NBC FORM No.

A-05

Republic of the Philippines

City of Baguio
Province of Benguet

CERTIFICATE OF SANITARY / PLUMBING INSPECTION

_________Final_________Partial
____________________
Date

This certifies that the plumbing works and fixtures installed in the premises of
______________________________ were tested and inspected on _____________________ and was
found to be in accordance with the approved plans and permit, and in conformity with the National
Building Code and Sec. 20, Republic Act No. 1378 ( National Building Law ).

QTY FIXTURES APPLIED COMPLETED REMARKS

INSTALLED FIXTURES FIXTURES
WATER CLOSET
LAVATORY
KITCHEN SINK
SHOWER HEAD
FAUCET
WATER DRAIN
URINAL
BATH TUB
CATCH BASIN
WATER TANK
ELEVATED TANK
WATER METER

Contractor_________________________________ Scope of Work_____________________________

Owner____________________________________ Permit No._________________________________
Occupants_________________________________ PS CHO Record No.__________________________
Inspection Remarks_________________________ Sewage Disposal____________________________
Period of Construction from _______________________20___ to _______________________ 20___

__________________ City Sewer line

__________________ Septic Tank
__________________ Baguio Water District
__________________ Others

The construction of the above described building has been found to be in order and
therefore the CERTIFICATE OF OCCUPANCY is hereby recommended for approval.
CONFORME:

_____________________________ _____________________________
Owner/Applicant In-charge, Sanitary/Plumbing Works

_____________________________
ENGR. ALBERT M. PAY-AN
Engineer II
Sanitary Engineer