FORM INSPEKSI

NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA
Tanggal : . . . . . .
Lokasi/Posisi : 2BR Unit . . . . . . Lantai . . . . . . Tower . . . . . . .
No. Reference Drawing : . . . . . .
Unit CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat WALL I II III
I Kitchen / Dinning Room
1 Plumbing
a Zink (CW & HW) 2 ttk
b Mesin Cuci (CW & WW) 2 ttk
2 Elektrikal
a Saklar 3 ttk
b Stop Kontak (SO) 6 ttk
c Thermostat 2 ttk
d Power AC 2 ttk
e Panel / KWH meter 1 ttk
3 Elektronik
a Video Phone 1 ttk
b Gas detector 1 ttk
c Selenoid valve 1 ttk
II Balcony
1 Plumbing
a Floor drain (WW) 1 ttk
2 Elektrikal
a Power outdoor AC 1 ttk
b Lampu 2 ttk
III Maid Room
1 Plumbing
a Water Heater (CW & HW) 2 ttk
b Main Gate Valve Unit 1 ttk
2 Elektrikal
a Saklar 1 ttk
b Stop Kontak (SO) 3 ttk
3 Elektronik
a MATV, Data & Telp
IV Bedroom 1
1 Elektrikal
a Saklar 2 ttk
b Stop Kontak (SO) 5 ttk
c Power AC 1 ttk
d Thermostat 1 ttk
2 Elektronik
a MATV, Data & Telp 2 ttk
V Master Bedroom
1 Elektrikal
a Saklar 2 ttk
b Stop Kontak (SO) 6 ttk
c Power AC 1 ttk
d Thermostat 1 ttk
2 Elektronik
a MATV, Data & Telp 3 ttk
VI Living Room
1 Elektrikal
a Saklar 2 ttk
b Stop Kontak (SO) 3 ttk
c Power AC 1 ttk
2 Elektronik
a MATV, Data & Telp 2 ttk
VII Foyer
1 Elektrikal
a Saklar 1 ttk
VIII Koridor Unit
1 Elektronik
a Door bell 1 ttk
b Indoicator lamp 1 ttk
Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :
Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU
Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :2BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

Unit CEK Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
Qty Sat CELLING I II III

I Maid Bathroom
1 Elektrikal
a Lampu 1 ttk
2 MVAC
a Ceilling Fan 1 ttk
II Bathroom
1 Elektrikal
a Lampu 3 ttk
2 MVAC
a Ceilling Fan 2 ttk
III Master Bathroom
1 Elektrikal
a Lampu 5 ttk
2 MVAC
a Ceilling Fan 2 ttk
3 Fire Fighting
a Sprinkler 1 ttk
IV Kitchen / Dinning Room
1 Elektrikal
a Lampu 3 ttk
2 MVAC
a Return Air 1 ttk
b Supply Air 1 ttk
3 Fire Fighting
a Sprinkler 2 ttk
4 Elektronik
a Speaker 1 ttk
b Temperatur Detector 1 ttk
c Smoke Detector 1 ttk
V Balcony
1 MVAC
a Outdoor Unit 1 ttk
b Exoust Louvre 1 ttk
VI Maid Room
1 Elektrikal
a Lampu 1 ttk
2 MVAC
a Ceilling Fan 1 ttk
3 Fire Fighting
a Sprinkler 1 ttk
4 Elektronik
a Smoke Detector 1 ttk
VII Bedroom 1
1 Elektrikal
a Lampu 2 ttk
2 MVAC
a Return Air 1 ttk
b Supply Air 1 ttk
3 Fire Fighting
a Sprinkler 1 ttk
4 Elektronik
a Smoke Detector 1 ttk
VIII Master Bedroom
1 Elektrikal
a Lampu 2 ttk
2 MVAC
a Return Air 1 ttk
b Supply Air 1 ttk
3 Fire Fighting
a Sprinkler 1 ttk
4 Elektronik
a Smoke Detector 1 ttk
IX Living Room
1 Elektrikal
a Lampu 5 ttk
2 MVAC
a Return Air 1 ttk
b Supply Air 1 ttk
3 Fire Fighting
a Sprinkler 1 ttk
4 Elektronik
a Smoke Detector 1 ttk
 Unit CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat CELLING I II III

