Republic of the Philippines
Department of Public Works and Highways
OFFICE OF THE BUILDING OFFICIAL
Palapag Northern Samar
CERTIFICATE OF FINAL ELECTRICAL INSPECTION/COMPLETION
THIS IS TO CERTIFY THAT THE FINAL INSPECTION OF THE ELECTRICAL INSTALLATION HAD BEEN CONDUCTED AND/OR
PREMISES BY THE BUILDING PERMIT NO. _____________________________ ISSUED ON ___________________ AND THE SAME WERE
FOUND COMPLETED IN ACCORDANCE WITH THE ELECTRICAL PLANS AND SPECIFICATIONS ON FILE WITH THE OFFICE OF THE BUILDING
OFFICIAL AND IN ACCORDANCE WITH THE PHILIPPINE ELECTRICAL CODE PROVISIONS.
NAME OF OWNER/ LAST NAME FIRST NAME MIDDLE NAME TIN
APPLICANT
STREET BARANGAY CITY/MUNICIPALITY TELEFAX
ADDRESS
LOCATION OF STREET BARANGAY CITY/MUNICIPALITY
INSTALLATION
TYPE OF OCCUPANCY OR USE
A. RESIDENTIAL DWELLING E. BUSINESS & MERCANTILE I. ASSEMBLY OCCUPANCT LOAD 100 OR MORE
B. RESIDENTIAL HOTEL, APARTMENT F. INDUSTRIAL J. ACCESSORY
C. EDUCATION & RECREATION G. STORAGE & HAZARDOUS K. OTHERS (SPECIFY)
D. INSTITUTION H. ASSEMBLY OTHER THAN GROUP ____________________________________
START OF DATE OF
INSTALLATION COMPLETION
OUTLET DEVICES/ EQUIPMENT
NUMBER OF OUTLETS NUMBER OF EQUIPMENT / WIRING DEVICES
____ LIGHT ____ SPO, COOLING UNIT ____ TOGGLE SWITCH ____ FIRE ALARM DETECTION
____ CONVENIENCE/RECEPTACLE ____ SPO, WATER HEATER ____ BELLS / BUZZERS ____ OTHER (SEE DETACHED SHEET)
____ SPO, AIRCON ____ SPO, WATER PUMP ____ PUSH BUTTONS
PERSON IN-CHARGE OF INSTALLATION
PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN
NAME PRC REG. NO. VALIDITY
ADDRESS TEL/FAX NO.
PTR NO. DATE ISSUED PLACE ISSUED
SIGNATURE DATE SIGNED TIN
ELECTRICAL CONTRACTOR 200 AMPERE MAIN AND ABOVE
NAME PCAB NO.
COMPANY NAME VALIDITY
TEL/FAX NO.
ADDRESS
SIGNATURE
TYPE OF INSTALLATION
TEMPORARY NEW REMODEL / ALTERATION
TYPES OF WIRING
OPEN WIRING CONDUIT CABLE ARMORED CABLE RACEWAYS
OTHERS ______________________________________________________________________
INSPECTED BY: RECOMMENDING APPROVAL: APPROVED BY:
_____________________________ _____________________________________________ _____________________________
ELECTRICAL INSPECTOR ELECTRICAL ENGINEER OF THE BUILDING OFFICIAL BUILDING OFFICIAL
(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME)
NUMBER OF STOREYS
ESTIMATED COST
ACTUAL COST
MATERIAL (TOTAL COST) Php ________________________
1. ELECTRICAL WIRES
2. LIGHTING OUTLETS
3. CONVENIENCE OUTLETS
4. SWITCHES
5. OTHERS (SPECIFY) Php ________________________ (includes Professional Fees, Permits and other fees)
OTHER COST
1. LOADS TO BE CONNECTED
____ LIGHT ____ SPO, COOLING UNIT ____ TOGGLE SWITCH ____ FIRE ALARM DETECTION
____ CONVENIENCE / RECEPTACLE ____ SPO, WATER HEATER ____ BELLZ / BUZZERS ____ OTHER (SEE ATTACHED SHEET)
____ SPO, AIRCON ____ SPO, WATER PUMP ____ PUSH BUTTONS
2. NUMBER OF WORKS
3. TYPE OF SERVICE VOLTAGE SIZE OF WIRE PHONE
4. REMARKS
I HEREBY CERTIFY THAT THE ABOVE DATA AND INFORMATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
ELECTRICAL FEES PEE / REE/ RME
FEE Php ____________________________
ADDRESS
SURCHARGE Php ____________________________
PRC REG. NO. VALIDITY
TOTAL Php ____________________________
PTR NO. TIN
COMPUTED BY: CTC NO.
DATE ISSUED
______________________________________________________
SIGNATURE OVER PRINTED NAME PLACE ISSUED
LOAD
NATURE OF WORK
INSPECTOR CONTRACTOR
FEE Php OWNER / APPLICANT
_________________________________________________________ _________________________________________
ELECTRICAL ENGINEER OF THE BUILDING OFFICIAL BUILDING OFFICIAL
RC REG. NO _________________________________ (SIGNATURE OVER PRINTED NAME)
