REQUEST FOR CONCRETE POURING

Date: __________________

Name of Project: _________________________________________________

Contractor: __________________________________________________
Portion of Structure to be Poured: ______________________________________
Estimated Volume: _________________________________________________
Target Schedule of Pouring: _________________ Time Start: ______________

Requested by:
_______________________
Name / Signature
(Contractor’s Representative)
REQUIREMENT CHECKLIST:

Architectural:
Dimensions on portion prepared for concrete
1 pouring conforms to the plan and building design.
Dimensions on portion prepared for concrete
2 pouring conforms to the National Building Code
standards.
Line and Grade alignment conforms to the plan Name / Signature
3 (Supervising Architect)
and standards.

Structural:
Dimensions on portion prepared for concrete
1 pouring conform to the structural design.
Number, sizes, proper placement and spacing of
2 steel bars conform to the plan and structural
design.
Re-bar block spacers and concrete covering
3 conform to standards. Name / Signature
(Supervising Structural Engineer)
Concrete forms, scaffoldings and shoring properly
4 in-place.

Electrical:

Electrical layout, roughing-ins, and embedment

1 conform to the plan and specifications. Name / Signature
(Supervising Electrical Engineer)

F-RCP-008, Rev. 01, 08/24/2022 Page 1 of 2

Plumbing/Sanitary:

Plumbing lines layout, roughing-ends, and

1 embedment conform to the plan and specifications. Name / Signature
(Supervising Sanitary Engineer or
Master Plumber )

General Construction Requirement:

Test results of aggregates used in concrete mix
1 submitted.
Test results and mill certificate of steel bars used
2 submitted.
Clean water to be used in concrete mixture Name / Signature
3 checked. (Supervising Project Engineer)
4 Concrete vibrator available on-site.
Cylindrical moulds for concrete samples and slump
5 cone for concrete mix slump test available on-site.
Name/ Signature
(University Safety Officer)
6 Concrete mixer (substantial)
Construction safety measures during concrete
7 pouring in-place.

CONCRETE POURING PERMIT

Date: ______________________

With the compliance of the above requirement checklist for concrete

pouring on the ___________________________________________________

(portion of structure subject for concrete pouring)

of the __________________________________________________________,
(Name of Project)

permit is hereby granted to conduct concrete pouring works starting on

________________________.
(Target date of concrete pouring)

Director, Office of Physical Plant & General Services

F-RCP-008, Rev. 01, 08/24/2022 Page 2 of 2