X Foyer
1 Elektrikal
a Lampu 2 ttk
2 Fire Fighting
a Sprinkler 2 ttk
3 Elektronik
a Smoke Detector 1 ttk
b Speaker 1 ttk
XI Storage
1 Elektrikal
a Lampu 1 ttk

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :2BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

Unit CEK CEK Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
Qty Sat FLOOR WALL I II III

I Maid Bathroom
1 Plumbing
a Kloset (WC) 1 ttk -
b Kloset (CW jet spray & supply) 2 ttk -
c Wastafel (CW) 1 ttk -
d Wastafel (WW) 1 ttk -
e Shower (CW) 1 ttk -
f FD (WW) 1 ttk -
II Bathroom
1 Plumbing
a Kloset (WC) 1 ttk -
b Kloset CW (jet spray & supply) 2 ttk -
c Wastafel (CW & HW) 2 ttk -
d Wastafel (WW) 1 ttk -
e Shower (CW & HW) 2 ttk -
f FD (WW) 2 ttk -
2 Elektrikal
a Saklar 2 ttk -
b Stop Kontak (SO) 1 ttk -
III Master Bathroom
1 Plumbing
a Kloset (WC) 1 ttk -
c Kloset (CW jet spray & supply) 2 ttk -
d Wastafel (CW & HW) 2 ttk -
e Wastafel (WW) 1 ttk -
f Shower (CW & HW) 2 ttk -
g FD (WW) 2 ttk -
h Bathup (WW) 1 ttk -
i Bathup (CW & HW) 2 ttk -
2 Elektrikal
a Saklar 2 ttk
b Stop Kontak (SO) 1 ttk
IV Kitchen / Dinning Room
1 Plumbing
a Zink (WW) 1 ttk -
V Balcony
1 Plumbing
a FD (WW) 2 ttk -

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
 Unit CEK CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat FLOOR WALL I II III

CV. MKU - One Galaxy-Surabaya

 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal :
......
Lokasi/Posisi :
2BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

HASIL PEMERIKSAAN Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
WALL CEILLING FLOOR I II III

I Maid Bathroom
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
II Bathroom
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
III Master Bathroom
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
IV Kitchen / Dinning Room
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
6 Gas
V Balcony
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
VI Maid Room
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
VII Bedroom 1
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
VIII Master Bedroom
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
IX Living Room
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
X Foyer
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
XI Storage
1 Elektrikal
2 MVAC
3 Elektronik

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :3BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

Unit CEK Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
Qty Sat WALL I II III

I Kitchen / Dinning Room

1 Plumbing
a Zink (CW & HW) 2 ttk
b Mesin Cuci (CW & WW) 2 ttk
2 Elektrikal
a Saklar 3 ttk
b Stop Kontak (SO) 6 ttk
c Thermostat 3 ttk
d Power AC 3 ttk
e Panel / MCB 1 ttk
3 Elektronik
a Video Phone 1 ttk
4 Gas 1 ttk
II Balcony
1 Elektrikal
a Lampu 2 ttk
III Maid Room
1 Plumbing
a Water Heater (CW & HW) 2 ttk
b Main Gate Valve Unit 1 ttk
2 Elektrikal
a Saklar 1 ttk
b Stop Kontak (SO) 3 ttk
IV Bedroom 1
1 Elektrikal
a Saklar 3 ttk
b Stop Kontak (SO) 6 ttk
c Power AC 1 ttk
d Thermostat 1 ttk
2 Elektronik
a MATV, Data & Telp 2 ttk
V Bedroom 2
1 Elektrikal
a Saklar 3 ttk
b Stop Kontak (SO) 6 ttk
c Power AC 1 ttk
d Thermostat 1 ttk
2 Elektronik
a MATV, Data & Telp 2 ttk
VI Master Bedroom
1 Elektrikal
a Saklar 3 ttk
b Stop Kontak (SO) 7 ttk
c Power AC 1 ttk
d Thermostat 1 ttk
2 Elektronik
a MATV, Data & Telp 2 ttk
VII Living Room
1 Elektrikal
a Saklar ttk
 Unit CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat WALL I II III

b Stop Kontak (SO) ttk

c Power AC ttk
2 Elektronik
a MATV, Data & Telp ttk
VIII Foyer
1 Elektrikal
a Saklar ttk
IX Koridor Unit
1 Elektronik
a Video Phone ttk
b Fire Alarm ttk

