Republic of the Philippines

OFFICE OF THE BUILDING OFFICIAL

City of Davao
i
Date:

The Resident Manager

Davao Light & Power Company
Davao City

Sir/Maam:

pursuant to the provision of pD IO96 othen^/ise known as the National Building

Code of th'e Philippines and its Ancillary, the Electrical Code of the Philippines, you are
hereby authorized to supply kilowatt-hour meter and service connection/s to Mr./Mrs.

(Given Name) (Middle Name) (Family Name)

a resident of
after they had been issued Bullding and Electrical Permit, as well as its Cerificate of
Final Inspection and Occupancy of his/her building located at,

(House /BIdg/Purok No.) (Street Name) (Barangay)

this city, his/her ElectrI.Gal Installation is found to be in accordance with the Electrical Code
of the Philippines and its lmplementing Rules and Regulations.

Your favorable action on this matter is highly appreciated.

Very truly yours,

ARCH. KHASHAYAR L. TOGHYANI

__________________________________

C-|n-
Officer-in-Charge
LONGITUDE : ENGR: CIRINIA GRACE I CATUBIG

LATITUDE

Alpha Numeric
 REPUBLIC OF THE PHILIPPINES
OFFICE OF THE BUILDING OFFICIAL
CITY GOVERNMENT OF DAVAO

Application No. Date Received

Name of Applicant :
Project Location :
Contact Person :
Tel/Contact No. :

CHECKLIST OF REQUIREMENTS
SEPARATION OF METER

Electrical Form
Photocopy of owner’s valid ID with three (3) specimen signature
Davao Light Bill or Statement of Account
Sketch (GOOGLE MAP)
Photo of the structure (GEO TAG - COLORED)
Authorization Letter if the Applicant is not the DLPC owner (NOTARIZED)

Remarks by Electrical Inspector :

Name of Inspector :
(signature over printed name)

Date of Inspection :

Reviewed by : ENGR. DINDO C. CORDA, EnP

(ENGINEER II)

Recommending Approved : ENGR. ALPHEO JOSE BOLOTAOLO

(ENGINEER II)
 DPWH FORM NO. 96-001-E
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL

DISTRICT/CITY/MUNICIPALITY
AREA CODE._________

APPLICATION NO. DATE FILED

Date of Proposed start of Installation Expected Date of Completion

APPLICATION FOR ELECTRICAL PERMIT

( Accomplished in print and in Duplicate)

BOX 1 ( TO BE ACCOMPLISHED BY DULY QUALIFIED ELECTRICAL PRACTITIONER)

NAME OF LAST NAME FIRST NAME MIDDLE NAME TIN
OWNER/APPLICANT
NO. STREET BARANGAY CITY/MUNICIPALITY TEL./FAX NO.
ADDRESS

LOCATION OF NO. STREET BARANGAY CITY/MUNICIPALITY

INSTALLATION
SCOPE OF WORK
( ) NEW INSTALLATION ( ) ADDITION OF __________ ( ) OTHERS (Specify)
( ) ANNUAL INSPECTION ( ) REPAIR OF _____________
( ) REMOVAL _____________
TYPE OF OCCUPANCY OR USE:
( ) A. RESIDENTIAL DWELLING ( )
E. BUSINESS & MERCANTILE ( ) I. ASSEMBLY OCCUPANT LOAD 100 OR MORE
( ) B. RESIDENTIAL HOTEL APARTMENT ( )
F. INDUSTRIAL ( ) J. ACCESSORY
( ) C. EDUCATION AND RECREATION ( )
G. STORAGE & HAZARDOUS ( ) K. OTHERS (Specify)
( ) D. INSTITUTIONAL ( )
H. ASSEMBLY OTHER THAN GROUP I
NUMBER OF OUTLETS NUMBER OF EQUIPMENT/WIRING DEVICES
LIGHT SPO COOKING UNIT TOGGLE SWITCH FIRE ALARM/SMOKE DETECTORS
CONVINIENCE/RECEPTACLE SPO. COOKING HEATER BELLS BUZZER OTHERS (See attached List)
SPO. AIRCON SPO WATER PUMP PUSH BOTTON

BOX 2 ( PROFESSIONAL ELECTRICAL ENGINEER WHO SIGNED AND SEALED THE PLANS & SPECIFICATION)
NAME PRC REG. NO. VALIDITY
ADDRESS TEL/FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE ISSUED TIN
BOX 3 ( ELECTRICAL CONTRACTOR 200-AMPERE MAIN AND ABOVE
NAME PCAB LIC. NO. (SPECIALTY - ELECTRICAL)
VALIDITY
ADDRESS TEL./FAX NO.
BOX 4 (PERSON IN-CHARGE OF INSTALLATION)
( ) PROFESIONAL ENGINEER ( ) REGISTERED ELECTRICAL ENGINEER ( ) REGISTERED MASTER ELECTRICIAN
(not exceeding 600 volts and 500 KVA)
NAME PRC REG. NO. VALIDITY
ADDRESS TEL/FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE ISSUED TIN
BOX 5 (OWNER/AUTHORIZED REPRESENTATIVE)
NAME SIGNATURE TIN CTC NO.
DATE ISSUED
PLACE ISSUED
BOX 6 ( TO BE RECEIVED BY RECEIVING/RECORDING SECTION)
RECEIVED BY:

