NUMBER OF STORIES :

ESTIMATED COST :
ACTUAL COST
A MATERIAL (TOTAL COST) Php
1 ELECTRICAL WIRES
2 LIGHTING OUTLETS
3 CONVENIENCE OUTLETS
4 SWITCHES
5 OTHERS (Specify)
B OTHER COST
This includes Professional Fees, Permits and other Fees.
1. LOADS TO BE CONNECTED

LIGHTS SPO COOKING UNIT TOGGLE SWITCH T A DETECTOR

CONVENIENCE/RECEPTACLE SPO WATER HEATER BELL BUZZERS OTHERS (Specify)

SPO AIRCON SPO WATER PUMP PUSH BUTTONS

2. NATURE OF WORKS
3. TYPE OF SERVICE
VOLTAGE : SIZE OF WIRE :
4. REMARKS:

I HEREBY CERTIFY THAT THE ABOVE DATE AND INFORMATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER

(Not Exceeding 600 Volts and 500kVA)
NAME : PRC REG. NO. :
ADDRESS : VALIDITY :
PTR NO. : DATE ISSUED : TEL./FAX NO. :
SIGNATURE : DATE SIGNED : PLACE ISSUED :
TIN :
ELECTRICAL FEES: COMPUTED BY:
FEE : P CTC NO. :
SURCHARGE : P DATE ISSUED :
TOTAL : P (Signature over Printed Name) PLACE ISSUED :
LOADS

NATURE OF WORKS:
INSPECTOR : CONTRACTOR :

FEE : P
(Signature over Printed Name) (Signature over Printed Name)

PAID UNDER O.R. NO. : P OWNER/OCCUPANT :

DATE : - -
(Signature over Printed Name)
RECOMMENDING APPROVAL : APPROVED BY :

CARMELO M. VALENZUELA JR.

ELECTRICAL ENGINEER OF THE BUILDING OFFICE BUILDING OFFICIAL
(Signature over Printed Name) (Signature over Printed Name)

PRC REG. NO. : VALIDITY : - - DATE : - -

NOTE : RENEWALS EXTENSION OF THIS PERMIT AND/OR FINAL CERTIFICATION OF THE ELECTRICAL INSTALLATION ARE SUBJECT TO INSPECTION
AND PAYMENT OF CORRESPONDING FEES IN CONFORMITY WITH PERTINENT PROVISIONS OF THE "NATIONAL BUILDING CODE" (P.D.
1096) AND ITS IMPLEMENTING RULES AND REGULATIONS.