DPWH FORM NO.

96-006-E
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
OFFICE OF THE LOCAL BUILDING OFFICIAL

DISTRICT/ CITY/MUNICIPALITY
AREA CODE

CERTIFICATE OF FINAL ELECTRICAL INSPECTION/COMPLETION

THIS IS TO CERTIFY THAT FINAL INSPECTION OF THE ELECTRICAL INSTALLATION HAD BEEN CONDUCTED ON
THE BUILDING AND/OR PREMISES COVERED BY BUILDING PERMIT NO. ISSUED ON
AND THE SAME WERE FOUND COMPLETED IN ACCORDANCE WITH THE APPROVED PLANS AND SPECIFICATION ON
ON WITH THE OFICE OF THE BUILDING OFFICIAL AND IN ACCORDANCE WITH PHILIPPINE ELECTRICAL CODE
PROVISION.
NAME OF OWNER/APPLICANT: LAST NAME FIRST NAME MIDDLE NAME

ADDRESS: NO., STREET, BARANGGAY, CITY/MUNICIPALITY

LOCATION OF INSTALLATION: NO., STREET, BARANGGAY, CITY/MUNICIPALITY

TYPE OF OCCUPANCY OR USE:

A. RESIDENTIAL DWELLING E. BUSINESS & MERCANTILE I. ASSEMBLY OCCUPANT LOAD 1000 OR MORE
B. RESIDENTIAL, HOTEL, APRTMENT F. INDUSTRIAL J. ACCESSORY
C. EDUCATION & RECREATION G. STORAGE & HAZARDOUS K. OTHERS (SPECIFY)
D. INSTITUTIONAL H. ASSEMBLY OTHER THAN GROUP 1

START OF INSTALLATION DATE OF COMPLETION

OUTLETS/DEVICES/EQUIPMENT
NUMBER OF OUTLETS: NUMBER OF EQUIPMENT/ WIRING DEVICES
LIGHT SPO, COOKING UNIT TOGGLE SWITCH FA DETECTORS
CONVENIENCE/ RECEPTACLE SPO, WATER HEATER BELLS/BUZZERS OTHERS(See attached List
SPO, AIRCON SPO, WATER PUMP PUSH BUTTONS

PERSON IN-CHARGE OF INSTALLATION

PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER ELECTRICIAN
(Not Exceeding 600 Volts & 500 kVA)

NAME PRC REG. NO.

SIGNATURE VALIDITY
ADDRESS
PTR NO. DATE ISSUED PLACE ISSUED
CTC NO. DATE ISSUED TIN
ELECTRICAL CONTRACTOR (200-AMPERE MAIN AND ABOVE)
NAME PCAB LIC. NO. (SPECIALTY ELECTRICAL)
VALIDITY
ADDRESS TEL/FAX NO.
TYPE OF INSTALLATION:

TEMPORARY NEW REMODEL/ALTERATION

TYPES OF WIRING:
OPEN WIRING CONDUITS CABLE ARMORED CABLE RACEWAYS
OTHERS

INSPECTED BY: RECCOMMENDING APPROVAL APPROVED BY:

ELECTRICAL INSPECTOR ELECTRICAL ENGINEER OF THE BUILDING OFFICE BUILDING OFFICIAL

(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)

PRC REG. NO. & VALIDITY PRC REG. NO. & VALIDITY

AMOUNT PAID P O.R. NO. DATE

NUMBER OF STORIES
ESTIMATED COST
ACTUAL COST
a) Material ( Total Cost) P
1. Electrical Wires
2. Lighting Outlets
3. Convenience Outlets
4. Swithches
Others (specify)
b) Other costs
This includes professional fees, permits and other fees.

1. Loads to be Connected:
LIGHT SPO, COOKING UNIT TOGGLE SWITH FA DETECTORS
CONVENIENCE/RECEPTACLE SPO, WATER HEATER BELLS/BUZZERS OTHERS (See attached list)

SPO, AIRCON SPO, WATER PUMP PUSH BUTTONS

2. Nature of Works:
3. Types of Services: 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 P ADDRESS
Surcharge P PRC REG.NO. VALIDITY
Total P PTR NO. TIN
CTC NO.
Computed by: DATE ISSUED
Signature (Over Printed Name) PLACE ISSUED
LOAD

Nature of Work:
Inspector
Fee: P Contractor
Paid under Official Receipt No. Owner/Occupant
Date
RECOMMENDING APPROVAL: APPROVED BY:

ELECTRICAL ENGINEER OF THE BUILDING OFFICE BUILDING OFFICIAL

(Signature Over Printed Name) (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 to
inspection and payment of corresponding fees in conformity with pertinent provosions of the " National Building Code"
(P.D. 1096) and its implementing rules and regulations.