ELECTRICAL PLANS & SPECIFICATIONS (5 SETS)

Signature over printed Name
DATE RECEIVED:
 DPWH FORM NO. 96-002-E
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL

DISTRICT/CITY/MUNICIPALITY
AREA CODE._________

PERMIT NO. APPLICATION NO.

DATE ISSUED : DATE FILED :

PAID UNDER O.R. NO. :
AMOUNT :
DATE ISSUED :
ELECTRICAL PERMIT
(To be accomplished by the Office Concerned)
BOX 1
NAME OF OWNER/APPLICANT LAST NAME FIRST NAME MIDDLE NAME TIN

ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY TEL/FAX NO.

LOCATION OF INSTALLATION NO. STREET BARANGAY CITY/MUNICIPALITY

BOX 2
ASSESSMENT
AMOUNT DUE ASSESSED BY O.R. NUMBER DATE PAID

REVIEWED BY

CHIEF OF PROCESSING DIV.SEC.

BOX 3
PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING, DEVICES AND EQUIPMENT ENUMERATED IN THIS
APPLICATION SUBJECT TO THE FOLLOWING CONDITIONS :
1 THAT THE PROPOSED INSTALLATION BE IN ACCORDANCE WITH THE APPROVED PLANS FILED WITH THIS OFFICE AND IN
CONFORMITY WITH THE PROVISIONS OF THE LATEST EDITION OF THE PHILIPPINE ELECTRICAL CODE.
2 THAT A DULY LICENSED ELECTRICAL PRACTITIONER BE INCHARGE OF THE INSTALLATION/CONSTRUCTION
3 THAT CERTIFICATE OF COMPLETION DULY SINGED BY THE ELECTRICAL PRACTITIONER INCHARGE OF THE INSTALLATION
BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER COMPLETION OF THE INSTALLATION.
4 THAT A CERTIFICATE OF FINAL ELECTRICAL INSPECTION BE OCCURRED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING
5 THIS PERMIT SHALL BE POSTED AT THE DOOR OR SITE OF WORK.

APPROVED :

ELECTRICAL ENGINEER OF THE BUILDING OFFICE DATE

(Signature over printed name)

PRC REG. NO. AND VALIDITY

NOTED :

ARCH. KHASHAYAR L. TOGHYANI DATE

OFFICER-IN-CHARGE
loymi_lapuz_2000
Note 1: This permit maybe cancelled or revoked pursuant to Section 305-306 of the National Buildind Code.
Note 2 : Alteration on this form are not allwed
 Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL

DISTRICT/CITY/MUNICIPALITY
AREA CODE._________

PERMIT FOR TEMPORARY SERVICE CONNECTION

PAID UNDER O.R. NO. : Permit No.
AMOUNT :
DATE ISSUED : Date

BOX 1
NAME OF OWNER/APPLICANT LAST NAME FIRST NAME MIDDLE NAME TIN

ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY TEL/FAX NO.

LOCATION OF INSTALLATION NO. STREET BARANGAY CITY/MUNICIPALITY

BOX 2
PURPOSE:

CONSTRUCTION LIGHTING & POWER CEMETERY LIGHTING & POWER CARNIVALFIESTA LIGHTING & POWER

CHRISTMAS DECORATIVE LIGHTING OTHERS (Specify)

BOX 3
NUMBER OF OUTLETS : LIGHTS SWITCHES
OTHERS :

BOX 4
PERSON IN-CHARGE OF INSTALLATION
PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN
(not exceeding 600 Volts & 500 KVA)

NAME PRC REG. NO. VALIDITY

ADDRESS TEL/FAX NO.

PTR NO. DATE ISSUED PLACE ISSUED

SIGNATURE DATE ISSUED TIN

BOX 5
OWNER/APPLICANT
NAME SIGNATURE TIN CTC NO.

DATE ISSUED
PLACE ISSUED

BOX 6
PERMIT IS HEREBY GRANTED TO CONNECT TEMPORARY ELECTRICAL INSTALLATION WITH THE AUTHORIZED LOAD SPECIFIED
ABOVE LOCATED AT FOR A PERIOD OF
DAYS FROM DATE
AFTER WHICH PERIOD THE SERVICE SHALL BE DISCONNECTED.

