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NBC Form NO.: Permit For Temporary Service Connection

This document is a permit application for a temporary service connection for an electronic fire alarm system. It provides details about the owner, location of construction, purpose of the connection, summaries of electrical loads and capacities, and approval from the design professional and supervisor. If approved, the building official will issue a permit allowing connection for a specified period, which can be suspended or revoked if the wiring system becomes unsafe. The permit provides authorization to connect the electrical installation for the approved load and purpose according to electrical and building codes.

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RANULFO C. RATO JR.
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668 views2 pages

NBC Form NO.: Permit For Temporary Service Connection

This document is a permit application for a temporary service connection for an electronic fire alarm system. It provides details about the owner, location of construction, purpose of the connection, summaries of electrical loads and capacities, and approval from the design professional and supervisor. If approved, the building official will issue a permit allowing connection for a specified period, which can be suspended or revoked if the wiring system becomes unsafe. The permit provides authorization to connect the electrical installation for the approved load and purpose according to electrical and building codes.

Uploaded by

RANULFO C. RATO JR.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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NBC FORM NO.

E - 03

ELECTRONIC Republic of the Philippines


FIRE ALARM
Municipality of Aurora
SYSTEM
Province of Zamboanga del Sur
OFFICE OF THE BUILDING OFFICIAL
PERMIT FOR TEMPORARY SERVICE CONNECTION
CONTROL NO. PTSC NO.

BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)


OWNER/APPLICANT: LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

BY AN ENTERPRISE
ADDRESS: NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE TELEPHONE NO

LOCATION OF CONSTRUCTION: LOT NO. ________ BLK NO. ____________ TCT NO. _____________________ TAX DEC. NO.
___________________

STREET______________________ BARANGAY ____________________________ CITY/ MUNICIPALITY OF


____________________________________

PURPOSE:
FOR CONSTRUCTION FOR TESTING OTHERS (Specify)____________________________
SUMMARY OF ELECTRICAL LOADS / CAPACITIES APPLIED FOR
TOTAL CONNECTED LOAD TOTAL TRANSFORMER CAPACITY TOTAL GENERATOR/UPS CAPACITY
___________________ kVA _____________________ kVA ____________________ kVA

BOX 2 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL)


DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
Address

PRC. No Validity
PROFESSIONAL ELECTRICAL ENGINEER
(Signed and Sealed Over Printed Name) PTR. No Date Issued
Date________________________ Issued at TIN

BOX 3
SUPERVISOR / IN-CHARGE OF ELECTRICAL
WORKS

PROFESSIONAL ELECTRICAL
ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN

Date______________
(Signed and Sealed Over Printed Name)

PRC. No Validity
PTR. No Date Issued
Issued at TIN
Address

BOX 4 (TO BE ACCOMPLISHED BY THE OWNER / APPLICANT)

OWNER / APPLICANT Address

C.T.C. No.

(Signature Over Printed Name) Date Issued

Date___________________ Place Issued


BOX 4 (TO BE ACCOMPLISHED BY THE PROCESSING & EVALUATION DIVISION)

FEE PAID: _______________________________________________ OFFICIAL RECEIPT NO.: ____________________________________

DATE PAID: ______________________________________________ DATE ISSUED : ___________________________________________

BOX 5 (TO BE ACCOMPLISHED BY THE BUILDING OFFICIAL)

ACTION TAKEN:

Permit is hereby issued/granted to _________________________________________________


with postal address at ________________________________________________________________
to connect the electrical installation with the authorized load and purpose specified therewith pursuant to
pertinent provision of the latest Philippine Electrical Code, the National Building Code and its
Implementing Rules and Regulations for a period of ________________________ ( ) days from
date_______________________________ after which period the service shall be disconnected unless
actually extended or renewed before the expiry date.

This permit shall be suspended or revoked any time before its expiration whenever alterations or
change in the wiring system have rendered it unsafe.

PERMIT ISSUED BY:

ENGR. LEO DC. ACENAS, EnP


BUILDING OFFICIAL
(Signature Over Printed Name)
Date __________________

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