Republic of the Philippines

CITY OF SANTA ROSA

Province of Laguna

OFFICE OF THE BUILDING OFFICIAL

APPLICATION NO. PERMIT NO.

ELECTRICAL PERMIT
DATE OF APPLICATION DATE ISSUED

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)

NAME OF THE OWNER/APPLICANT LAST NAME 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 REMOVAL OF 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
BELL SYSTEM ELECTRIC RANGE K.W. WATER HEATER K.W.
AIRCONDITIONING SYSTEM TELEPHONE MOTORS
OTHERS (SPECIFY)

DATE PROPOSED ESTIMATED COST OF

START OF CONSTRUCTION: ELECTRICAL INSTALLATION:

EXPECTED DATE TOTAL CONNECTED LOAD: KVA

OF COMPLETION:

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

ELECTRICAL DOCUMENTS FIVE (5) SETS EACH

ELECTRICAL PLAN & SPECIFICATIONS BILL OF MATERIALS

COST ESTIMATE OTHERS (SPECIFY)

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

BOX 3 (PERSON WHO SIGNED AND SEALED PLANS & SPECIFICATION) BOX 4 (PERSON-IN-CHARGE OF THE INSTALLATIONS)

PROFESSIONAL PRC. REG. NO. PEE/ELECTRICAL ENGINEER/ PRC. REG. NO.

ELECTRICAL ENGINEER MASTER ELECTRICIAN

PRINT NAME: VALIDITY PRINT NAME: VALIDITY

ADDRESS: ADDRESS:

P.T.R NO.: DATE ISSUED: PLACE ISSUED: P.T.R. NO.: DATE ISSUED: PLACE ISSUED:

SIGNATURE: TIN: SIGNATURE: TIN:

SIGNATURE (OWNER): TIN RES. CERT. NO. DATE ISSUED PLACE ISSUED
BOX 5 (TO BE ACCOMPLISHED BY PROFESSIONAL ELECTRICAL ENGINEER/MASTER ELECTRICIAN IN PRINT)
NAME OF OWNER/APPLICANT: LAST NAME FIRST NAME M.I. TAX ACCT. 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
NOTED: IN OUT ACTION/REMARK PROCESS BY
CHIEF PROCESSING DIVISION/SECTION TIME DATE TIME DATE
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 SUBJECT TO INSTALL THE ELECTRICAL WIRING AND ISSUED:
EQUIPMENT ENUMERATED HEREIN SUBJECT TO THE FOLLOWING CONDITIONS

1. THAT THE PROPOSED INSTALLATION SHALL BE IN ACCORDANCE WITH THE

APPROVED PLANS FILED WITH THIS OFFICE AND IN CONFORMITY WITH THE
NATIONAL BUILDING CODE. DATE

2. THAT A DULY LICENSED ELECTRICAL ENGINEER/MASTER ELECTRICIAN BE

ENGAGED TO UNDERTAKE THE INSTALLATION/CONSTRUCTION.
3. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY A ELECTRICAL ENGINEER/
MASTER ELECTRICIAN INCHARGE OF INSTALLATION SHALL BE SUBMITTED NOT
LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.
Engr. Myles H. Funtila
4. THAT A CERTIFICATE OF FINAL INSPECTION AND A CERTIFICATE OF OCCUPANCY BUILDING OFFICIAL
BE SECURED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING.

NOTE:
THIS PERMIT MAY BE CANCELLED OR REVOKED PURSUANT TO SECTION 305 AND 306 OF THE “NATIONAL BUILDING CODE “
 Republic of the Philippines
CITY OF SANTA ROSA
Province of Laguna

OFFICE OF THE BUILDING OFFICIAL

APPLICATION NO. PERMIT NO.

ELECTRICAL PERMIT
DATE OF APPLICATION DATE ISSUED

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)

NAME OF THE OWNER/APPLICANT LAST NAME 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 REMOVAL OF 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
BELL SYSTEM ELECTRIC RANGE K.W. WATER HEATER K.W.
AIRCONDITIONING SYSTEM TELEPHONE MOTORS
OTHERS (SPECIFY)

DATE PROPOSED ESTIMATED COST OF

START OF CONSTRUCTION: ELECTRICAL INSTALLATION:

EXPECTED DATE TOTAL CONNECTED LOAD: KVA

OF COMPLETION:

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

ELECTRICAL DOCUMENTS FIVE (5) SETS EACH

ELECTRICAL PLAN & SPECIFICATIONS BILL OF MATERIALS

COST ESTIMATE OTHERS (SPECIFY)

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

BOX 3 (PERSON WHO SIGNED AND SEALED PLANS & SPECIFICATION) BOX 4 (PERSON-IN-CHARGE OF THE INSTALLATIONS)

PROFESSIONAL PRC. REG. NO. PEE/ELECTRICAL ENGINEER/ PRC. REG. NO.

ELECTRICAL ENGINEER MASTER ELECTRICIAN

PRINT NAME: VALIDITY PRINT NAME: VALIDITY

ADDRESS: ADDRESS:

P.T.R NO.: DATE ISSUED: PLACE ISSUED: P.T.R. NO.: DATE ISSUED: PLACE ISSUED:

SIGNATURE: TIN: SIGNATURE: TIN:

SIGNATURE (OWNER): TIN RES. CERT. NO. DATE ISSUED PLACE ISSUED

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

 NAME OF OWNER/APPLICANT: LAST NAME FIRST NAME M.I. TAX ACCT. 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
NOTED: IN OUT ACTION/REMARK PROCESS BY
CHIEF PROCESSING DIVISION/SECTION TIME DATE TIME DATE
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 SUBJECT TO INSTALL THE ELECTRICAL WIRING AND ISSUED:
EQUIPMENT ENUMERATED HEREIN SUBJECT TO THE FOLLOWING CONDITIONS

5. THAT THE PROPOSED INSTALLATION SHALL BE IN ACCORDANCE WITH THE

APPROVED PLANS FILED WITH THIS OFFICE AND IN CONFORMITY WITH THE
NATIONAL BUILDING CODE. DATE

6. THAT A DULY LICENSED ELECTRICAL ENGINEER/MASTER ELECTRICIAN BE

ENGAGED TO UNDERTAKE THE INSTALLATION/CONSTRUCTION.
7. THAT A CERTIFICATE OF COMPLETION DULY SIGNED BY A ELECTRICAL ENGINEER/
MASTER ELECTRICIAN INCHARGE OF INSTALLATION SHALL BE SUBMITTED NOT
LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.
Engr. Myles H. Funtila
8. THAT A CERTIFICATE OF FINAL INSPECTION AND A CERTIFICATE OF OCCUPANCY BUILDING OFFICIAL
BE SECURED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING.

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