THIS PERMIT SHALL BE SUSPENDED OR REVOKED ANY TIME BEFORE ITS EXPIRATION WHENEVER ALTERATIONS ORCHANGES
IN THE ELECTRICAL WIRING SYSTEM HAVE RENDERED IT UNSAFE.

RECOMMENDING APPROVAL : APPROVED :

ARCH. KHASHAYAR L. TOGHYANI

ELECTRICAL ENGINEER OF THE BUILDING OFFICIAL OFFICER IN-CHARGE

PRC REG. NO. AND VALIDITY PRC REG. NO. AND VALIDITY

loymi_lapuz_2000
 Republic of the Philippines
OFFICE OF THE BuILDING OFFICIAL
City of Davao
(ELECTRICAL DIVISION)

REQUEST FOR INSPECTION

DATE :

NAME OF APPLICANT :

ADDRESS :

LOCATION OF INSTALLATION:

TOTAL NuMBER OF OUTLETS AND EQUIPMENT INSTALLED

LIGHTS: SWITCHES: CONVINIENCE OUTLET: MAIN SWITCH :

BELL SYSTEM: ELECTRIC RANGE: K.W... WATER HEATER: K.W. :

AIRCONDITIONING SYSTEM: H.P.: TELEPHONE: MOTORS: H.P.:

OTHERS (SPECIFY):

NATURE OF WORKS:

P.E.E/R.E.E/R.M.I.

OWNER/APPLICANT SIGNATURE PRC BEG_#

P.T.R.#
RES.CERT.#
ISSUED AT:
DATE ISSUED:
T.I.N.#

INSPECTION REPORT

REMARKS:

INSPECTOR DATE :

TIME :
 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF PUBLIC WORKS AND HIGHWAY
OFFICE OF THE CITY BUILDING OFFICIAL
Davao City

CERTIFICATE OF FINAL ELECTRICAL INSPECTION/COMPLETION

THIS IS TO CERTIFY THAT FINAL INSPECTION OF THE ELECTRICAL INSTALLATION HAS 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 LAST NAME FIRST NAME MIDDLE NAME

ADDRESS NO., STREET BARANGAY CITY/MUNICIPALITY

LOCATION OF INSTALLATION NO., STREET BARANGAY

CITY/MUNICIPALITY
TYPE OF OCCUPANCY OR USE:
A. RESIDENTIAL DWELLING E. BUSINESS & MERCHANTILE I.ASSEMBLY LOAD
B. RESIDENTIAL, HOTEL, APARTMENT F. INDUSTRIAL 1000 OR MORE
C. EDUCATION & RECREATION G. STORAGE & HAZARDOUS J. ACCESSORY
D. INSTITUTIONAL H. ASSEMBLY OTHER THAN GROUP I K. OTHERS (SPECIFY) ____________

START OF INSTALLATION _____________________________________ DATE OF COMPLETION ____________________________________

OUTLETS/DEVICES/EQUIPMENT

NUMBER OF OUTLETS: NUMBER OF EQUIPMENT/WIRING DEVICES:

____ LIGHT ____ SPO, COOKING UNIT ____ TOGGLE SWITCH ____ FA DETECTORS
____ CONVENIENCE/RECEPTACLE ____ SPO, WATER HEATER ____ BELLS/BUZZERS ____ OTHERS (See Attached List)
____ SPO, AIRCON ____ SPO, WATER PUMP ____ PUSH BUTTON ________________________

PERSON IN-CHARGE OF INSTALLATION

REGISTERED MASTER ELECTRICIAN
PROFESIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER
Not Exceeding 600 Volts & 500 kVA

NAME
PRC REG. NO. _______________________
SIGNATURE VALIDITY __________________________

ADDRESS

PTR. NO. DATE ISSUED PLACE ISSUED

CTC NO. DATE ISSUED TIN

ELECTRICAL CONTRACTOR (200-AMPERE MAIN AND ABOVE

NAME PCAB LIC. NO. (SPECIALTY ELECTRICAL)

VALIDITY

ADDRESS TEL/FAX NO.

TYPE OF INSTALLATION:
TEMPORARY NEW REMODEL/ALTERATION

TYPE/S OF WIRING:
OPEN WIRING CONDUITS CABLE ARMORED CABLE RACEWAYS
OTHERS ___________________________________________________________________________________________________

INSPECTED BY: RECOMMENDING APPROVAL: APPROVED BY:

__________________________________________
ELECTRICAL INSPECTOR
(Signature Over Printed Name)
_____________________________________
CHIEF, ELECTRICAL SECTION
ARCH. KHASHAYAR L. TOGHYANI
__________________________________
(Signature Over Printed Name) Officer-in-Charge

__________________________________________ _____________________________________
PRC REG. NO. & VALIDITY PRC REG. NO. & VALIDITY

AMOUNT PAID P __________________________ O. R NO. __________________________ DATE __________________________