DPWH FORM NO. 96-002-E
DATE ISSUED : DATE FILED :PAID UNDER O.R. NO. :AMOUNT :DATE ISSUED :
BOX 1NAME OF OWNER/APPLICANT LAST NAME FIRST NAME MIDDLE NAME TIN
ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY TEL/FAX NO.
LOCATION OF INSTALLATION NO. STREET BARANGAY CITY/MUNICIPALITY
BOX 2
REVIEWED BY
BOX 3
PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING, DEVICES AND EQUIPMENT ENUMERATED IN THISAPPLICATION SUBJECT TO THE FOLLOWING CONDITIONS :
THAT THE PROPOSED INSTALLATION BE IN ACCORDANCE WITH THE APPROVED PLANS FILED WITH THIS OFFICE AND INCONFORMITY WITH THE PROVISIONS OF THE LATEST EDITION OF THE PHILIPPINE ELECTRICAL CODE.
THAT A DULY LICENSED ELECTRICAL PRACTITIONER BE INCHARGE OF THE INSTALLATION/CONSTRUCTION
THAT CERTIFICATE OF COMPLETION DULY SINGED BY THE ELECTRICAL PRACTITIONER INCHARGE OF THE INSTALLATIONBE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.
THAT A CERTIFICATE OF FINAL ELECTRICAL INSPECTION BE OCCURRED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING
THIS PERMIT SHALL BE POSTED AT THE DOOR OR SITE OF WORK.
APPROVED :
NOTED :
loymi_lapuz_2000
Note 1: This permit maybe cancelled or revoked pursuant to Section 305-306 of the National Buildind Code.Note 2 : Alteration on this form are not allwed
ASSESSED BY O.R. NUMBER DATE PAID
DATE
DATE
ELECTRICAL ENGINEER OF THE BUILDING OFFICE(Signature over printed name)
PRC REG. NO. AND VALIDITY
ENGR. CIRINIA GRACE L. CATUBIG
Republic of the PhilippinesDEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL
DISTRICT/CITY/MUNICIPALITYAREA CODE._________
PERMIT NO.
OFFICER-IN-CHARGE
ELECTRICAL PERMIT (To be accomplished by the Office Concerned)
APPLICATION NO.
CHIEF OF PROCESSING DIV.SEC.
54
1
23
ASSESSMENT
AMOUNT DUE
DPWH FORM NO. 96-001-E
BOX 1 ( TO BE ACCOMPLISHED BY DULY QUALIFIED ELECTRICAL PRACTITIONER)LAST NAME FIRST NAME MIDDLE NAME TIN
NO. STREET BARANGAY CITY/MUNICIPALITY
NO. STREET BARANGAY CITY/MUNICIPALITY
SCOPE OF WORKNEW INSTALLATION ADDITION OF __________ OTHERS (Specify)ANNUAL INSPECTION REPAIR OF _____________
REMOVAL _____________
TYPE OF OCCUPANCY OR USE:A. RESIDENTIAL DWELLING E. BUSINESS & MERCANTILE I. ASSEMBLY OCCUPANT LOAD 100 OR MORE
B. RESIDENTIAL HOTEL APARTMENT F. INDUSTRIAL J. ACCESSORYC. EDUCATION AND RECREATION G. STORAGE & HAZARDOUS K. OTHERS (Specify) D. INSTITUTIONAL H. ASSEMBLY OTHER THAN GROUP I
NUMBER OF OUTLETS NUMBER OF EQUIPMENT/WIRING DEVICESLIGHT SPO COOKING UNIT TOGGLE SWITCH FIRE ALARM/SMOKE DETECTORS
CONVINIENCE/RECEPTACLE SPO. COOKING HEATER BELLS BUZZER OTHERS (See attached List)SPO. AIRCON SPO WATER PUMP PUSH BOTTON
BOX 2 ( PROFESSIONAL ELECTRICAL ENGINEER WHO SIGNED AND SEALED THE PLANS & SPECIFICATION)
PRC REG. NO. VALIDITY
BOX 3 ( ELECTRICAL CONTRACTOR 200-AMPERE MAIN AND ABOVE
BOX 4 (PERSON IN-CHARGE OF INSTALLATION)REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN
(not exceeding 600 volts and 500 KVA)
PRC REG. NO. VALIDITY
BOX 5 (OWNER/AUTHORIZED REPRESENTATIVE)
BOX 6 ( TO BE RECEIVED BY RECEIVING/RECORDING SECTION)RECEIVED BY:
DATE RECEIVED:
ELECTRICAL PLANS & SPECIFICATIONS (5 SETS)Signature over printed Name
PROFESIONAL ENGINEER
NAME SIGNATURE TIN CTC NO.
DATE ISSUED
PLACE ISSUED
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE ISSUED TIN
( ) ( )
NAME
ADDRESS TEL/FAX NO.
