NBC FORM NO.
A-03
Republic of the Philippines
Municipality of Masantol
Province of Pampanga
OFFICE OF THE BUILDING OFFICIAL
ELECTRICAL PERMIT
Application No. EP No. Building Permit No.
BOX 1 (To be Accomplished in print by the Owner/applicant)
Owner/Applicant Last Name First Name M.I. TIN
For Construction Owned Form of Ownership Use or Character of Occupancy
By an Enterprise
Address No. Street Brgy. City/Municipality ZIP Code Tel. No.
Location of Construction: Lot No.__________ Blk. No.___________ TCT No._____________ TAX Dec. No.___________
Street________________________ Brgy.____________________________ City/Municipality of __________________________
SCOPE OF WORK
New Installation Reconnection of Service Entrance Relocation of Service Entrance
Annual Inspection Separation of Service Entrance Others (Specify) __________________________
Temporary Remodeling of Service Entrance ____________________________________________
SUMMARY OF ELECTRICAL LOAD / CAPACITIES APPLIED FOR
TOTAL CONNECTED LOAD TOTAL TRANSFORMER CAPACITY TOTAL GENERATOR/UPS LOAD
___________________kVA ___________________kVA ___________________kVA
BOX 2 (To be Accomplished in print by the Design Professional)
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
Address:
__________________________Date____________ PRC No. Validity:
Professional Electrical Engineer PTR No. Date Issued:
(Signed and Sealed Over Printed Name) Issued At: TIN:
BOX 3
SUPERVISOR / IN-CHARGE OF ELECTRICALWORKS
Professional Electrical Engineer Registered Electrical Engineer Registered Master Electrician
___________________________________________Date___________________
(Signed and Sealed Over Printed Name)
PRC. No. Validity
PTRB. No. Date Issued
Issued At TIN
Address
BOX 4 BOX 5
Building Owner With My Consent: Lot Owner
_________________________________Date_______________ _______________________________Date_____________
(Signature Over Printed Name) (Signature Over Printed Name)
Address: Address:
C.T.C. No. Date Issued: Place Issued: C.T.C. No. Date Issued: Place Issued:
TO BE ACCOMLISHED BY THE PROCESSING & EVALUATION
BOX 6
Received By: Date:
FIVE (5) SETS OF ELECTRICAL DOCUMENTS
Electrical Plans and Specifications Expected Date of Completion/Installation/Construction
Special Fixture and Equipment _________________________________________
Proposed Starting Date of Installation/Construction Others
(Specify)___________________________________
_________________________________________________
BOX 7
PROGRESS FLOW
IN OUT PROCESSED BY
Date Time Date Time
Electrical ___________________________________________
ELECTRICAL ENGINEER
Others (Specify) (Signature Over Printed Name)
PRC Reg. No.__________________
Validity_______________________
BOX 8
ACTION TAKEN
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed electrical works shall be in accordance with the electrical plans filed with this Office and in conformity
with the provisions of the latest Philippine Electrical Code, the National Building Co9de and its IRR.
2. That prior to any electrical installation, the owner/permittee shall submit a duly accomplished prescribed “Notice of
Construction” to the Office of the Building Official.
3. That for installed electrical capacity of 200 amperes and above at 230 volts nominal and above, a specialty electrical
contractor duly license to the Philippine Contractors Accreditation Board (PCAB) shall be required.
4. That a duly license electrical practitioner shall be in charge of the installation, and that upon completion of the electrical
works, he shall submit the entry of the logbook duly signed and sealed to the OBO including as-built plans and other
documents. He shall also accomplish the Certificate of Completion stating that the electrical works conform to the
provisions of the Philippine Electrical Codes, the National Building Code and its IRR.
5. That this permit is Null and Void unless accompanied by the building permit except for projects involving purely electrical
works in which case only the building permit number of the existing building/structure shall be required.
6. That a Certificate of Final Electrical Inspection (CFEI) shall be secured prior to the actual occupancy of the building.
7. That this permit shall be posted at the door or site of work.
PERMIT ISSUED BY:
ENGR. GARRY N. VIRAY
BUILDING OFFICIAL
(Signature Over Printed Name)
Date__________________________________
