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