Republic of the Philippines Department of Labor and Employment
National Capital Region
DOLE-NCR Building, 967 Maligaya St., Malate, Manila

APPLICATION FOR BOILER/PRESSURE VESSEL INSTALLATION

1. Name of establishment : _______________________________________________________________

2. Address: ___________________________________________________________________________
3. Owner/Manager and Address : _________________________________________________________
4. Where Boiler/Pressure Vessel is to be installed : ___________________________________________
__________________________________________________________________________________

5. Plans to be submitted : Submit ( in quadruplicate ) the foundation plan with design, installation and
location plans of the boiler/pressure vessel. The plans shall be prepared, signed and sealed by a
Professional Mechanical Engineer. Plans shall also bear the name and signature of the owner or
manager submitted together with the First Inspection Report.

6. Boiler/Pressure Vessel Data :

a) Manufacturer : _________________________________________________________________
b) Type : _____________________________ c) Serial No. _______________________________
d) Place of Origin : _______________________________________________________________
e) Date of Make : __________________________________________________________
f) Heating Surface : _________________________________________________________
g) Max A.W.P. : ___________________________________________________________
h) Horsepower/Cubic Feet : ___________________________________________________

7. Name and Signature of Person top Supervise the installation :

____________________________________________________________________________________
Board of Mechanical Engineering Reg. No. ______________________________________
Lic. No. ______________________________________
8. Other accessories or equipment : __________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________
 
 
_______________________________ 
                        Name and Signature of
Owner/Manager

_______________________________
Tax Identification No.
Application No. ________________________
Plan Fee : _____________________________
O.R. No. ______________________________
Date Received : ________________________
Received by : __________________________