DPWH FORM NO.

96-001-E

REPUBLIC OF THE PHILIPPINES PROVINCE OF NORTHERN SAMAR MUNICIPALITY OF ALLEN OFFICE OF THE LOCAL BUILDING OFFICIAL AREA CODE __48018___ CERTIFICATE OF FINAL ELECTRICAL INSPECTION/COMPLETION
THIS IS TO CERTIFY THAT FINAL INSPECTION OF THE ELECTRICAL INSTALLATION HAD BEEN CONDUCTED ON THE BUILDING AND/OR PREMISES COVERED BY BUILDING PERMIT NO.________________ISSUED ON __________________ THE SAME WERE FOUND COMPLETED IN ACCORDANCE WITH THE APPROVED PLANS AND SPECIFICATIONS ON FILE WITH THE OFFCE OF THE BUILDING OFFICIAL AND IN ACCORDANCE WITH THE PHILIPPINE ELECTRICAL CODE PROVISION.
NAME OF OWNER/APPLICANT ADDRESS NO. LAST NAME STREET NO. FIRST NAME BARANGAY STREET MIDDLE NAME CITY/MUNICIPALITY BARANGAY TIN TELEFAX NO.

LOCATION OF INSTALLATION: TYPE OF OCCUPANCY OR USE: A. RESIDENTIAL DWELLING

CITY/MUNICIPALITY

E. BUSINESS & MERCANTILE F. INDUSTRIAL G. STORAGE & HAZARDOUS H. ASSEMBLY OTHER THATN GROUP I

I. ASSEMBLY OCCUPANT LOAD 1000 OR MORE J. ACCESSORY K. OTHERS [SPECIFY]

B. RESIDENTIAL, HOTEL, APARTMENT C. EDUCATION & RECREATION D. INSTITUTIONAL

START OF INSTALLATION

DATE OF COMPLETION OUTLETS/DEVICES/EQUIPMENTS

NUMBER OF OUTLETS LIGHT CONVENIENCE/RECEPTACLE SPO, AIRCON SPO, COOKING UNIT SPO, WATER HEATER SPO, WATER PUMP

NUMBER OF EQUIPMENT/WIRING DEVICES TOGGLE SWITCH BELL/BUZZERS PUSH BUTTONS FA DETECTOR OTHERS [See attached List]

PERSON IN CHARGE OF INSTALLATION

PROFESSIONAL ELECTRICAL ENGINEER NAME: SIGNATURE: ADDRESS PTC NO. CTC NO. REGISTETRED ELECTRICALENGINEER REGISTERED MASTER ELECTRICIAN
[Not Exceeding 600 Volts & 500 KVA]

PRC REG. NO. VALIDITY DATE SIGNED: DATE ISSUED: PLACE OF ISSUED: TIN:

TYPE OF INSTALLATION TEMPORARY TYPE OF WIRING OPEN WIRING OTHER INSPECTED: APPROVED: NOTED: CONDUITS CABLE ARMORED CABLE RACEWAYS NEW REMODE/ALTERATION

ELECTRICAL INSPECTOR [Signature Over Printed Name] PRC REG. NO. VALIDITY

ELECTRICAL ENGINEER OF THE BUILDING OFFICE [Signature Over Printed Name] PRC REG. NO. VALIDITY

BUILDING OFFICIAL [Signature Over Printed Name]

AMOUNT PAID Php.

O.R. NO.

DATE