Catatan : r Tidak Diterima √ Diterima

Sign Sign
Joint Inspection Date Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :
SPGN TATA
Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU
Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :3BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

Unit CEK Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
Qty Sat CELLING I II III

I Maid Bathroom
1 Elektrikal
a Lampu ttk
2 MVAC
a Ceilling Fan ttk
II Bathroom
1 Elektrikal
a Lampu ttk
2 MVAC
a Ceilling Fan ttk
III Master Bathroom
1 Elektrikal
a Lampu ttk
2 MVAC
a Ceilling Fan ttk
3 Fire Fighting
a Sprinkler ttk
IV Kitchen / Dinning Room
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Speaker ttk
b Temperatur Detector ttk
c Smoke Detector ttk
V Balcony
1 MVAC
a Outdoor Unit ttk
b Exoust Louvre ttk
VI Maid Room
1 Elektrikal
a Lampu ttk
2 MVAC
a ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
VII Bedroom 1
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
VIII Bedroom 2
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
IX Master Bedroom
1 Elektrikal
a Lampu ttk
 Unit CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat CELLING I II III

2 MVAC
a Return Air ttk
b Supply Air ttk
 Unit CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat CELLING I II III

3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
X Living Room
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
XI Foyer
1 Elektrikal
a Lampu ttk
2 Fire Fighting
a Sprinkler ttk
3 Elektronik
a Smoke Detector ttk
b Speaker ttk
XII Storage
1 Elektrikal
a Lampu ttk

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :3BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

Unit CEK CEK Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
Qty Sat FLOOR WALL I II III

I Maid Bathroom
1 Plumbing
a Kloset (WC) ttk -
b Kloset (CW jet spray & supply) ttk -
c Wastafel (CW) ttk -
d Wastafel (WW) ttk -
e Shower (CW) ttk -
f FD (WW) ttk -
II Bathroom
1 Plumbing
a Kloset (WC) ttk -
b Kloset CW (jet spray & supply) ttk -
c Wastafel (CW & HW) ttk -
d Wastafel (WW) ttk -
e Shower (CW & HW) ttk -
f FD (WW) ttk -
2 Elektrikal
a Saklar ttk -
b Stop Kontak (SO) ttk -
III Master Bathroom
1 Plumbing
a Kloset (WC) ttk -
c Kloset (CW jet spray & supply) ttk -
d Wastafel (CW & HW) ttk -
e Wastafel (WW) ttk -
f Shower (CW & HW) ttk -
g FD (WW) ttk -
h Bathup (WW) ttk -
i Bathup (CW & HW) ttk -
2 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
IV Kitchen / Dinning Room
1 Plumbing
a Zink (WW) ttk -
V Balcony
1 Plumbing
a FD (WW) ttk -

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :3BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

HASIL PEMERIKSAAN Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
WALL CEILLING FLOOR I II III

I Maid Bathroom
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
II Bathroom
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
III Master Bathroom
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
IV Kitchen / Dinning Room
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
6 Gas
V Balcony
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
VI Maid Room
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
VII Bedroom 1
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
VIII Bedroom 2
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
IX Master Bedroom
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
X Living Room
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
XI Foyer
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
XII Storage
1 Elektrikal
2 MVAC
3 Elektronik

Catatan : r Tidak Diterima √ Diterima

 Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :4BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

Unit CEK Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
Qty Sat WALL I II III

I Kitchen / Dinning Room

1 Plumbing
a Zink (CW & HW) ttk
b Mesin Cuci (CW & WW) ttk
2 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
c Thermostat ttk
d Power AC ttk
e Panel / MCB ttk
3 Elektronik
a Video Phone ttk
4 Gas ttk
II Balcony
1 Elektrikal
a Power outdoor AC ttk
b Lampu ttk
III Maid Room
1 Plumbing
a Water Heater (CW & HW) ttk
b Main Gate Valve Unit ttk
2 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
IV Bedroom 1
1 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
c Power AC ttk
d Thermostat ttk
2 Elektronik
a MATV, Data & Telp ttk
V Bedroom 2
1 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
c Power AC ttk
d Thermostat ttk
2 Elektronik
a MATV, Data & Telp ttk
VI Bedroom 3
1 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
c Power AC ttk
d Thermostat ttk
2 Elektronik
a MATV, Data & Telp ttk
VII Master Bedroom
1 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
c Power AC ttk
d Thermostat ttk
2 Elektronik
a MATV, Data & Telp ttk
 Unit CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat WALL I II III

