PUA_ELECTRICAL FORM_1669326769

NBC FORM NO.
A-03
TRACKING NO
137-9Y9NLWFM
Republic of the Philippines
PROVINCE OF ALBAY
CITY OF LEGAZPI
OFFICE OF THE CITY BUILDING OFFICIAL
ELECTRICAL PERMIT
APPLICATION NO. EP NO. BUILDING PERMIT NO.
BOX 1 (TO BE ACCOMPLISHED IN PRINT BY THE OWNER/APPLICANT)

OWNER/APPLICANT LAST NAME FIRSTNAME M.I. TIN
PUA JHON KENNETH D 410-404-466
FOR CONSTRUCTION OWNED FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY
INDIVIDUAL E301 - ALL PERMITTED USES IN DIVISION E-1(OR
BY AN ENTERPRISE FOR C-1 AND C-2 CLASS) BUILDINGS /
ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY ZIP CODE TELEPHONE NO.

30 DON RAMON STREET TALAYAN VILLAGE QUEZON CITY (0917) 880-1072
LOCATION OF CONSTRUCTION: LOT NO. 14 BLK NO. 7 TCT NO. TAX DEC NO.
STREET F. IMPERIAL STREET CORNER BARANGAY CAPANTAWAN CITY/MUNICIPALITY CITY OF LEGAZPI
SCOPE OF WORK
X NEW INSTALLATION RECONNECTION OF SERVICE ENTRANCE RELOCATION SERVICE ENTRANCE
ANNUAL INSPECTION SEPARATION OF SERVICE ENTRANCE OTHERS (specify)
TEMPORARY UPGRADING OF SERVICE ENTRANCE
SUMMARY OF ELECTRICAL LOADS/CAPACITIES APPLIED FOR

TOTAL CONNECTED LOAD TOTAL TRANSFORMER CAPACITY TOTAL GENERATOR/UPS CAPACITY
74.84 kVA 45.00 kVA 50.00 kVA
BOX 2 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL)

DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
Address
ANGELITO R FLORES Date 05/13/1999 PRC No. 0003104 Validity 11/22/2024

PROFESSIONAL ELECTRICAL ENGINEER PTR No. 7663689 Date Issued 01/03/2022
(Signed And Sealed Over Printed Name) Issued at VALENZUELA TIN
BOX 3
SUPERVISOR / IN-CHARGE OF ELECTRICAL WORKS
PROFESSIONAL ELECTRICAL X REGISTERED ELECTRICAL REGISTERED MASTER

ENGINEER ENGINEER ELECTRICIAN
GED ERIC CAPINA SAMBAJON Date 09/22/2017

(Signed And Sealed Over Printed Name)
PRC No. 0065605 Validity 07/08/2023

PTR No. 9828972 Date Issued 01/21/2021
Issued at LEGAZPI CITY TIN
Address
BOX 4 BOX 5
BUILDING OWNER WITH MY CONSENT: LOT OWNER
JHON KENNETH D. PUA JHON KENNETH D. PUA

(Signature Over Printed Name) (Signature Over Printed Name)
Date Date
Address 30 DON RAMON STREET TALAYAN VILLAGE QUEZON Address 30 DON RAMON STREET TALAYAN VILLAGE QUEZON
License No Date Issued Place Issued License No Date Issued Place Issued
N04-06-004779 10/10/2019 QUEZON CITY N04-06-004779 10/10/2019 QUEZON CITY
BOX 6 (TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION DIVISION)
RECEIVED BY: DATE:
FIVE (5) SETS OF ELECTRICAL DOCUMENTS
ELECTRICAL PLANS AND SPECIFICATIONS EXPECTED DATE OF COMPLETION/INSTALLATION/

SPECIAL FIXTURES AND EQUIPTMENT CONSTRUCTION
PROPOSED STARTING DATE OF INSTALLATION/ OTHERS (Specify)

CONSTRUCTION
BOX 7
PROGRESS FLOW
IN OUT
PROCESSED BY:
DATE TIME DATE TIME
ELECTRICAL
ELECTRICAL ENGINEER
OTHERS (Specify) (Signature Over Printed Name)
PRC Reg. No.
Validity
BOX 8
ACTION TAKEN
PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:
1. That the proposed electrical works shall be in accordance with the electrical plans filed with this Office and in conformity with the provisions
of the latest Philippine Electrical Codes, the National Building Code and its IRR.
2. That prior to any electrical installation, the Owner/Permittee shall submit a duly accomplished prescribed "Notice of Construction" to the
Office of the Building Official.
3. That for installed electrical capacity of 200 amperes and above at 230 volts nominal and above, a specialty electrical contractor duly
licensed by the Philippines Contractors Accreditation Board (PCAB) shall be required.
4. That a duly licensed electrical practitioner shall be in-charge of the installation, and that upon completion of the electrical works, he shall
submit the entry of the logbook duly signed and sealed to the OBO including as-built plans and other documents. He shall also accomplish
the Certification of Completion stating that the electrical works conform to the provisions of the Philippine Electrical Codes, the National
Building Code and its IRR.
5. That this permit is null and void unless accompanied by the building permit except for projects involving purely electrical works in which
case only the building permit number of the existing building/structure shall be required.
6. That a Certificate of Final Electrical Inspection (CFE) shall be secured prior to the actual occupancy of the building.
7. That this permit shall be posted at the door or site of work.
PERMIT ISSUED BY:
CITY BUILDING OFFICIAL

(Signature Over Printed Name)
Date

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NBC FORM NO.

OFFICE OF THE CITY BUILDING OFFICIAL

APPLICATION NO. EP NO. BUILDING PERMIT NO.

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

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

STREET F. IMPERIAL STREET CORNER BARANGAY CAPANTAWAN CITY/MUNICIPALITY CITY OF LEGAZPI

SUMMARY OF ELECTRICAL LOADS/CAPACITIES APPLIED FOR

BOX 2 (TO BE ACCOMPLISHED IN PRINT BY THE DESIGN PROFESSIONAL)

ANGELITO R FLORES Date 05/13/1999 PRC No. 0003104 Validity 11/22/2024

PROFESSIONAL ELECTRICAL X REGISTERED ELECTRICAL REGISTERED MASTER

GED ERIC CAPINA SAMBAJON Date 09/22/2017

PRC No. 0065605 Validity 07/08/2023

JHON KENNETH D. PUA JHON KENNETH D. PUA

RECEIVED BY: DATE:

FIVE (5) SETS OF ELECTRICAL DOCUMENTS

ELECTRICAL PLANS AND SPECIFICATIONS EXPECTED DATE OF COMPLETION/INSTALLATION/

PROPOSED STARTING DATE OF INSTALLATION/ OTHERS (Specify)

PERMIT IS HEREBY ISSUED SUBJECT TO THE FOLLOWING:

7. That this permit shall be posted at the door or site of work.

PERMIT ISSUED BY:

CITY BUILDING OFFICIAL

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