DIOCESE OF PASIG

Memorial Department
Sta. Clara de Montefalco Parish Complex, C. Raymundo Avenue
Caniogan, Pasig City, Philippines 1606
(02) 746 7777

Date: ______________

CONCRETE POURING PERMIT

Name of Project
Location
Contractor
Part of Structure Estimated
to be poured Volume (m):
Point Limits /
Section
Date of Pouring Time of pouring:

Requested by:

Contractor: _______________________
(Name & Signature)

CHECKLIST
Concrete Vibrator
Protective Covering Materials
Warning Signs / Barricades
Concrete Block Spacers / Cover Blocks
Bar Chairs / Bar Spacers or Bolster
Finishing or Leveling Tools
Line and Grade Alignment (form setting,
elevations, etc)
Required Construction Equipment
Concrete Cylinder Molds
Curing Materials
Slump Cone
Plumbness
Mill Test Certificates, MTC (per material
delivery)
Lighting System (Night Pouring)
Falsework / Formworks Adequacy
Compacted Gravel Bedding (as per plan)
Rebar Sizes, Spacing and Number (as per plan)
Rebar Arrangement and Installation
Requirements (as per plan)
Plumbing Layout (roughing-ins/embedments)
Sump Pump and Hose

Concrete Pouring Permit (CPP-MD-MF&RW) Page 1

Checked By

Inspector 1 Date

(Name and Signature)

Remarks /
Recommendation

Inspector 2 Date

(Name and Signature)

Remarks /
Recommendation

Request: Approved Disapproved

Remarks /
Recommendation

Project In-charge
(Name and Signature)
Date

Concrete Pouring Permit (CPP-MD-MF&RW) Page 2