VIII Living Room

1 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
c Power AC ttk
2 Elektronik
a MATV, Data & Telp ttk
IX Foyer
1 Elektrikal
a Saklar ttk
X Koridor Unit
1 Elektronik
a Video Phone ttk
b Fire Alarm ttk

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :4BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

Unit CEK Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
Qty Sat CELLING I II III

I Maid Bathroom
1 Elektrikal
a Lampu ttk
2 MVAC
a Ceilling Fan ttk
II Bathroom
1 Elektrikal
a Lampu ttk
2 MVAC
a Ceilling Fan ttk
III Bathroom I
1 Elektrikal
a Lampu ttk
2 MVAC
a Ceilling Fan ttk
IV Master Bathroom
1 Elektrikal
a Lampu ttk
2 MVAC
a Ceilling Fan ttk
3 Fire Fighting
a Sprinkler ttk
V Kitchen / Dinning Room
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Speaker ttk
b Temperatur Detector ttk
c Smoke Detector ttk
VI Balcony
1 MVAC
a Outdoor Unit ttk
b Exoust Louvre ttk
VII Maid Room
1 Elektrikal
a Lampu ttk
2 MVAC
a Ceilling Fan ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
VIII Bedroom 1
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
IX Bedroom 2
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
 Unit CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat CELLING I II III

4 Elektronik
a Smoke Detector ttk
X Bedroom 3
 Unit CEK Diperbaiki
NO ITEM PEKERJAAN KETERANGAN
Qty Sat CELLING I II III

1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
XI Master Bedroom
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
XII Living Room
1 Elektrikal
a Lampu ttk
2 MVAC
a Return Air ttk
b Supply Air ttk
3 Fire Fighting
a Sprinkler ttk
4 Elektronik
a Smoke Detector ttk
XIII Foyer
1 Elektrikal
a Lampu ttk
2 Fire Fighting
a Sprinkler ttk
3 Elektronik
a Smoke Detector ttk
b Speaker ttk
XIV Storage
1 Elektrikal
a Lampu ttk

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :4BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

Unit CEK CEK Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
Qty Sat FLOOR WALL I II III

I Maid Bathroom
1 Plumbing
a Kloset (WC) ttk -
b Kloset (CW jet spray & supply) ttk -
c Wastafel (CW) ttk -
d Wastafel (WW) ttk -
e Shower (CW) ttk -
f FD (WW) ttk -
II Bathroom
1 Plumbing
a Kloset (WC) ttk -
b Kloset CW (jet spray & supply) ttk -
c Wastafel (CW & HW) ttk -
d Wastafel (WW) ttk -
e Shower (CW & HW) ttk -
f FD (WW) ttk -
2 Elektrikal
a Saklar ttk -
b Stop Kontak (SO) ttk -
III Bathroom 1
1 Plumbing
a Kloset (WC) ttk -
b Kloset CW (jet spray & supply) ttk -
c Wastafel (CW & HW) ttk -
d Wastafel (WW) ttk -
e Shower (CW & HW) ttk -
f FD (WW) ttk -
2 Elektrikal
a Saklar ttk -
b Stop Kontak (SO) ttk -
IV Master Bathroom
1 Plumbing
a Kloset (WC) ttk -
c Kloset (CW jet spray & supply) ttk -
d Wastafel (CW & HW) ttk -
e Wastafel (WW) ttk -
f Shower (CW & HW) ttk -
g FD (WW) ttk -
h Bathup (WW) ttk -
i Bathup (CW & HW) ttk -
2 Elektrikal
a Saklar ttk
b Stop Kontak (SO) ttk
V Kitchen / Dinning Room
1 Plumbing
a Zink (WW) ttk -
VI Balcony
1 Plumbing
a FD (WW) ttk -

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : . . . . . .
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :4BR Unit . . . Lantai . . . Tower . . .
No. Reference Drawing : . . . . . .

