8/4/2019 Form untuk submittal P3

http://slidepdf.com/reader/full/form-untuk-submittal-p3 1/1

CONTRACTOR'S NAME PROJECT'S NAME

PT. PEMBANGUNAN PERUMAHAN (PP) - ITOCHU HASANUDDIN UNIVERSITY ENGINEERING

Joint Operation FACULTY DEVELOPMENT PROJECT

JBIC LOAN IP-541

P 3 S M I S 0 0 1 0

ISSUEER AND ADDRESSEE(S) OF THE REQUEST

From : PP- ITOCHU Joint Operation To : Oriental Consultants Co.,Ltd.

Name : I Nyoman Karmana Signature : Name : Nobutaka Komai

(Project Manager)

Date :

CONTRACT NO : 15375/H.4/LK.13/2011

TRANSMITTAL OF :DAILY REPORT EQUIPMENT DATA METHODE OF STATEMENT

WEEKLY REPORT BUILDING EQUIPMENT DATA TEST RESULT

MONTHLY REPORT BROCHURE OF MATERIAL CHANGE ORDER

SCHEDULE MANUFACTURING'S CERTIFICATE VARIATION ORDEROF COMPLIENCE

OTHERS

DESCRIPTION OF ITEM SUBMITTED

1 Volume of Cut & Fill for Package-3 2

REVIEW / APPROVAL

POSITION :

NAME :

APPROVED

APPR WITH COMMENT

(see below/attached)

REJECTED(with details below/attached)

DATE:

SIGNATURE :

Comments: ……………………………………………………………………………………………………………………………………………………

6

MISCELLANEOUS APPROVAL REQUEST

26-Sep-11

ITEM

NO

DESCRIPTION OF ITEM SUBMITED

(Type, size, model number etc)NO. OF COPIES

CONTRACT REFERENCE DOCUMENTVARIATION

FOR ENGINEER

USE CODESPEC. PARA NO. DRAWING SHEET NO.

1 2 3 4 5

26-Sep-11

PP-ITOCHU Joint Operation Consultants Engineer

Site Engineer Manager Project Manager

Galang Bastiono I Nyoman Karmana

26-Sep-11