pRepublic of the Philippines
Department of Public Works and Highways
OFFICE OF THE BUILDING OFFICIAL
Municipality of Santa Barbara
AREA CODE: 06065
A P P L I C A T I O N N O. P E R M I T N O.
APPLICATION FOR ELECTRICAL PERMIT
(ACCOMPLISH IN PRINT AND IN DUPLICATE)
_________________________________________________ _________________________________________________
DATE OF PROPOSED START OF INSTALLATION EXPECTED DATE OF COMPLETION
BOX 1 (TO BE ACCOMPLISHED BY THE DULY QUALIFIED ELECTRICAL PRACTITIONER)
NAME OF THE OWNER / APPLICANT LAST NAME, FIRST NAME, MIDDLE NAME TAX ACCOUNT NO.
ADDRESS NO., STREET, BARANGAY, CITY / MUNICIPALITY TELEPHONE NO.
LOCATION OF INSTALLATION NO., STREET, BARANGAY, CITY / MUNICIPALITY TELEPHONE NO.
SCOPE OF WORKS: [ ] RENOVATION OF ____________________ OTHERS SPECIFY:
[ ] NEW INSTALLATION [ ] REPAIR OF _________________________ _________________________________________
[ ] ANNUAL INSPECTION [ ] DEMOLITION OF _____________________ _________________________________________
USE OR TYPE OF OCCUPANCY:
[ ] RESIDENTIAL [ ] INDUSTRIAL [ ] SPECIAL BUILDINGS [ ] OTHERS SPECIFY
[ ] COMMERCIAL [ ] THEATERS [ ] HOSPITALS ____________________________
[ ] INDUSTRIAL [ ] SHOPPING MALLS [ ] WAREHOUSES ____________________________
[ ] OFFICE BUILDING [ ] ASSEMBLY HALLS [ ] TOWNHOUSES ____________________________
NUMBER OF OUTLETS:
_____ LIGHT _____ SPO, AIRCON _____ TOGGLE SWITCH _____ OTHER (SEE ATTACHED LIST)
_____ CONVENIENCE/RECEPTACLE _____ SPO, COOKING UNIT _____ BELLS/BUZZERS ______________________________
_____ TEL/TV/COMPUTER _____ SPO, WATER HEATER _____ PUSH BUTTONS ______________________________
_____ SIGNALING SYSTEM _____ SPO, WATER PUMP _____ FA DETECTORS
BOX 2 (PROFESSIONAL ELECTRICAL ENGINEER WHO SIGNED AND SEALED PLANS & SPECIFICATIONS)
______________________________________________________________________________ _____________________________________________________
NAME P.R.C. REG. NO.
______________________________________________________________________________ _____________________________________________________
ADDRESS TELEPHONR / FAX NO.
______________________________________________________________________________ _____________________________________________________
P.T.R. DATE ISSUED PLACE ISSUED
______________________________________________________________________________ _____________________________________________________
SIGNATURE DATE ISSUED T.I.N.
BOX 3 (ELECTRICAL CONTRACTOR – IF APPLICABLE)
______________________________________________________________________________ _____________________________________________________
NAME PCAB LICENSE NO. VALIDITY
______________________________________________________________________________ _____________________________________________________
ADDRESS TELEPHONE / FAX.NO
BOX 4 (PERSON INCHARGE FOR INSTALLATION)
[ ] PROFESSIONAL ELECTRICAL ENGINEER [ ] REGISTERED ELECTRICAL ENGINEER [ ] REGISTERED MASTER ELECTRICIAN
(Not exceeding 600 Volts & 500 KVA)
______________________________________________________________________________ _____________________________________________________
NAME P.R.C. REG. NO.
______________________________________________________________________________ _____________________________________________________
ADDRESS TELEPHONR / FAX NO.
______________________________________________________________________________ _____________________________________________________
P.T.R. DATE ISSUED PLACE ISSUED
______________________________________________________________________________ _____________________________________________________
SIGNATURE DATE ISSUED T.I.N.
BOX 5 (OWNER / AUTHORIZED REPRESENTATIVE)
______________________________________________________________________________________________ _____________________________________
NAME SIGNATURE T.I.N. C.T.C NO.:
DATE ISSUED:
PLACE ISSUED:
BOX 6 (TO BE RECEIVED BY RECEIVING / RECORDING SECTION
ELECTRICAL PLANS & SPECIFICATIONS (5 SETS) RECEIVED BY: _______________________________________
Signature over Printed Name
DATE RECEIVED: _____________________________________
Republic of the Philippines
Department of Public Works and Highways
OFFICE OF THE BUILDING OFFICIAL
Municipality of Santa Barbara
AREA CODE: 06065
A P P L I C A T I O N N O. P E R M I T N O.
DATE ISSUED : _____________________________ DATE FILED : _______________________
PAID UNDER O.R. NO. : _____________________________
AMOUNT PAID : _____________________________ DATE PAID : _______________________
ELECTRICAL PERMIT
NAME OF THE OWNER / APPLICANT LAST NAME, FIRST NAME, MIDDLE NAME T.I.N.
ADDRESS NO. STREET, BARANGAY, CITY / MUNICIPALITY TELEPHONE NO.
LOCATION OF CONSTRUCTION NO. STREET, BARANGAY, CITY / MUNICIPALITY
PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING, DEVICES AND EQUIPMENT ENUMERATED IN THE
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 PROVISION OF THE LATEST EDITION OF THE PHILIPPINES ELECTRICAL CODE.
2. THAT A DULY LICENSED ELECTRICAL PRACTITIONER INCHARGE OF THE INSTALLATION / CONSTRUCTION.
3. THAT A CERFICATE OF COMPLETION DULY SIGNED BY THE ELECTRICAL PRACTITIONER ACHORAGED OF THE
INSTALLATION BE SUBMITTED NOT LATER THAN SEVEN (7) DAYS AFTER THE COMPLETION OF THE
INSTALLATION.
4. THAT A CERTIFICATE OF FINAL ELECTRICAL INSPECTION BE SECURED PRIOR TO THE ACTUAL OCCUPANCY OF
THE BUILDING.
5. THIS PERMIT IS VALID FOR ___________________ DAYS.
APPROVED:
________________________________________ ___________________________________
MUNICIPAL ENGINEER DATE
NOTED:
________________________________________ ___________________________________
BUILDING OFFICIAL DATE
ORIGINAL - TO BE POSTED CONSPICUOUSLY AT THE DOOR OR SITE OF WORKS.
Note 1. This permit may be canceled or revoked pursuant to Section 305 and 306 of the National Building Code.
Note 2. Alterationa on this form are not allowed.
