NBC FORM NO A - 07

Republic of the Philippines PHILIPPINE ECONOMIC ZONE AUTHORITY

ZONE OFFICE OF THE BUILDING OFFICIAL

ELECTRONICS PERMIT

APPLICATION NO. -

I I I I 1 - 1 l-m BUILDING PERMIT N.O<

I I I

PRWECTTITLE (AS INDICATED IN PLANS)

BOX 1 (TO BE ACCOMPLISHED PRINT BY THE OWNEWAPPLICANT) OWNEWAPPLICANT P W REGISTERED ENTERPRISE

I

LOCATION OF CONSTRUCTION: LOT NO. BLK NO. TCT NO. TAX DEC NO. STREET ZONE CITY/MUNICIPAUP( OF

SCOPE OF W O W 'U - -A-

n NEW INSTALLATION COST OF INSTALLATION .L -

TIN

ADDRESS: NO. STREET ZONE CITY/MUNICIPALITY ZIP CODE

I TELEPHONE NO.

I BOX 2 (TO BE ACCOMPLISHED BY THE DESIGN PROFESSIONAL)

1

t

BOX3 BOX 4

NATURE OF INSTALLATION WORKSIEQUIPMENT SYSTEM:

C] TELECOMMUNICATION SYSTEM ELECTRONICS FIRE ALARM SYSTEM C] ELECTRONICS COMPUTERIZED PROCESS CONTROLS AUTOMATION SYSTEM

C] B R W T I N G SYSTEM [7 SWND COMMWICATION SYSTEM C] BUILDING AUTOMATION MANAGEMENT AN0 TELEVIG1ON SYSTEM C] CENTW\UZED CLOCK SYSTEM CONTIlOL SYSTEM

[7 BUILDING WIRING UrILIZING COPPER CABLE, C] INFORMATION TECHNOLOGY SYSTEM SOW@ WSTEM F lER OPTIC CABLE OR OTHER MEMAL

ELECTRONCIS SMEM C] SECURITYAND ALARM SYSTEM ELECTRONICS CONTROLAND CONVEYOR SYSTEM

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DESIGN PROFESSIONAL, PLANSAND SPECIFICATIONS

Date Pmf. ELECTRONICS ENGINEER

(Sgned and Sealed edr Pnnted Name)

Address

PRC No. Valldltj

PTR No Dab Issued

Issued at TIN

ANY OTHER ELECTRONICSAND 1.T SYSTEMS, EQUIPMENT, APPARATUS, DEVICE AND/OR COMPONENT (Spedfy)

PREPARED BY

SUPERVISOR I IN-CHARGE OF ELECTRONICS WORKS

Date Pmf. ELECTRONICS ENGINEER

(Sand and Sealed Over Printed Name)

Addrass

PRC No. Valldltj

PTR No. Dete l s u d

Issuedat TIN

BOX 6

WITH MY CONSENT, LOT OWNER

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F M (5) SETS OF ELECTRONICS DOCUMENTS

I BOX7

1 ELECTRONICS PMNSAND SPECIFICATIONS COST ESTIMATES

BILLOF MATERIALS 17 OTHERS (specify)

I ( RECENEDBY:

BOX 8

DATE:

PROCESSED BY:

BOX 9

ACTION TAKEN: I 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, the National Building Code and its IRR.

2. That prior to any electronics installation, a dub accomplished prescribed "Notice of Construction" shall be submitted, to the Office of the Building Official.

3. That upon completion of the electronic works, the licensed supe~isorhn-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 electronic 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.