NBC FORM No.

E-04
CERTIFICATE OF ELECTRICAL INSPECTION
FOR TEMPORARY POWER CONNECTION Republic of the Philippines
MIMAROPA REGION
MUNICIPALITY OF RIZAL
___________________________________________________________________
PROVINCE OF OCCIDENTAL MINDORO
Name of Owner/Applicant/Lessee OFFICE OF THE BUILDING OFFICIAL

___________________________________________________________________ CERTIFICATE OF ELECTRICAL INSPECTION

Located At/Along
FOR TEMPORARY POWER CONNECTION
_____________________________ _______________________
Use or character of occupancy Group CEIFTPC No. ________________________
Fee Paid _____________________________
A certificate was submitted by _______________________________________________ Official Receipt No. ___________________
A duly licensed : ( ) professional electrical engineer ( ) registered electrical engineer
Date Paid ____________________________
( ) registered master electrician hired by the owner who undertook the electrical inspection
and that the installation is in order.
PRC license no. _____________ issued on: _____________ with validity ____________ _________________________________
Date Issued
Verified and Complied as to the following: This Certificate of Electrical Inspection for Temporary Power Connection is issued/granted
Total Connected Load___________________________________ KVA pursuant to pertinent provisions of the latest Philippine Electrical Code, the National Building Code and
Total Transformer Capacity_______________________________ KVA its Implementing Rules and Regulations for:
Total Generator/UPS Capacity_____________________________KVA [ ] Construction Purposes [ ] Testing Purposes
Others (Specify): _________________________________________________________ [ ] Others (Specify) _________
_______________________________________________________________________
for a period of [ ] Days from date ________________________________ after which the service
_______________________________________________________________________
shall be considered illegal, unless actually extended or renewed before the expiry date.
The above described electrical installation covered by Electrical Permit No. _________________ issued
on _________________________has been found substantially Name of Owner/Lessee ____________________________________________
satisfactory complied, therefore, the “Certificate of Electrical Inspection for Temporary Name of Project __________________________________________________
Power Connection” is hereby recommended for issuance
Use or Character of Occupancy _________________ Group _______________
Located at/,Along ________________________________________________

The Owner/Applicant shall be liable for any damages to property and injury or loss of life in
connection with an illegal installation and/or whenever changes/alterations/upgrading or deviating in the
ELECTRICAL INSPECTOR CHIEF, ELECTRICAL SECTION electrical installation have rendered unsafe.
Date:____________________ Date: ____________________

PRC. Reg. No. Validity PRC. Reg. No. Validity

____________________________________
BUILDING OFFICIAL
Date: _____________________
Chief, Processing and Enforcement Division
Date: _________________________