NBC FORM No.

E-04
CERTIFICATE OF ELECTRICAL INSPECTION Republic of the Philippines
FOR TEMPORARY POWER CONNECTION CITY OF BAGUIO
Province of Benguet
___________________________________________________________________
OFFICE OF THE BUILDING OFFICIAL
Name of Owner/Applicant/Lessee

___________________________________________________________________ CERTIFICATE OF ELECTRICAL INSPECTION

Located At/Along FOR TEMPORARY POWER CONNECTION

_____________________________ _______________________ CEIFTPC No. ________________________

Use or character of occupancy Group Fee Paid _____________________________
Official Receipt No. ___________________
A certificate was submitted by _______________________________________________
A duly licensed : ( ) professional electrical engineer ( ) registered electrical engineer
Date Paid ____________________________
( ) registered master electrician hired by the owner who undertook the electrical inspection
and that the installation is in order. _________________________________
PRC license no. _____________ issued on: _____________ with validity ____________ Date Issued
This Certificate of Electrical Inspection for Temporary Power Connection is
Verified and Complied as to the following:
issued/granted pursuant to pertinent provisions of the latest Philippine Electrical Code, the
Total Connected Load___________________________________ KVA National Building Code and its Implementing Rules and Regulations for:
Total Transformer Capacity_______________________________ KVA [ ] Construction Purposes [ ] Testing Purposes
Total Generator/UPS Capacity_____________________________KVA [ ] Others (Specify) _________
Others (Specify): _________________________________________________________
_______________________________________________________________________
for a period of [ ] Days from date ________________________________ after which
_______________________________________________________________________ the service shall be considered illegal, unless actually extended or renewed before the expiry
date.
The above described electrical installation covered by Electrical Permit No.
_________________ issued on _________________________has been found substantially Name of Owner/Lessee ____________________________________________
satisfactory complied, therefore, the “Certificate of Electrical Inspection for Temporary
Power Connection” is hereby recommended for issuance Name of Project __________________________________________________
Use or Character of Occupancy _________________ Group _______________
Located at/,Along ________________________________________________

ENGR. CEASAR C. DEGAY ENGR. RENATO S. CIANO

The Owner/Applicant shall be liable for any damages to property and injury or loss of
ENGINEER I ENGINEER III life in connection with an illegal installation and/or whenever changes/alterations/upgrading or
ELECTRICAL INSPECTOR CHIEF, ELECTRICAL SECTION deviating in the electrical installation have rendered unsafe.
Date:____________________ Date: ____________________
0001468 March 15, 2020 0003384 November 12, 2019
PRC. Reg. No. Validity PRC. Reg. No. Validity

ENGR. NAZITA F. BAÑEZ

City Government Department Head II
ENGR. SAMUEL P. SALVADOR CITY BUILDING OFFICIAL
Chief, Processing and Enforcement Division
Date: _____________________
Date: _________________________