( )
( ) ( )
DATE ISSUED TIN
NAME PCAB LIC. NO. (SPECIALTY - ELECTRICAL)
VALIDITY
( ) ( )
NAME
ADDRESS TEL/FAX NO.
APPLICATION NO. DATE FILED
Date of Proposed start of Installation Expected Date of Completion
( ) ( ) ( )
APPLICATION FOR ELECTRICAL PERMIT( Accomplished in print and in Duplicate)
NAME OF
OWNER/APPLICANT
ADDRESSTEL./FAX NO.
( ) ( )
Republic of the PhilippinesDEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL
DISTRICT/CITY/MUNICIPALITYAREA CODE._________
( ) ( ) ( )
LOCATION OF
INSTALLATION
ADDRESS TEL./FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE
( )( ) ( )
( )
( )
PAID UNDER O.R. NO. : Permit No.AMOUNT :DATE ISSUED :
BOX 1NAME OF OWNER/APPLICANT LAST NAME FIRST NAME MIDDLE NAME TIN
ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY TEL/FAX NO.
LOCATION OF INSTALLATION NO. STREET BARANGAY CITY/MUNICIPALITY
BOX 2PURPOSE:
CONSTRUCTION LIGHTING & POWER CEMETERY LIGHTING & POWER CARNIVALFIESTA LIGHTING & POWER
CHRISTMAS DECORATIVE LIGHTING OTHERS (Specify)
BOX 3
NUMBER OF OUTLETS : LIGHTS SWITCHES
OTHERS :
BOX 4
PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN(not exceeding 600 Volts & 500 KVA)
NAME PRC REG. NO. VALIDITY
ADDRESS TEL/FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE ISSUED TIN
BOX 5
CTC NO.
DATE ISSUED
PLACE ISSUED
BOX 6
PERMIT IS HEREBY GRANTED TO CONNECT TEMPORARY ELECTRICAL INSTALLATION WITH THE AUTHORIZED LOAD SPECIFIED
ABOVE LOCATED AT FOR A PERIOD OF
DAYS FROM DATE
AFTER WHICH PERIOD THE SERVICE SHALL BE DISCONNECTED.
THIS PERMIT SHALL BE SUSPENDED OR REVOKED ANY TIME BEFORE ITS EXPIRATION WHENEVER ALTERATIONS ORCHANGES
IN THE ELECTRICAL WIRING SYSTEM HAVE RENDERED IT UNSAFE.
RECOMMENDING APPROVAL : APPROVED :
ELECTRICAL ENGINEER OF THE BUILDING OFFICIAL
loymi_lapuz_2000
Republic of the PhilippinesDEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL
DISTRICT/CITY/MUNICIPALITYAREA CODE._________
ENGR. CIRINIA GRACE L. CATUBIG
PRC REG. NO. AND VALIDITY PRC REG. NO. AND VALIDITY
PERMIT FOR TEMPORARY SERVICE CONNECTION
PERSON IN-CHARGE OF INSTALLATION
OWNER/APPLICANT
NAME SIGNATURE TIN
Date
OFFICER IN-CHARGE
Aplication No. Date Received
Name of Applicant :
Project Location :
Contact Person :
Tel/Contact No. :
Application Letter; Photocopy of owner's valid ID with three (3) specimensignatures; authorization leeter.
Barangay Certification as Bonafide resident of the area.
Sketch/Vicinity Map/Location
Photo of the structure to be Connected
Affidavit of Undertaking.
If Temporary : Photocopy of Approved Building Permit.
Davao Light Electric Bill (Transfer location of Meter/Separation of Meter/Reconnection of Meter/Change of Service Entrance.)
Remarks by Electrical Inspector :
Name of Inspector :
Date of Inspection :
Reviewed by : Engr. DENNIS REUBEN C. JARANILLA / ENGR. ALPHEO JOSE BOLOTAOLO
Recommending Approved : ENGR. ROLANDO A. EBAD(ENGINEER III)
REPUBLIC OF THE PHILIPPINES
OFFICE OF THE BUILDING OFFICIAL
CITY GOVERNMENT OF DAVAO
CHECKLIST OF REQUIREMENTSTEMPORARY/REVOCABLE ELECTRICAL
(signature over printed name)
(ENGINEER II) (ENGINEER II)
Republic of the PhilippinesOFFICE OF THE BUILDING OFFICIAL
City of Davao
iDate:
The Resident ManagerDavao Light & Power CompanyDavao City
Sir/Maam:
pursuant to the provision of pD IO96 othen^/ise known as the National BuildingCode of th'e Philippines and its Ancillary, the Electrical Code of the Philippines, you arehereby authorized to supply kilowatt-hour meter and service connection/s to Mr./Mrs.
