DPWH FORM NO.

96-002-E
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL

DISTRICT/CITY/MUNICIPALITY
AREA CODE._________

PERMIT NO. APPLICATION NO.

DATE ISSUED : DATE FILED :

PAID UNDER O.R. NO. :
AMOUNT :
DATE ISSUED :
ELECTRICAL PERMIT
(To be accomplished by the Office Concerned)
BOX 1
NAME 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
ASSESSMENT
AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

REVIEWED BY

CHIEF OF PROCESSING DIV.SEC.

BOX 3
PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING, DEVICES AND EQUIPMENT ENUMERATED IN THIS
APPLICATION SUBJECT TO THE FOLLOWING CONDITIONS :
1 THAT THE PROPOSED INSTALLATION BE IN ACCORDANCE WITH THE APPROVED PLANS FILED WITH THIS OFFICE AND IN
CONFORMITY WITH THE PROVISIONS OF THE LATEST EDITION OF THE PHILIPPINE ELECTRICAL CODE.
2 THAT A DULY LICENSED ELECTRICAL PRACTITIONER BE INCHARGE OF THE INSTALLATION/CONSTRUCTION
3 THAT CERTIFICATE OF COMPLETION DULY SINGED BY THE ELECTRICAL PRACTITIONER INCHARGE OF THE INSTALLATION
BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.
4 THAT A CERTIFICATE OF FINAL ELECTRICAL INSPECTION BE OCCURRED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING
5 THIS PERMIT SHALL BE POSTED AT THE DOOR OR SITE OF WORK.

APPROVED :

ELECTRICAL ENGINEER OF THE BUILDING OFFICE DATE

(Signature over printed name)

PRC REG. NO. AND VALIDITY

NOTED :

ENGR. CIRINIA GRACE L. CATUBIG DATE

OFFICER-IN-CHARGE
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
 DPWH FORM NO. 96-001-E
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL

DISTRICT/CITY/MUNICIPALITY
AREA CODE._________

APPLICATION NO. DATE FILED

Date of Proposed start of Installation Expected Date of Completion

APPLICATION FOR ELECTRICAL PERMIT

( Accomplished in print and in Duplicate)

BOX 1 ( TO BE ACCOMPLISHED BY DULY QUALIFIED ELECTRICAL PRACTITIONER)

NAME OF LAST NAME FIRST NAME MIDDLE NAME TIN
OWNER/APPLICANT
NO. STREET BARANGAY CITY/MUNICIPALITY TEL./FAX NO.
ADDRESS

LOCATION OF NO. STREET BARANGAY CITY/MUNICIPALITY

INSTALLATION
SCOPE OF WORK
( ) NEW 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. ACCESSORY
( ) C. EDUCATION AND RECREATION ( )
G. STORAGE & HAZARDOUS ( ) K. OTHERS (Specify)
( ) D. INSTITUTIONAL ( )
H. ASSEMBLY OTHER THAN GROUP I
NUMBER OF OUTLETS NUMBER OF EQUIPMENT/WIRING DEVICES
LIGHT 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)
NAME PRC REG. NO. VALIDITY
ADDRESS TEL/FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE ISSUED TIN
BOX 3 ( ELECTRICAL CONTRACTOR 200-AMPERE MAIN AND ABOVE
NAME PCAB LIC. NO. (SPECIALTY - ELECTRICAL)
VALIDITY
ADDRESS TEL./FAX NO.
BOX 4 (PERSON IN-CHARGE OF INSTALLATION)
( ) PROFESIONAL ENGINEER ( ) REGISTERED ELECTRICAL ENGINEER ( ) REGISTERED MASTER ELECTRICIAN
(not exceeding 600 volts and 500 KVA)
NAME PRC REG. NO. VALIDITY
ADDRESS TEL/FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE ISSUED TIN
BOX 5 (OWNER/AUTHORIZED REPRESENTATIVE)
NAME SIGNATURE TIN CTC NO.
DATE ISSUED
PLACE ISSUED
BOX 6 ( TO BE RECEIVED BY RECEIVING/RECORDING SECTION)
RECEIVED BY:

ELECTRICAL PLANS & SPECIFICATIONS (5 SETS)

Signature over printed Name
DATE RECEIVED:
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL

DISTRICT/CITY/MUNICIPALITY
AREA CODE._________

PERMIT FOR TEMPORARY SERVICE CONNECTION

PAID UNDER O.R. NO. : Permit No.
AMOUNT :
DATE ISSUED : Date

BOX 1
NAME 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
PURPOSE:

CONSTRUCTION LIGHTING & POWER CEMETERY LIGHTING & POWER CARNIVALFIESTA LIGHTING & POWER

CHRISTMAS DECORATIVE LIGHTING OTHERS (Specify)

BOX 3
NUMBER OF OUTLETS : LIGHTS SWITCHES
OTHERS :