HASIL PEMERIKSAAN Diperbaiki

NO ITEM PEKERJAAN KETERANGAN
WALL CEILLING FLOOR I II III

I Maid Bathroom
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
II Bathroom
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
III Bathroom 1
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
IV Master Bathroom
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
V Kitchen / Dinning Room
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
6 Gas
VI Balcony
1 Plumbing
2 Elektrikal
3 MVAC
4 Elektronik
VII Maid Room
1 Plumbing
2 Elektrikal
3 Fire Fighting
4 MVAC
5 Elektronik
VIII Bedroom 1
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
IX Bedroom 2
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
X Bedroom 3
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
XI Master Bedroom
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
XII Living Room
1 Elektrikal
2 Fire Fighting
 3 MVAC
4 Elektronik
XIII Foyer
1 Elektrikal
2 Fire Fighting
3 MVAC
4 Elektronik
XIV Storage
1 Elektrikal
2 MVAC
3 Elektronik

Catatan : r Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Joint Inspection 2 Quality Control inspector Construction Manager
Joint Inspection 3
Joint Inspection 4
Joint Inspection 5 (………………………) (………………...……) (……………………………)
CV. MKU - One Galaxy-Surabaya
 DATA UKURAN SANITARY BATHROOM UNIT
UNTUK PEKERJAAN PLUMBING

DINDING LANTAI
NO TYPE BATHROOM Tinggi (H) From AS Jarak (B) From AS ILUSTRASI GAMBAR
mm mm mm mm
KLOSET
I MAID BATHROOM L R
a Kloset (CW 421 J)
WC - - 500 Center
CW Supply 150 L-110 - -
CW Spray 580 L-100 - -
b Wastafel (LW 7 - CJW) t.850+55mm H
CW Supply 590 R-75 - - H
WW Drain 600 Center - -
c Shower (TX 423 S)
CW Supply 1050 Center - - AS DINDING L

II BATHROOM 1 & 2 WASTAFEL

a Kloset (CW 821 J)
WC - - 220 Center
CW Supply 150 L-160 - -
CW Spray 580 L-237 - -
b Wastafel (LW 642 CJ) t.850mm
CW Supply 580 L-75 - -
HW Supply 580 R-75 - -
WW Drain 555 Center - - R
c Shower (TX 474 SRR) H H
CW Supply 1050 L-75 - -
HW Supply 1050 R-75 - -
AS DINDING
III MASTER BATHROOM
a Kloset (CW 823 NJ)
WC - - 305 Center
CW Supply 150 L-200 - - SHOWER
CW Spray 580 L-344 - -
b Wastafel (LW 642 CJ) t.850mm
CW Supply 580 L-75 - -
HW Supply 580 R-75 - -
WW Drain 555 Center - -
c Shower (TX 471 SRR) L R
CW Supply 1050 L-75 - -
HW Supply 1050 R-75 - -
d Bathtubs (FB 1700 - 70)
CW Supply 580 L-75 - -
HW Supply 580 R-75 - - H
WW Drain - - 352 Center

IV MAID ROOM
a Wather Heater
CW Supply 2050 L-75 - - AS DINDING
HW Supply 2050 R-75 - -

LEGEND :
WC = Water Closed Pipe
CW = Clean Water Pipe
HW = Hot Water Pipe
WW = Waste Water Pipe
FD = Floor drain
R = Kanan
L = Kiri
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III

1 Shaft C1-19
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø 80 Drain AC 1

2 Shaft C1-20
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa CIP Ø100 KD 1

3 Shaft C1-21
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1

4 Shaft C1-43
Pipa PVC Ø100 RWP 2

5 Shaft C1-40
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1

6 Shaft C1-41
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa CIP Ø100 KD 1

7 Shaft C1-42
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø 80 Drain AC 1

8 Pipa C1-54
Pipa PVC Ø100 RWP 2

9 Shaft C1-22
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø100 KD 1
Pipa PVC Ø50 Drain AC 1

10 Shaft C1-23
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø50 Drain AC 1
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
11 Pipa C1-44
Pipa PVC Ø100 RWP 2

