Republic of the Philippines

Province of Nueva Ecija

SCIENCE CITY OF MUÑOZ
OFFICE OF THE BUILDING OFFICIAL

__________________________
DISTRICT/CITY/MUNICIPALITY

AREA CODE
APPLICATION NO. PERMIT NO.

APPLICATION FOR
ELECTRICAL PERMIT
_________________________________ ______________________________
DATE OF APPLICATION DATE ISSUED
BOX 1 (TO BE ACCOMPLISHED BY PROFESSIONAL ELECTRICAL ENGINEER/MASTER ELECTRICIAN, IN PRINT)
NAME OF OWNER/APPLICANT LASTNAME, FIRST NAME, M.I. TIN

ADDRESS NO., STREET, BARANGAY, CITY/MUNICIPALITY TELEPHONE NO.

LOCATION OF INSTALLATION NO., STREET, BARANGAY, CITY/MUNICIPALITY

SCOPE OF WORK ADDITION OF ________________________ OTHERS (SPECIFY)

NEW INSTALLATION
REPAIR OF __________________________ ___________ OF ____________
ANNUAL INSPECTION
___________ OF ____________
REMOVAL OF ________________________

USE OR TYPE OF OCCUPANCY

RESIDENTIAL _________________________________________ AGRICULTURAL ______________________________________

COMMERCIAL _________________________________________ STREET FURNITURE, LANDSCAPING_____________________

INDUSTRIAL ___________________________________________ SIGNBOARDS ________________________________________

INSTITUTIONAL ________________________________________ OTHERS (SPECIFY) ____________________________________

NUMBER OF OUTLETS AND EQUIPMENT TO BE INSTALLED

LIGHTS ______________________________ SWITCHES ___________________________ CONV OUTLETS _______________________

BELLSYSTEM _________________________ ELECTRIC RANGE _________KW________ WATER HEATER __________KW__________

AIRCONDITIONING SYSTEM _____________ TELEPHONE _________________________ MOTORS _____________________________

OTHER (SPECIFY) _____________________________________________________________________________________________________________________

________________________________________________________________________________________________________
DATE OF PROPOSED ESTIMATED COST OF

START OF CONSTRUCTION_________________________________ ELECTRICAL INSTALLATION _____________________________

EXPECTED DATE PREPARED BY ________________________________________

OF COMPLETION __________________________________________

BOX 2 (TO BE ACCOMPLISHED BY RECEIVEING & RECORDING SECTION)

ELECTRICAL DOCUMENTS (FIVE (5) SETS EACH)

ELECTRICAL PLAN & SPECIFICATIONS BILL OF MATERIALS

COST ESTIMATES OTHERS (SPECIFY) ____________________________________

_____________________________________________________

WE HEREBY AFFIX OUR HANDS SIGNIFYING OUR CONFORMITY TO THE INFORMATION HEREIN ABOVE SETFORTH

BOX 3 (Person who signed and sealed plans & specifications) BOX (PERSON IN-CHARGE OF THE INSTALLATIONS)
ELECTRICAL ENGINEER/ P.R.C REG. No.
ELECTRICAL ENGINEER/ P.R.C. REG. No. MASTER ELECTRICIAN
MASTER ELECTRICIAN
PRINT NAME PRINT NAME

ADDRESS
ADDRESS

P.T.R. No. DATE ISSUED PLACE ISSUED P.T.R. No. DATE ISSUED PLACE ISSUED

SIGNATURE TIN
SIGNARURE TIN

BOX 4

SIGNATURE OWNER TIN RES. CERT NO. DATE ISSUED PLACE ISSUED
 ELECTRICAL PERMIT

BOX 5 (TO BE ACCOMPLISHED BY PROFESSIONAL ELECTRICAL ENGINEER/MASTER ELECTRICIAN IN PRINT)

NAME OF OWNER/APPLICANT LAST NAME, FIRST NAME, M.I. TAXPAYER’S IDENTIFICATION NO.

ADDRESS NO., STREET, BARANGAY, CITY/MUNICIPALITY TELEPHONE NO.

LOCATION OF INSTALLATION NO., STREET, BARANGAY, CITY/MUNICIPALITY

BOX 6 (TO BE ACCOMPLISHED BY DIVISION/SECTION CONCERNED)

PROGRESS FLOW

NOTE: IN OUT

CHIEF, PROCESSIUNG DIVISION/SECTION TIME DATE TIME DATE ACTION \/REMARKS PROCESS BY

RECEIVING AND RECORDING

ELECTRICAL

BOX 7 (TO BE ACCOMPLISHED BY DIVISION/SECTION CONCERNED)

ASSESSED FEES

AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

REVIEWED

CHIEF, PROCESSING, DIV./SEC.

BOX 8 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN:
PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING
AND EQUIPMENT ENUMERATED HEREIN SUBJECT TO THE FOLLOWING
CONDITIONS. _____________________________________
BUILDING OFFICIAL

1. THAT THE PROPOSED INSTALLATION SHALL BE IN ACCOR-

WITH APPROVED PLANS FILED WITH THIS OFFICE AND IN
CONFORMITY WITH THE NATIONAL BUILDING CODE.
2. THAT A DULY LICENSED ELECTRICAL ENGINEER/MASTER
ELECTRICIAN BE ENGAGED TO UNDERTAKE THE INSTALLA-
TION/CONSTRUCTION.
3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY A
ELECTRICAL ENGINEER/MASTER ELECTRCIAN IN CHARGE ______________________________________
OF INSTALLATION SHALL BE SUBMITTED NOT LATER THAN DATE
SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.
4. THAT A CERTIFICATE OF FINAL INSPECTION AND A CERTIFICATE
OF OCCUPANCY BE SECURED PRIOR TO THE ACTUAL OCCU-
PANCY OF THE BUILDING.

NOTE:
THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTIONS 305 &306 OF THE “NATIONAL BUILDING CODE”