NBC FORM NO.
A-03
Republic of the Philippines
TUGUEGARAO CITY
Province of Cagayan
OFFICE OF THE BUILDING OFFICIAL
ELECTRICAL PERMIT
APPLICATION NO. EP NO. BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER APPLICANT)
OWNER/APPLICANT: LAST NAME FIRST M.I. TIN
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY
BY AN ENTERPRISE
ADDRESS: NO. STREET 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 GENERATION CAPACITY
kVA kVA kVA
BOX 2 (TO BE ACCOMPLISHED 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/or 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
(Signature Over Printed Name) (Signature Over Printed Name)
Date ____________________ Date ____________________
Address Address
C.T.C. No. Date Issued Place Issued C.T.C. No. Date Issued Place Issued
ENG
BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
RECEIVED BY: DATE:
FIVE (5) SETS OF ELECTRICAL DOCUMENTS
ELECTRICAL PLANS AND SPECIFICATIONS EXPECTED DATE OF COMPLETION OF INSTALLATION/
SPECIAL FIXTURES AND EQUIPMENT CONSTRUCTION ___________________________________
PROPOSED STARTING DATE OF INSTALLATION/ OTHERS (Specify) __________________________________
CONSTRUCTION ____________________________ _________________________________________________
BOX 7
PROGRESS FLOW
IN OUT PROCESSED BY:
DATE TIME DATE TIME
ELECTRICAL _________________________
ELECTRICAL ENGINEER
OTHERS (Specify) (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 conformity with
provisions of the latest Philippines 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 contractor
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 plan and other documents. He shall
also accomplish the Certificate of Completion stating that the electrical works conform to the provisions of the Philippine
Electrical Code, 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:
ENGR. EMILIO L. MATANGUIHAN, JR.
CITY ENGINEER/BUILDING OFFICIAL
(Signature Over Printed Name)
Date : ________________________
