Republic of the Philippines Department of Public Works and Highways Office of the Local Building Official Quezon City

ELECTRICAL DIVISION
DPWH FORM NO. 96-006-E W.P. NO. _______________________________ Date: _______________________________ C.E.I.___________________________________ Date: ___________________________________

CERTIFICATE OF FINAL ELECTRICAL INSPECTION/COMPLETION

This is to certify the final inspection of the Electrical Installation had been conducted on the Building and/or premises covered by Building Permit No. ____________issued on______________ and the same were found completed in accordance with the approved plans and specifications on file with the office of the Building Official and in accordance with Philippine Electrical Code Provisions.
Name of owner/Applicant: Address: Location of Installation: Type of Occupancy or Use: A. Residential Dwelling B. Residential, Hotel, Apartment C. Education & Recreation D. Institutional E. Business & Merchantile F. Industrial G. Storage & Hazardous H. Assembly other than Group DATE OF COMPLETION______________________________ I. Assembly Occupant Load 100o or more J. Accessory K. Others (specify) ___________________ Last Name No. No. Street Street First Name: Barangay Barangay Middle City/Municipality City/Municipality

START OF INSTALLATION________________________________

OUTLETS/DEVICES EQUIPMENT NUMBER OF OUTLETS:

LIGHT CONVENIENCE/RECEPTACLE SPO. AIRCON SPO. COOKING UNIT SPO. WATER HEATER SPO. WATER PUMP

NUMBER OF EQUIPMENT/WIRING DEVICES

TOGGLE SWITCH BELLS, BUZZER PUSH BUTTON FA DETECTORS OTHERS(SEE ATTACHED LIST)

PERSON IN-CHARGE OF INSTALLATION

PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN (Not Exceeding 600 Volts & 500 KVA)

NAME: SIGNATURE: ADDRESS: PTR NO. CTC NO. ELECTRICAL CONTRACTOR (200 AMPERE MAIN AND ABOVE) NAME: ADDRESS: TYPE OF INSTALLATION:
TEMPORARY NEW REMODEL/ALTERATION

www.quezoncity.gov.ph OFFICE OF THE BUILDING OFFICIAL

PCAB LIC. NO. VALIDITY: (SPECIAL ELECTRICAL) TEL/FAX NO.

TYPE OF WIRING:
OPEN WIRING CONDUIT CABLE ARMORED CABLE RACEWAYS OTHERS:____________________________________________________________________________________________________________

INSPECTED:

APPROVED:

NOTED:

ELECTRICAL INSPECTOR (Signature Over Printed Name)

ENGR. RODEL A. MESA HEAD ELECTRICAL DIVISION (Signature Over Printed Name) R.E.E. 1314 PRC REG. NO. & VALIDITY O.R. NO. ________________________

ENGR. ISAGANI R. VERZOSA JR. LOCAL BUILDING OFFICIAL (Signature Over Printed Name)

PRC REG. NO. & VALIDITY AMOUNT PAID___________________

DATE: ___________________________