BOX 4
PERSON IN-CHARGE OF INSTALLATION
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
OWNER/APPLICANT
NAME SIGNATURE TIN 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 :

ENGR. CIRINIA GRACE L. CATUBIG

ELECTRICAL ENGINEER OF THE BUILDING OFFICIAL OFFICER IN-CHARGE

PRC REG. NO. AND VALIDITY PRC REG. NO. AND VALIDITY

loymi_lapuz_2000
 REPUBLIC OF THE PHILIPPINES
OFFICE OF THE BUILDING OFFICIAL
CITY GOVERNMENT OF DAVAO

Aplication No. Date Received

Name of Applicant :
Project Location :
Contact Person :
Tel/Contact No. :

CHECKLIST OF REQUIREMENTS
TEMPORARY/REVOCABLE ELECTRICAL

Application Letter; Photocopy of owner's valid ID with three (3) specimen

signatures; 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 :
(signature over printed name)

Date of Inspection :

Reviewed by : Engr. DENNIS REUBEN C. JARANILLA / ENGR. ALPHEO JOSE BOLOTAOLO

(ENGINEER II) (ENGINEER II)

Recommending Approved : ENGR. ROLANDO A. EBAD

(ENGINEER III)
 Republic of the Philippines
OFFICE OF THE BUILDING OFFICIAL
City of Davao
i
Date:

The Resident Manager

Davao Light & Power Company
Davao City

Sir/Maam:

pursuant to the provision of pD IO96 othen^/ise known as the National Building

Code of th'e Philippines and its Ancillary, the Electrical Code of the Philippines, you are
hereby authorized to supply kilowatt-hour meter and service connection/s to Mr./Mrs.

(Given Name) (Middle Name) (Family Name)

a resident of
after they had been issued Bullding and Electrical Permit, as well as its Cerificate of
Final 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 Code
of the Philippines and its lmplementing Rules and Regulations.

Your favorable action on this matter is highly appreciated.

Very truly yours,

LONGITUDE :
C-|n-
ENGR: CIRINIA GRACE I CATUBIG

LATITUDE

Alpha Numeric

Date Issued
 Republic of the Philippines
OFFICE OF THE BuILDING OFFICIAL
City 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 HIGHWAYS
OFFICE 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) ON
w'" "E APPROVED P.ANSTfro-A'NTbuEFrLEU"wITii-,:"ADL TAN"I.S#AEc.::A.EANFcOEU"w:,:0#E'=,EEC.T'RNre,A,CCcO.R5:AN.i
THE PHluPPINES_

III
RESII)ENTIAL OW£LLING
B|lSINESS MERCMl"LE
ASSEMBLY OCCUPANT |OAD loop OR MORE
RESIDENTIAL HOTEL APMTMENT
INl)USTRIAL
ACCESSORY
EO|lCAT]ON ANI) RECREATION

I
STORAGE AND HAZARDOUS
O"ERS (specify)
INSTrrUTIONAL
ASSEMBLY O"ER "AN GROUP I

START OF INSTAuJ\TION
DATE OF COMPlnlON

|||||||||- _
OUTLET/S DEVICES / EQUIPMENT
NUMBER OF OUTLETS:LIGHT spa, cooKING IJNIT

TOGGLE SWITCH fE OEl.ECTORS

CONVINIENCunECEPTACLE spa_ WATER llEATER

BEL|SrouzzER o"ERS (see attached llst)
I
Spa. AIRCON spa. WATER PuMP
PUSH BUTTONS

I |= |||IL`|lL`r|.I,I.rdr|l.Il|[+ I I
I I PROFESSIONAL El-ECTRICA| ENGINEER I I REGISTERED hMSTER ELEC"lCIAN(Notexceeding600volesa600KVA)
I I REGISTERED ELECTRICAL ENGINEER

NAMESIGNATURE
PRC BEG. NO.

VALIDITY

ADDRESS

PTR NO_
DATE rsSUED PLACE ISSUED

CTC NO.
DATE ISSUED TIN

ELECTRICAL CONTRACTOR ZOO-AMl)ERE MAIN AND ABOVE

PCAB UC. NO. (SPEaFICAL|Y - ELEmlCA|)
VALIDITY

TEL/I:AI NO.

( ]TEMroRARY ( 1NEW I I REMODEL/A|TERATION

I lOPENWIRlllG I lcoNOUITS
I ]CABLE [ ]AIWOREDCABLE I ]RACEWAYS

I ]0"ERS

lNseECTEO eY :

ENGR. CIRINIA GRACE L CATuBIG

ELECTRICAL INSPEerOR CHIEF, ELECTRICAL SEenON OfffcerJn-Charge
(sq!nature over "nted Name) (signature Over Prlnted Name) (signatIJre Over mnted Name)

PRC RES_ NO. VALJOITY PRC REG. NO_ VouOm/

AMOUNT PAID P a.R. NO. DATE