REPUBLIC OF THE PHILIPPINES PROVINCE OF CAGAYAN OFFICE OF THE LOCAL BUILDING OFFICIAL MUNICIPALITY OF BUGUEY APPLICATION NO. DATE APPLICATION FILED TT Date of Proposed Start of Installation Expected Date of Completion APPLICATION FOR ELECTRICAL PERMIT (Accomplish in print and in duplicate) OX 1 (TO BE ACCOMPLISHED BY A DULY QUALIFIED ELECTRICAL PRACTITIONER) [RAME-OF CWNERAPPLCANT: LAST NAME, FIRST NAME, THDOLE NAME TiN ADDRESS: NO. STREET, BARANGAY, CITVAONGPALTY — [TELEFAKNO. LOCATION OF INSTALLATION. NO. ‘STREET BARANGAY ‘SITWMUNICIPALITY Bugue’ [SCOPE OF WORK: [Janpmion oF TE OTHERS isPeciryy (Oxew insTaLLation (repair (lannuatinsrection — []Rewovat oF, HYPE OF OCCUPANCY OR USE: (da. RESIDENTIAL DWELLING (7) £. susinees & MERCANTILE [O). AssemeLy occuPANT LOAD [ie respenmat Hore, apartment C2] F.INDUSTRAL 1000 OR MORE JC.EDUCATIONA RECREATION [/"] G. STORAGE & HAZARDOUS (CIs accessory Clb. wsrrutiona [EJ wassevaiy omer anroup: (Tn omens (ePeciry) [NUMBER OF OUTLETS: NUNBER OF EGUPHENTINIRNG DEVICES: uchT ___SP0, COOKING UNIT. -_TOGOLE SWITCH _FADETECTORS. CONVENIENCERECEPTACLE __SPO,WATERHEATER __ BELLSIBUZZERS OTHERS. SPO. ARGON “_SPO.WATERPUMP ——__ PUSH BUTTONS {See Atached Lis) OK2 [PROFESSIONAL ELECTRICAL ENGNEER WHO SIGNED AND SEALED PLANS & SPECIFICATIONS) Nant: [eR REG. NO van [ADDRESS FTELIFAXNO. IPTRNO. DATE SUED PLAGE ISSUED [SIGNATURE DATE SIGNED fre ‘BOX 3 (ELECTRICAL CONTRACTOR 200 AMPERE MAIN AND ABOVE) inane PoAB UC. NO (SPECIALTY ELECTRIGND) lvauioiry (ADDRESS. TELFAKNO. BOX 4 (PERSON IN CHARGE OF INSTALLATION) TOREGISTERED MASTER ELECTRICIAN (CC lproFeSSIONAL ELECTRICAL ENGINEER [7] REGISTERED ELECTRICAL ENGINEER (Not Exceeding 609 Volts & SOOKVA INANE [PRC REG. NO, Jannress [TEL IFAK NO. VALDIFY [PTR NO. [DATE ISSUED PLACE ISSUED [SIGNATURE [DATE SIGNED im BOK 5 (OWNERIAUTHORWED REPRESENTATIVE) NAME [SIGNATURE i lerono a loare issued __ = 2 PLACE IeeUED BOX (70 BE ACCOMPLISHED BY RECENINGRECORDING SECTION) RECEIVED BY. ELECTRICAL PLANS AND SPECIFICATIONS (6 SETS) Signature Over Printed Name DATE RECEIVED:REPUBLIC OF THE PHILIPPINES PROVINCE OF CAGAYAN OFFICE OF THE LOCAL BUILDING OFFICIAL, MUNICIPALITY OF BUGUEY AREA CODE PERMIT NO. DATE APPLICATION FILED EEE DATE ISSUED DATE FILED PAID UNDER O.R. NO. AMOUNT: DATE ELECTRICAL PERMIT (To be Accomplished by the Office Concemed) 0x1 [NAME OF OWNERIAPFLGANT: LAST NAME, FIRST NANE, TMIOOLE NAE Print [aDDRESS: No. ‘STREET, BARANGAY CITYAAGNIGIPALITY [TELE/PAKNO. [TOCATION OF INSTALLATION NO. ‘STREET ‘BARANGAY CiVIMONCPALTY Buguey 0x2 ‘ASSESSED FEES "ANOUNT DUE ASSESSED EY OR NUMBER, DATE PAD, REVIEWED: ‘CHIEF, PROCESSING DIVISEC. BOxS PERMIT IS HEREBY GRANTED TO INSTALL THE ELECTRICAL WIRING, DEVICES AND EQUIPMENT ENUMERATED IN THE APPLICATION SUBJECT TO THE FOLLOWING CONDITIONS: {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 INSTALLATIONICONSTRUCTION, 3 THAT A CERTIFICATE OF COMPLETION DULY SIGNED SY 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 SECURED PRIOR TO THE ACTUAL OCCUPANCY OF THE BUILDING 5 THIS PERMIT SHALL BE POSTED AT THE DOOR OR SITE OF WORK. |approveo: ELECTRICAL ENGINEER OF THE BUILDING OFFICE ‘DATE: (Gignature Over Printed Name} oreo: MELVIN A AGBALOG BUILDING OFFICIAL DATE: (Signature Over Pintod Name) NOTE 1: This permit may be cancelled or revoked pursuant to Sections 305 are 308 ofthe National Bulding Code. NOTE 2: Alterations on tis form are not towed