NBC form no.

M - 09 Republic of the Philippines

City/Municipality of _____________________

Certificate of Operation: Escalator Province of __________________________________

OFFICE OF THE BUILDING OFFICIAL

Name of Owner/Lessee
Certificate of Operation: Escalator
Located at/along No.
Fee Paid
A certificate was submitted by _________________________________________ a duly Official Receipt No.
(Name) Date Paid
licensed professional mechanical engineer hired by the owner who undertook the mechanical
inspection and that the installation is in order. Date Issued

Verified as to the following This Certificate of Operation: Escalator is issued/granted pursuant to pertinent provision of the latest Philippine
Mechanical Code, the National Building Code and its Implementing Rules and Regulations.
Rated Load
Pass./HR. Name of Owner/Lessee
Speed. Width. Located at/along
Tread Width Floor Height Rated Load Capacity per hour Speed
Horsepower Effective Width Tread width Floors served
Verified on Expires on Floor Height Motor Horsepower h.p. of engine
Inspection fee paid
Official Receipt no. Date Issued The owner/lessee shall properly maintain the equipment/machineries to ensure its safe operation.
No change, addition or upgrading/alteration deviating from the original mechanical plans shall be made without
appropriate permit.
The above described mechanical installation covered by Mechanical Permit The aforementioned Escalator may now be operated for a period of one (1) year from the date of inspection.
No._____________________ issued on___________________has been found substantially The owner/lessee of the building/structure shall notify in writing the office of the building official for the granting/issuance
satisfactory complied, therefore the “Certificate of Operation: Escalator” is hereby of a Certificate of Operation: Escalator for a period of one (1) year from the date of issuance of this certificate and yearly
recommended for issuance. thereafter.
A certified copy hereof shall be posted within the premises of the building and shall not be removed without authority from
the building official.

Mechanical Inspector Chief, Mechanical Section

(Signature Over Printed Name) (Signature Over Printed Name)
Date_______________________ Date_______________________
________________ ______________ ________________ ______________
PRC reg. No. validity PRC reg. No. validity

Chief, Chief, Building Official

Inspection and Enforcement Division Processing and Evaluation Division (Signature Over Printed Name)
(Signature over Printed Name) (Signature Over Printed Name) Date________________________
Date________________________ Date________________________