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This Certificate of Operation: Air-Conditioning/Refrigeration is issued/granted pursuant to

pertinent provision of rule iii of the National Building Code, PD 1096.

NBC form no. M - 04


Name of Owner/Lessee Republic of the Philippines
Certificate of Inspection: City/Municipality of _____________________
Located at/along
Unfired Pressure Vessels Province of __________________________________
No. of Units
OFFICE OF THE BUILDING OFFICIAL
Name of Owner/Lessee Description

Certificate of Operation:
Total HP
Located at/along

A certificate was submitted by _________________________________________ a


Unfired Pressure Vessels
The owner/lessee shall properly maintain the equipments/machineries to ensure its safe operation.
(Name)
duly licensed professional mechanical engineer hired by the owner who undertook No change, addition or alteration deviating from the original mechanical plans shall be made without
the mechanical inspections and that the installation is in order. appropriate permit. No.
Verified as to the following Fee Paid
The aforementioned air-conditioning/refrigeration may now be operated for a period of one (1) year from
Official Receipt No.
Type _________________________________________________________________ the date of inspection. Date Paid
Length of shell ____________________________________________________ The owner/lessee of the building/structure shall notify in writing the office of the building official for the
Date Issued
Diameter of shell plate ____________________________________________ granting/issuance of a Certificate of Operation: Air-Conditioning/Refrigeration for a period of one
Thickness of shell plate ___________________________________________ This Certificate
(1) year from the dateofofOperation:
issuance ofUnfired Pressure
this certificate andVessels is issued/granted pursuant to pertinent
yearly thereafter.
Type of head_________________________________________________________ provision of the latest Philippine Mechanical Code, the National building Code and its Implementing rules
A certified copy hereof shall be posted within the premises of the building and shall not be removed
and Regulations.
Radius _______________________________________________________________ without authority from the building official.
Longitudinal joint __________________________________________________
Name of Owner/Lessee ______________________________________________________________
Efficiency of long joint ____________________________________________
Located at/along____________________________________________________________________
Pressure allowed __________________________________________________
Pressure not to exceed __________________ kgms./sq. cm. type _____________________
Date of inspection __________________________________________________
Longitudinal joint_________________________________________ Efficiency _____________% Shell
Date of expiration __________________________________________________
Diameter ___________________ Length ________________ Head Type _______________
Date issued__________________________________________________________
Shell thickness __________________ Ten. Strg. _____________ Head Thickness _________
Capacity______________________________________________________ Cu. M.
Use for _______________________________________________________________________________
Fee paid______________________________________________________________
The owner/lessee shall properly maintain the equipment/ machineries to ensure its safe use
Official receipt no. _________________________________________________ and operation.
Date paid ____________________________________________________________ No change, addition or upgrading/alteration deviating from the original mechanical plans shall be
made without appropriate permit.
The above described mechanical installation covered by Mechanical Permit The aforementioned Unfired Pressure Vessels may now be operated for a period of one (1) year
No.______________________ issued on______________________________ has been found from the date of inspection.
substantially satisfactory complied, therefore the Certificate of Operation: The owner/lessee of the building/structure shall notify in writing the office of the building official for
Unfired Pressure Vessels is hereby recommended for issuance. the granting/issuance of a Certificate of Operation: Unfired Pressure Vessels for a period of one (1)
year from the date of issuance of this certificate and yearly thereafter.
Mechanical Inspector Chief, Mechanical Section
(Signature Over Printed Name) (Signature Over Printed Name) A certified copy hereof shall be posted within the premises of the building and shall not be removed
Date________________________ Date________________________ without authority from the building official.
__________________ __________________ _________________ ________________
PRC Reg. No. validity PRC Reg. No. Validity

Building Official
Chief, Chief, (Signature Over Printed Name)
Inspection and Enforcement Division Processing and Evaluation Division Date________________________
(Signature Over Printed Name) (Signature Over Printed Name)
Date________________________ Date_________________________