12 Shaft C1-38
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø50 Drain AC 1

13 Shaft C1-39
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø100 KD 1
Pipa PVC Ø50 Drain AC 1

14 Shaft C1-53
Pipa PVC Ø100 RWP 2

15 Shaft C1-37
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø80 Drain AC 1

16 Shaft C1-16
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa CIP Ø100 KD 1

17 Shaft C1-52
Pipa PVC Ø100 RWP 2

18 Shaft C1-24
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø80 Drain AC 1

19 Shaft C1-07
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa CIP Ø100 KD 1

20 Shaft C1-45
Pipa PVC Ø100 RWP 2

21 Shaft C1-25
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
22 Shaft C1-26
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø80 Drain AC 1

23 Shaft C1-46
Pipa PVC Ø150 RWP 2

24 Shaft C1-36
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1

25 Pipa C1-35
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø80 Drain AC 1

26 Shaft C1-51
Pipa PVC Ø150 RWP 2

27 Shaft C1-12
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1
Pipa PVC Ø50 Drain AC 1

28 Shaft C1-34
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø50 Drain AC 1

29 Shaft C1-50
Pipa PVC Ø150 RWP 2

30 Shaft C1-10
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1
Pipa PVC Ø50 Drain AC 1

31 Shaft C1-27
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø50 Drain AC 1

32 Shaft C1-47
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
Pipa PVC Ø150 RWP 2
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
33 Shaft C1-30
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1

34 Shaft C1-28
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1

35 Shaft C1-29
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø50 Drain AC 1

36 Shaft C1-48
Pipa PVC Ø150 RWP 2

37 Shaft C1-32
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1

38 Shaft C1-33
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1

39 Shaft C1-31
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø50 Drain AC 1

40 Shaft C1-49
Pipa PVC Ø150 RWP 2

41 Shaft C1-03
Pipa PVC Ø150 RWP 2

42 Shaft C1-05
Pipa BS Ø100 SPDR 1
Pipa BS Ø150 SP 1
Pipa BS Ø150 SP-HZ 1
Pipa BS Ø150 FH-HZ 1
Pipa Galvanis Ø150 CW Roof Tank 1
Pipa Galvanis Ø150 CW Grafitasi 1

43 Shaft C1-17
Ducting 1400x350 1
Ducting 1400x950 1
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
Ducting 1000x500 1

44 Shaft C1-06
Cable Tray 500x100 1
Cable Ladder 800x100 1

45 Shaft C1-09
Ducting 1400x350 1
Ducting 1400x950 1

46 Shaft C1-14
Ducting 950x550 1

47 Shaft C1-13
Pipa PVC Ø150 RWP 2
Pipa BS Ø150 FH-HZ 1

Catatan : X Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Quality Control inspector Construction Manager
Joint Inspection 2

Joint Inspection 3

Joint Inspection 4

Joint Inspection 5 (………………………) (………………...……) (……………………………)

CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III

1 Shaft C1-19
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø 80 Drain AC 1

2 Shaft C1-20
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa CIP Ø100 KD 1

3 Shaft C1-21
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1

4 Shaft C1-43
Pipa PVC Ø100 RWP 2

5 Shaft C1-40
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1

6 Shaft C1-41
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa CIP Ø100 KD 1

7 Shaft C1-42
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø 80 Drain AC 1

8 Pipa C1-54
Pipa PVC Ø100 RWP 2

9 Shaft C1-22
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø100 KD 1
Pipa PVC Ø50 Drain AC 1

10 Shaft C1-23
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø50 Drain AC 1
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
11 Pipa C1-44
Pipa PVC Ø100 RWP 2

