OF OWNERSHIP
M.I.
TIN
USE OR CHARACTER OF OCCUPANCY
BY AN ENTERPRISE
ADDRESS:
NO.,
STREET,
LOCATION OF CONSTRUCTION:
BARANGAY,
CITY/MUNICIPALITY
ZIP CODE
TELEPHONE NO
LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO. ____________________
STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF________________________________
SCOPE OF WORK
NEW CONSTRUCTION
ERECTION
ADDITION
ALTERATION
RENOVATION ________________________
CONVERSION ________________________
REPAIR _____________________________
MOVING _____________________________
RAISING_______________________________________
DEMOLITION ___________________________________
ACCESSORY BUILDING/STRUCTURE ______________
OTHERS (Specify) _______________________________
BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
INSTALLATION AND OPERATION OF:
BOILER
CENTRAL AIRCONDITIONING
DUMBWAITER
PRESSURE VESSEL
MECHANICAL VENTILLATION
PUMPS
INTERNAL COMBUSTION ENGINE
ESCALATOR
REFRIGERATION AND ICE MAKING
MOVING SIDEWALK
COMPRESSED AIR, VACUUM, INSTITUTIONAL
and/or INDUSTRIAL GAS
WINDOW TYPE AIRCONDITIONING
FREIGHT ELEVATOR
PACKAGED/ SPLIT TYPE AIRCONDITIONING
PASSENGER ELEVATOR
PNEUMATIC TUBES, CONVEYORS
and/or MONORAILS
OTHERS (Specify) _____________________
CABLE CAR
FUNICULAR
PREPARED BY _____________________________________________________________________________________________________________
BOX 3
BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
SUPERVISOR / IN-CHARGE OF MECHANICAL WORKS
PROFESSIONAL MECHANICAL ENGINEER
PROFESSIONAL MECHANICAL ENGINEER
(Signed and Sealed Over Printed Name)
MECHANICAL ENGINEER
(Signed and/or Sealed Over Printed Name)
Date________________________
Date___________________
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)
Date__________________
Address
C.T.C. No.
(Signature Over Printed Name)
Date__________________
Address
Date Issued
Place Issued
C.T.C. No.
Date Issued
Place Issued
TO BE ACCOMPLISHED BY THE PERMITS AND LICENSES DIVISION
BOX 7
RECEIVED BY:
DATE:
FIVE (5) SETS 20”X30” & ONE (1) A3 OF MECHANICAL DOCUMENTS
MECHANICAL PLANS AND SPECIFICATIONS
COST ESTIMATES
BILL OF MATERIALS
OTHERS (Specify) ____________________________________
BOX 8
PROGRESS FLOW
IN
DATE
OUT
TIME
DATE
TIME
PROCESSED BY:
MECHANICAL
OTHERS (Specify)
BOX 9
ACTION TAKEN:
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed mechanical works shall be in accordance with the mechanical plans filed with this Office and in conformity
with the latest Philippine Mechanical Code, the National Building Code and its IRR.
2. That prior to any mechanical installation, a duly accomplished prescribed “NOTICE OF CONSTRUCTION” shall be
submitted to the Office of the Building Official.
3. That upon completion of the mechanical 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 mechanical works conform to the provision of the Philippine Mechanical Code, the
National Building Code and its IRR.
4. That this permit is null and void unless accompanied by the building permit.
5. That a Certificate of Operation shall be issued for the continuous use of mechanical installations.
PERMIT ISSUED BY:
BUILDING OFFICIAL
(Signature Over Printed Name)
Date ______________________
