DPWH FORM NO. 77-006-E
Revision No. 00
REPUBLIC OF THE PHILIPPINES
PROVINCE OF PAMPANGA
CITY OF SAN FERNANDO
OFFICE OF THE BUILDING OFFICIAL
AREA CODE: 5416W
CERTIFICATE OF FINAL ELECTRICAL INSPECTION/COMPLETION
THIS IS TO CERTIFY THAT FINAL INSPECTION OF THE ELECTRICAL INSTALLATION HAS BEEN CONDUCTED ON THE BULDING
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
LAST NAME
ADDRESS
NO.,
LOCATION OF INSTALLATION
CITY/MUNICIPALITY
FIRST NAME
STREET
NO.,
MIDDLE NAME
BARANGAY
STREET
CITY/MUNICIPALITY
BARANGAY
TYPE OF OCCUPANCY OR USE:
A.
B.
C.
D.
RESIDENTIAL DWELLING
RESIDENTIAL, HOTEL, APARTMENT
EDUCATION & RECREATION
INSTITUTIONAL
E.
F.
G.
H.
BUSINESS & MERCHANTILE
INDUSTRIAL
STORAGE & HAZARDOUS
ASSEMBLY OTHER THAN GROUP I
I.
ASSEMBLY LOAD
1000 OR MORE
J. ACCESSORY
K. OTHERS (SPECIFY) ____________
START OF INSTALLATION _____________________________________ DATE OF COMPLETION ____________________________________
OUTLETS/DEVICES/EQUIPMENT
NUMBER OF OUTLETS:
____ LIGHT
____ CONVENIENCE/RECEPTACLE
____ SPO, AIRCON
NUMBER OF EQUIPMENT/WIRING DEVICES:
____ SPO, COOKING UNIT
____ SPO, WATER HEATER
____ SPO, WATER PUMP
____ TOGGLE SWITCH
____ BELLS/BUZZERS
____ PUSH BUTTON
____ FA DETECTORS
____ OTHERS (See Attached List)
________________________
PERSON IN-CHARGE OF INSTALLATION
PROFESIONAL ELECTRICAL ENGINEER
REGISTERED MASTER ELECTRICIAN
Not Exceeding 600 Volts & 500 kVA
REGISTERED ELECTRICAL ENGINEER
NAME
PRC REG. NO. _______________________
VALIDITY __________________________
SIGNATURE
ADDRESS
PTR. NO.
DATE ISSUED
PLACE ISSUED
CTC NO.
DATE ISSUED
TIN
ELECTRICAL CONTRACTOR (200-AMPERE MAIN AND ABOVE
NAME
PCAB LIC. NO.
VALIDITY
ADDRESS
(SPECIALTY ELECTRICAL)
TEL/FAX NO.
TYPE OF INSTALLATION:
TEMPORARY
NEW
REMODEL/ALTERATION
TYPE/S OF WIRING:
RACEWAYS
OPEN WIRING
CONDUITS
CABLE
ARMORED CABLE
OTHERS ___________________________________________________________________________________________________
INSPECTED BY:
__________________________________________
ELECTRICAL INSPECTOR
(Signature Over Printed Name)
__________________________________________
PRC REG. NO. & VALIDITY
AMOUNT PAID P __________________________
RECOMMENDING APPROVAL:
APPROVED BY:
____________________________________________
ELECTRICAL ENGINEER OF THE BUILDING OFFICE
(Signature Over Printed Name)
EFREN M. DE LEON
_____________________________
Building Official
(Signature Over Printed Name)
__________________________________________
PRC REG. NO. & VALIDITY
O. R NO. __________________________
DATE __________________________
NUMBER OF STOREYS
Conn
____________________________________________________________________________________________________
ESTIMATED COST ______________________________________________________________________________________________________
ACTUAL COST __________________________________________________________________________________________________________
Materials (Total Cost) P
1. Electrical Wires ___________________________________________________________________________________
a) b)
2.
3.
Lighting outlets ___________________________________________________________________________________
Convenience outlets _______________________________________________________________________________
4.
Switches ________________________________________________________________________________________
Others (specify) _______________________________________________________________________________________
Other Costs ________________________________________________________________________________________
a)
This includes professional fees, permits and other fees.
1.
Loads to be Connected:
____ LIGHT
____ CONVENIENCE/RECEPTACLE
____ SPO, AIRCON
____ SPO, COOKING UNIT
____ SPO, WATER HEATER
____ SPO, WATER PUMP
____ TOGGLE SWITCH
____ BELLS/BUZZERS
____ PUSH BUTTON
____ FA DETECTORS
____ OTHERS (See Attached List)
________________________
2.
Nature of Works: ______________________________________________________________________________________
3.
Type of Service: Voltage _______________
4.
Remarks: ____________________________________________________________________________________________
_____________________________________________________________________________________________
Size of Wire ____________________
Phone ____________________
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
P _____________________
ADDRESS
Surcharge
P _____________________
PRC REG NO.
VALIDITY
Total
P _____________________
PTR NO.
TIN
CTC NO. _____________________________________________
Computed by:
__________________________________
Signature Over Printed Name
DATE ISSUED ________________________________________
PLACE ISSUED _______________________________________
LOAD
Nature of Work:
Inspector ________________________________________
Contractor ___________________________________________
Fee: P
Paid under Official Receipt No ______________________
Date ___________________________________________
Owner/Occupant ______________________________________
RECOMMENDING APPROVAL:
APPROVED BY:
_________________________________________________
ELECRICAL ENGINEER OF THE BUILDING OFFICE
(Signature Over Printed Name)
__________________________________
BUILDING OFFICIAL
_________________________________________________
(Signature Over Printed Name)
PRC REG. NO. & VALIDITY
NOTE: Renewals or extension of this permit and/ or final certification of the electrical installation are subject and payment of corresponding in
conformity with pertinent provisions of the “National Building Code” (P.D 1096 and its implementing rules and regulations.