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Cert
Cert
ELECTRICAL DIVISION
DPWH FORM NO. 96-006-E W.P. NO. _______________________________ Date: _______________________________ C.E.I.___________________________________ Date: ___________________________________
This is to certify the final inspection of the Electrical Installation had been conducted on the Building and/or premises covered by Building Permit No. ____________issued on______________ and the same were found completed in accordance with the approved plans and specifications on file with the office of the Building Official and in accordance with Philippine Electrical Code Provisions.
Name of owner/Applicant: Address: Location of Installation: Type of Occupancy or Use: A. Residential Dwelling B. Residential, Hotel, Apartment C. Education & Recreation D. Institutional E. Business & Merchantile F. Industrial G. Storage & Hazardous H. Assembly other than Group DATE OF COMPLETION______________________________ I. Assembly Occupant Load 100o or more J. Accessory K. Others (specify) ___________________ Last Name No. No. Street Street First Name: Barangay Barangay Middle City/Municipality City/Municipality
START OF INSTALLATION________________________________
NAME: SIGNATURE: ADDRESS: PTR NO. CTC NO. ELECTRICAL CONTRACTOR (200 AMPERE MAIN AND ABOVE) NAME: ADDRESS: TYPE OF INSTALLATION:
TEMPORARY NEW REMODEL/ALTERATION
TYPE OF WIRING:
OPEN WIRING CONDUIT CABLE ARMORED CABLE RACEWAYS OTHERS:____________________________________________________________________________________________________________
INSPECTED:
APPROVED:
NOTED:
ENGR. RODEL A. MESA HEAD ELECTRICAL DIVISION (Signature Over Printed Name) R.E.E. 1314 PRC REG. NO. & VALIDITY O.R. NO. ________________________
ENGR. ISAGANI R. VERZOSA JR. LOCAL BUILDING OFFICIAL (Signature Over Printed Name)
DATE: ___________________________