Republic of the Philippines
Province of Albay
City of Tabaco
OFFICE OF THE BUILDING OFFICIAL
ELECTRICAL PERMIT
APPLICATION NO. EP NO. BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED PRINT BY THE OWNER/APPLICANT)
OWNER/APPLICANT LAST NAME FIRST NAME M. I. TIN
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY
BY AN ENTERPRISE
ADDRESS NO. OF STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.
LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. .. TAX DEC. NO. _______
STREET BARANGAY CITY/MUNICIPALITY OF _______________
SCOPE OF WORK
NEW INSTALLATION RECONNECTION OF SERVICE ENTRANCE RELOCATION OF SERVICE ENTRANCE
ANNUAL INSPECTION SEPARATION OF SERVICE ENTRANCE OTHERS (Specify) ____________
TEMPORARY UPGRADING OF SERVICE ENTRANCE _______________________________
SUMMARY OF ELECTRICAL LOADS/CAPACITIES APPLIED FOR
TOTAL CONNECTED LOAD TOTAL TRANSFORMER CAPACITY TOTAL GENERATOR/UPS CAPACITY
__________________KVA __________________KVA _________________KVA
BOX 2 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL)
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
Address
______________________________Date___________ PRC. No. Validity
PROFESSIONAL ELECTRICAL ENGINEER PTR. No. Date Issued
(Signed and Sealed Over Printed Name) Issued at TIN
BOX 3
SUPERVISOR / IN-CHARGE OF ELECTRICAL WORKS
PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN
__________________________________________Date______________
(Signed and Sealed Over Printed Name)
PRC. No. Validity
PTR. No. Date Issued
Issued at TIN
Address
BOX 4 BOX 5
BUILDING OWNER WITH MY CONSENT: LOT OWNER
__Date__________ __________________________________Date__________
(Signature Over Printed Name) (Signature Over Printed Name)
Address: Address:
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
TO BE ACCOMPLISHED BY THE PROCESSING & EVALUATION DIVISION
BOX 6
RECEIVED BY: DATE:
FIVE (5) SETS OF ELECTRICAL DOCUMENTS
ELECTRICAL PLANS AND SPECIFICATIONS EXPECTED DATE OF COMPLETION/INSTALLATION/CONSTRUCTION
SPECIAL FIXTURES AND EQUIPMENT
PROPOSED STARTING DATE OF INSTALLATION/CONSTRUCTION OTHERS (Specify)_________________________________________
_____________________________________________ _____________________________________________
BOX 7
PROGRESS FLOW
IN OUT PROCESSED BY:
DATE TIME DATE TIME
ELECTRICAL
OTHERS (Specify) _________________________
ELECTRICAL ENGINEER
(Signature Over Printed Name)
PRC Reg. No. ______________
Validity:___________________
BOX 8
ACTION TAKEN:
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed electrical works shall be in accordance with the electrical plans filed with this Office and in confirmity
with the provision of the latest Philippine Electrical Codes, the National Building Code and its IRR.
2. That prior to any electrical installation, the Owner/Permittee shall submit a duly accomplished prescribed Notice of
Construction to the Office of the Building Official.
3. That for installed electrical capacity of 200 amperes and above at 230 volts nominal and above, a specialty electrical
duly licensed by the Philippine Contractors Accreditation Board (PCAB) shall be required.
4. That a duly licensed electrical practitioner shall be in-charge of the installation, and that upon completion of the electrical
works, he shall submit the entry of the logbook duly signed and sealed to the OBO including as-built plans and other
documents. He shall also accomplish the Certificate of Completion stating that the electrical works conform to the
provosions of the Philippine Electrical Codes, the National Building Code and its IRR.
5. That this permit is null and void unless accompanied by the building permit except for projects involving purely electrical
works in which case only the building permit number of the existing building/structure shall be required.
6. That a Certificate of Final Electrical Inspection (CFEI) shall be secured prior to the actual occupancy of the building.
7. That this permit shall be posted at the door or site of work.
PERMIT ISSUED BY:
ARCH. FRANCO BITE
Local Building Official
(Sinature Over Printed Name)
Date_____________________
