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Electronics Form A4 1

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42 views2 pages

Electronics Form A4 1

Uploaded by

johnchristnardf
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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NBC FORM No A.

-07

Republic of the Philippines


City/Municipality of Naga
Province of Camarines Sur
OFFICE OF THE BUILDING OFFICIAL

ELECTRONICS PERMIT
APPLICATION NO. ELP NO. BUILDING PERMIT NO.

BOX 1(TO BE ACCOMPLISHED PRINT BY THE OWNER/APPLICANT)


OWNER/APPLICANT LAST NAME FIRST NAME M.I. TIN

FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

LOCATION OF CONSTRUCTION: LOT NO.________ BLK NO. _____________ TCT NO. _____________________________ TAX DEC.NO. _______________________________

STREET_______________________________________ BARANGAY_____________________________________ CITY//MUNICIPALITY OF_____________________________

SCOPE OF WORK
 NEW INSTALLATION ANNUAL INSPECTION OTHERS (Specify)_____________________________

BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)


NATURE OF INSTALLATION WORKS/EQUIPMENT SYSTEM:
 TELECOMMUNICATION SYSTEM  ELECTRONICS AND ALARM SYSTEM  ELECTRONICS COMPUTERIZED PROCESS
 BROADCASTING SYSTEM  SOUND COMMUNICATION SYSTEM CONTROLS AUTOMATION SYSTEM
 TELEVISION SYSTEM  CENTRALIZED CLOCK SYSTEM  BUILDING AUTOMATION MANAGEMENT AND
 INFORMATION TECHNOLOGY SYSTEM  SOUND SYSTEM CONTROL SYSTEM
 SECURITY AND ALARM SYSTEM  ELECTRONICS CONTROL AND CONVEYOR SYSTEM  BUILDING WIRING UTILIZING COPPER CABLE
 ANY OTHER ELECTRONICS AND IT SYSTEMS, FIBER OPTIC CABLE OR OTHER MEDIAL
EQUIPMENT, APPARATUS, DEVICE AND/OR ELECTRONICS SYSTEM
COMPONENT (Specify___________________________)

PREPARED BY____________________________________________________________________________________________________________________________

BOX 3 BOX 4
DESIGN PROFESSIONAL PLANS AND SPECIFICATIONS SUPERVISOR/ IN-CHARGE OF ELECTRONICS WORKS

_________________________________________________ Date_________________ ______________________________________________ Date__________________


PROPESSIONAL ELECTRONICS ENGINEER ELECTRONICS ENGINEER
(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)
Address Address
PRC No. Validity PRC No. Validity
PTR No. Date Issued PTR No. Date Issued
Issued at TIN Issued at TIN

BOX 5 BOX 6
BUILDING OWNER WITH MY CONSENT: LOT OWNER

_______________________________________________________ _____________________________________________________
(Signature Over Printed Name) (Signature Over Printed Name)
Date: _________________ Date:_________________

Address Address

C.T.C No. Date Issued Place Issued: C.T.C No. Date Issued Place Issued:
BOX 7 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
RECEIVED BY: DATE:

FIVE (5) SETS OF ELECTRONICS DOCUMENTS

 ELECTRONICS PLANS AND SPECIFI CATIONS  COST ESTIMATES


 BILL OF MATERIALS  OTHERS (Specify)

BOX 8
PROGRESS FLOW

IN OUT
PROCESSED BY
DATE TIME DATE TIME

ELECTRONICS

OTHERS (Specify)

BOX 9

ACTION TAKEN:

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

1. That the proposed electronics works shall be in accordance with the electronics plans filed with this Office and in conformity with the latest Electronics
Code of the Philippines
2. That prior to any electronics installation, a duly accomplished prescribed "Notice of Construction" shall be submitted to the Office of the Building Official.
3. That upon the completion of the electronic works, the licensed supervisor/in-charge shall submit the entry to the logbook duly signed and sealed to the
building official including as-built plans and other documents and shall also accomplish the Certificate of Completion stating that the Electronics works
conform to the provision of the electronics Code of the Philippines, the National Building Code and its IRR.
4. That this permit is null and void unless accompanied by the building permit.

PERMIT ISSUED BY:

ALEXANDER N. CANING
ACTING BUILDING OFFICIAL
(Signature Over Printed Name)
Date____________________

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