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ELECTRONICS-PERMIT

The document is an Electronics Permit application form for construction in Antipolo, Philippines, requiring detailed information from the applicant, including ownership, location, and scope of work. It outlines the responsibilities of the design professional and the supervisor in charge of electronics works, along with necessary documentation for permit issuance. The permit is subject to compliance with the Electronics Code and National Building Code, and is invalid without a building permit.

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VINCENT VAN GOGSH
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4 views

ELECTRONICS-PERMIT

The document is an Electronics Permit application form for construction in Antipolo, Philippines, requiring detailed information from the applicant, including ownership, location, and scope of work. It outlines the responsibilities of the design professional and the supervisor in charge of electronics works, along with necessary documentation for permit issuance. The permit is subject to compliance with the Electronics Code and National Building Code, and is invalid without a building permit.

Uploaded by

VINCENT VAN GOGSH
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

City of Antipolo
Province of Rizal
OFFICE OF THE BUILDING OFFICIAL

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

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


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

FOR CONSTRUCTION OWNED BY AN ENTERPRISE FORM OF OWNERSHIP USE OR CHARACTER OF OCCUPANCY

(ADDRESS): NO., STREET, BARANGAY, CITY/MUNICIPALITY ZIP CODE CONTACT NO.

(LOCATION OF CONSTRUCTION) LOT NO. BLK NO. TCT NO. CURRENT TAX DEC. NO.

STREET BARANGAY CITY OF ANTIPOLO


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 FIRE 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 I.T. SYSTEMS, FIBER OPTIC CABLE OR OTHER MEDIAL
APPARATUS, DEVICE AND/OR COMPONENT (Specify) ELECTRONICS SYSTEM

PREPARED BY:

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

ELECTRONICS ENGINEER ELECTRONICS ENGINEER


(Signed and Sealed Over Printed Name) (Signed and Sealed Over Printed Name)
Date: Date:
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:

Electronics Permit Page 1 of 2


TO BE ACCOMPLISHED BY THE PROCESSING AND EVALUATION SECTION
BOX 7

RECEIVED BY: DATE:

FOUR (4) SETS OF ELECTRONICS DOCUMENTS

ELECTRONICS PLANS AND SPECIFICATIONS 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 electronic works shall be in accordance with the electronics plans filed with this office and in
conformity with the latest Electronics Code of the Philippines, the National Building Code and its IRR.
2. That upon 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
accomplished the Certificate of Completion stating that the electronic works conform to the provision of the
Electronics Code of the Philippines, the National Building Code and its IRR.
3. That this permit is null and void unless accompanied by the building permit.

PERMIT ISSUED BY:

MELVIN Q. BALAGOT, CE, SE, MM


CITY BUILDING OFFICIAL
(Signature Over Printed Name)
Date:

Electronics Permit Page 2 of 2

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