(Given Name)
a resident of
(Middle Name) (Family Name)
after they had been issued Bullding and Electrical Permit, as well as its Cerificate ofFinal Inspection and Occupancy of his/her building located at,
(House /BIdg/Purok No.) (Street Name) (Barangay)this city, his/her ElectrI.Gal Installation is found to be in accordance with the Electrical Codeof the Philippines and its lmplementing Rules and Regulations.
Your favorable action on this matter is highly appreciated.
Very truly yours,
LONGITUDE :
LATITUDE
ENGR: CIRINIA GRACE I CATUBIGC-|n-
Alpha Numeric
Date Issued
Republic of the Philippines
OFFICE OF THE BuILDING OFFICIALCity of Davao
(ELECTRICAL DIVISION)
REQUEST FOR INSPECTION
DATE :
NAME OF APPLICANT :
ADDRESS :
LOCATION OF INSTALLATION:
TOTAL NuMBER OF OUTLETS AND EQUIPMENT INSTALLED
LIGHTS: SWITCHES: CONVINIENCE OUTLET: MAIN SWITCH :
BELL SYSTEM: ELECTRIC RANGE: K.W... WATER HEATER: K.W. :
AIRCONDITIONING SYSTEM: H.P.: TELEPHONE: MOTORS: H.P.:
OTHERS (SPECIFY):
NATURE OF WORKS:
P.E.E/R.E.E/R.M.I.
OWNER/APPLICANT SIGNATURE PRC BEG_#
P.T.R.#
RES.CERT.#
ISSUED AT:
DATE ISSUED:
T.I.N.#
INSPECTION REPORT
REMARKS:
INSPECTOR DATE :
TIME :
REPUBLICOFTHE PHILIPPINES
DEPARTMENT OF PueuC WORKS AND HIGHWAYSOFFICE OF"E Cm/ BulLDING OFFICIAL
Davco any
CERTIFICATE OF FINAL ELECTRICAL INSPECTION/COMTFifeFToN"s ls TO CERTIFY THAT FINAL INSPECTIO" OF "E ELECTRICAL INSTAunTION HAD BEEN CONDUC"D O" BUllDING AND/OR mEMISES COVERED
BY"E BtJl|DING PERMrr NO. lss|lEl) ONw'" "E APPROVED P.ANSTfro-A'NTbuEFrLEU"wITii-,:"ADL TAN"I.S#AEc.::A.EANFcOEU"w:,:0#E'=,EEC.T'RNre,A,CCcO.R5:AN.iTHE PHluPPINES_
RESII)ENTIAL OW£LLING
RESIDENTIAL HOTEL APMTMENT
EO|lCAT]ON ANI) RECREATION
INSTrrUTIONAL
START OF INSTAuJ\TION
IIIIB|lSINESS MERCMl"LE
INl)USTRIAL
STORAGE AND HAZARDOUS
ASSEMBLY O"ER "AN GROUP I
DATE OF COMPlnlON
ASSEMBLY OCCUPANT |OAD loop OR MORE
ACCESSORY
O"ERS (specify)
OUTLET/S DEVICES / EQUIPMENTNUMBER OF OUTLETS:LIGHT spa, cooKING IJNIT
TOGGLE SWITCH fE OEl.ECTORS
CONVINIENCunECEPTACLE spa_ WATER llEATERBEL|SrouzzER o"ERS (see attached llst)I
Spa. AIRCON spa. WATER PuMPPUSH BUTTONS|||||||||- _
I |= |||IL`|lL`r|.I,I.rdr|l.Il|[+ I I
I I PROFESSIONAL El-ECTRICA| ENGINEERI I REGISTERED ELECTRICAL ENGINEER I I REGISTERED hMSTER ELEC"lCIAN(Notexceeding600volesa600KVA)
NAMESIGNATUREPRC BEG. NO.
VALIDITY
ADDRESS
PTR NO_ DATE rsSUED PLACE ISSUED
CTC NO. DATE ISSUED TIN
ELECTRICAL CONTRACTOR ZOO-AMl)ERE MAIN AND ABOVEPCAB UC. NO.
VALIDITY
( ]TEMroRARY ( 1NEW
(SPEaFICAL|Y - ELEmlCA|)
TEL/I:AI NO.
I I REMODEL/A|TERATION
I lOPENWIRlllG I lcoNOUITS
I ]0"ERS
I ]CABLE [ ]AIWOREDCABLE I ]RACEWAYS
lNseECTEO eY :
ELECTRICAL INSPEerOR(sq!nature over "nted Name)
PRC RES_ NO. VALJOITY
AMOUNT PAID P
CHIEF, ELECTRICAL SEenON
(signature Over Prlnted Name)
PRC REG. NO_ VouOm/
a.R. NO.
ENGR. CIRINIA GRACE L CATuBIGOfffcerJn-Charge
(signatIJre Over mnted Name)
DATE