12 Shaft C1-38
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø50 Drain AC 1

13 Shaft C1-39
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø100 KD 1
Pipa PVC Ø50 Drain AC 1

14 Shaft C1-53
Pipa PVC Ø100 RWP 2

15 Shaft C1-37
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø80 Drain AC 1

16 Shaft C1-16
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa CIP Ø100 KD 1

17 Shaft C1-52
Pipa PVC Ø100 RWP 2

18 Shaft C1-24
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa PVC Ø80 Drain AC 1

19 Shaft C1-07
Pipa PVC Ø 100 WW 1
Pipa PVC Ø 150 SW 1
Pipa PVC Ø 100 VT 1
Pipa CIP Ø100 KD 1

20 Shaft C1-45
Pipa PVC Ø100 RWP 2

21 Shaft C1-25
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
22 Shaft C1-26
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø80 Drain AC 1

23 Shaft C1-46
Pipa PVC Ø150 RWP 2

24 Shaft C1-36
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1

25 Pipa C1-35
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø80 Drain AC 1

26 Shaft C1-51
Pipa PVC Ø150 RWP 2

27 Shaft C1-12
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1
Pipa PVC Ø50 Drain AC 1

28 Shaft C1-34
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø50 Drain AC 1

29 Shaft C1-50
Pipa PVC Ø150 RWP 2

30 Shaft C1-10
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1
Pipa PVC Ø50 Drain AC 1

31 Shaft C1-27
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø50 Drain AC 1

32 Shaft C1-47
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
Pipa PVC Ø150 RWP 2
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
33 Shaft C1-30
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1

34 Shaft C1-28
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1

35 Shaft C1-29
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø50 Drain AC 1

36 Shaft C1-48
Pipa PVC Ø150 RWP 2

37 Shaft C1-32
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa CIP Ø100 KD 1

38 Shaft C1-33
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1

39 Shaft C1-31
Pipa PVC Ø100 WW 1
Pipa PVC Ø150 SW 1
Pipa PVC Ø100 VT 1
Pipa PVC Ø50 Drain AC 1

40 Shaft C1-49
Pipa PVC Ø150 RWP 2

41 Shaft C1-03
Pipa PVC Ø150 RWP 2

42 Shaft C1-05
Pipa BS Ø100 SPDR 1
Pipa BS Ø150 SP 1
Pipa BS Ø150 SP-HZ 1
Pipa BS Ø150 FH-HZ 1
Pipa Galvanis Ø150 CW Roof Tank 1
Pipa Galvanis Ø150 CW Grafitasi 1

43 Shaft C1-17
Ducting 1400x350 1
Ducting 1400x950 1
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
Ducting 1000x500 1

44 Shaft C1-06
Cable Tray 500x100 1
Cable Ladder 800x100 1

45 Shaft C1-09
Ducting 1400x350 1
Ducting 1400x950 1

46 Shaft C1-14
Ducting 950x550 1

47 Shaft C1-13
Pipa BS Ø150 FH-HZ 1

Catatan : X Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Quality Control inspector Construction Manager
Joint Inspection 2

Joint Inspection 3

Joint Inspection 4

Joint Inspection 5 (………………………) (………………...……) (……………………………)

CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi :Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
1 Shaft C1-19
Pipa PVC Ø 80 Drain AC 1

2 Shaft C1-42
Pipa PVC Ø 80 Drain AC 1

3 Shaft C1-22
Pipa PVC Ø50 Drain AC 1

4 Shaft C1-23
Pipa PVC Ø50 Drain AC 1

5 Shaft C1-38
Pipa PVC Ø50 Drain AC 1

6 Shaft C1-39
Pipa PVC Ø50 Drain AC 1

7 Shaft C1-37
Pipa PVC Ø80 Drain AC 1

8 Shaft C1-24
Pipa PVC Ø80 Drain AC 1

9 Shaft C1-26
Pipa PVC Ø80 Drain AC 1

10 Pipa C1-35
Pipa PVC Ø80 Drain AC 1

11 Shaft C1-12
Pipa PVC Ø50 Drain AC 1

12 Shaft C1-34
Pipa PVC Ø50 Drain AC 1

13 Shaft C1-10
Pipa PVC Ø50 Drain AC 1

14 Shaft C1-27
Pipa PVC Ø50 Drain AC 1

15 Shaft C1-29
Pipa PVC Ø50 Drain AC 1

16 Shaft C1-31
Pipa PVC Ø50 Drain AC 1

17 Shaft C1-05
Pipa BS Ø100 SPDR 1
Pipa BS Ø150 SP 1
Pipa BS Ø150 SP-HZ 1
Pipa BS Ø150 FH-HZ 1
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal :
......
Lokasi/Posisi :Lantai . . . Tower . . .
No. Reference Drawing : MEP.COM.001.1

