Republic of the Philippines
City of Antipolo
Province of Rizal
OFFICE OF THE BUILDING OFFICIAL
MECHANICAL PERMIT
APPLICATION NO. MP NO. BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE APPLICANT)
(OWNER/APPLICANT) LAST NAME FIRST NAME M.I TIN
FOR CONSTRUCTION OWNED BY AN ENTERPRISE FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY
(ADDRESS): NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE CONTACT NO.
(LOCATION OF CONSTRUCTION) LOT NO. BLK NO. TCT NO. CURRENT TAX DEC. NO.
STREET BARANGAY CITY OF ANTIPOLO
SCOPE OF WORK
NEW CONSTRUCTION RENOVATION RAISING
ERECTION CONVERSION DEMOLITION
ADDITION REPAIR ACCESSORY BUILDING/STRUCTURE
ALTERATION MOVING OTHERS (Specify)
BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)
INSTALLATION AND OPERATION OF:
BOILER CENTRAL AIRCONDITIONING DUMBWAITER
PRESSURE VESSEL MECHANICAL VENTILATION PUMPS
INTERNAL COMBUSTION ENGINE ESCALATOR COMPRESSED AIR, VACUUM, INSTITUTIONAL
REFRIGERATION AND ICE MAKING MOVING SIDEWALK and/or INDUSTRIAL GAS
WINDOW TYPE AIRCONDITIONING FREIGHT ELEVATOR PNEUMATIC TUBES, CONVEYORS
PACKAGED/SPLIT TYPE AIRCONDITIONING PASSENGER ELEVATOR and/or MONORAILS
OTHER (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) (Signed and 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) (Signature Over Printed Name)
Date: Date:
Address: Address:
C.T.C. No. Date Issued: Place Issued: C.T.C. No. Date Issued: Place Issued:
Mechanical Permit Page 1 of 2
TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION SECTION
BOX 7
RECEIVED BY: DATE:
FOUR (4) SETS OF MECHANICAL DOCUMENTS
MECHANICAL PLANS AND SPECIFICATIONS COST ESTIMATES
BILL OF MATERIALS OTHERS (Specify)
BOX 8
PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME
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 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
accomplished 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.
3. That this permit is null and void unless accompanied by the building permit.
4. That a Certificate of Operation shall be issued for the continuous use of mechanical installation.
PERMIT ISSUED BY:
MELVIN Q. BALAGOT, CE, SE, MM
CITY BUILDING OFFICIAL
(Signature Over Printed Name)
Date:
Mechanical Permit Page 2 of 2