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III
Pipa Galvanis Ø150 CW Roof Tank 1
Pipa Galvanis Ø150 CW Grafitasi 1

18 Shaft C1-17
Ducting 1400x350 1
Ducting 1400x950 1
Ducting 1000x500 1

18 Shaft C1-06
Cable Tray 500x100 1
Cable Ladder 800x100 1

19 Shaft C1-09
Ducting 1400x350 1
Ducting 1400x950 1

20 Shaft C1-14
Ducting 950x550 1

21 Shaft C1-13
Pipa BS Ø150 FH-HZ 1

Catatan : X Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Quality Control inspector Construction Manager
Joint Inspection 2

Joint Inspection 3

Joint Inspection 4

Joint Inspection 5 (………………………) (………………...……) (……………………………)

CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN : MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : ......
Lokasi/Posisi : Lantai . . . Tower . . .
No. Reference Drawing :

Cek Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN
Braket I II III

1 Shaft Unit _______

Pipa Refrigrant
Pipa Refrigrant

2 Shaft Unit _______

Pipa Refrigrant
Pipa Refrigrant

3 Shaft Unit _______

Pipa Refrigrant
Pipa Refrigrant

4 Shaft Unit _______

Pipa Refrigrant
Pipa Refrigrant

5 Shaft Unit _______

Pipa Refrigrant
Pipa Refrigrant

6 Shaft Unit _______

Pipa Refrigrant
Pipa Refrigrant

Catatan : X Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Supervisor Inspector Inspector
Joint Inspection 2

Joint Inspection 3

Joint Inspection 4

Joint Inspection 5 (………………………) (………………...……) (……………………………)

CV. MKU - One Galaxy-Surabaya
 FORM INSPEKSI
NO :......
PEKERJAAN :MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : .........................
Lokasi/Posisi : Lantai . . . . . . . . . . . . . . . . . . . .
No. Reference Drawing : .........................

Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN STANDAR PEMASANGAN
I II III
I MATERIAL
1 Pipa BS
2 Fitting Screw
3 Fitting Welded
Sesuai spesifikasi & Approval,
4 Support baik dan tidak cacat.
5 Hanger
6 Zinchromate
7 Cat Finish

II PEMASANGAN INSTALASI
Posisi Lurus, diameter, jarak antar

support/hanger sesuai dengan shop

drawing/metode yang disetujui,

1 Posisi & Kelurusan Support / Hanger dan sudah di zinchromate, dan

seluruh komponen support/hanger

lengkap terpasang dan tidak

longgar/goyang.

Pemasangan pipa rapih, lurus

2 Pabrikasi & Pemasangan Pipa sesuai dengan shop drawing yang
disetujui dan methode kerja.

Penyambungan pipa rapih, tidak

goyang, tidak bocor dalam
3 Penyambungan pipa pengetesan, dan sesuai dengan
spesifikasi dan metode yang
disetujui.

Di cat rata sesuai dengan

4 Pengecatan spesifikasi dan metoda yang
disetujui.

Catatan : X Tidak Diterima √ Diterima

Joint Inspection Date Sign SPGN Sign TATA Sign MKU Dibuat Oleh : DiKetahui Oleh : Disetujui Oleh :

Joint Inspection 1 PT. SPGN PT. TATAMULIA MKU

Quality Control inspector Construction Manager
Joint Inspection 2

Joint Inspection 3

Joint Inspection 4

Joint Inspection 5 (………………………) (………………...……) (……………………………)

 FORM INSPEKSI
NO :......
PEKERJAAN :MEP
Proyek : ONE GALAXY - SURABAYA

Tanggal : .........................
Lokasi/Posisi : Lantai . . . . . . . . . . . . . . . . . . . .
No. Reference Drawing : .........................

Diperbaiki
NO ITEM PEKERJAAN Qty Cek Install KETERANGAN STANDAR PEMASANGAN
I II III
CV. MKU - One Galaxy-Surabaya