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Electronics Permit
TIEZA application form for electronic permit
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: NBC FORM NO. A - 07
Tourism Infrastructure and Enterprise Zone Authority
Office of the Building Official
ELECTRONICS PERMIT
APPLICATION NO.
BUILDING PERMIT NO.
ELP NO
BOX 1 (TO BE ACCOMPLISHED PRINT BY THE OWNER/APPLICANT)
OWNER/APPLICANT
LAST NAME
FOR CONSTRUCTION OWNED
BY AN ENTERPRISE
ADDRESS:
NO.,
M.I.
FORM OF OWNERSHIP
STREET,
LOCATION OF CONSTRUCTION:
FIRST NAME
BARANGAY,
TIN
USE OR CHARACTER OF OCCUPANCY
CITY/MUNICIPALITY
ZIP CODE
TELEPHONE NO
LOT NO. _______________ BLK NO. ________________ TCT NO. ______________________ TAX DEC. NO. ____________________
STREET___________________ BARANGAY ____________________________________________________ CITY/ MUNICIPALITY OF________________________________
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
CONTROLS AUTOMATION SYSTEM
BROADCASTING SYSTEM
SOUND COMMUNICATION SYSTEM
TELEVISION SYSTEM
CENTRALIZED CLOCK SYSTEM
BUILDING AUTOMATION MANAGEMENT AND
CONTROL SYSTEM
INFORMATION TECHNOLOGY SYSTEM
SOUND SYSTEM
SECURITY AND ALARM SYSTEM
ELECTRONICS CONTROL AND CONVEYOR SYSTEM
BUILDING WIRING UTILIZING COPPER CABLE,
FIBER OPTIC CABLE OR OTHER MEDIAL
ELECTRONICS SYSTEM
ANY OTHER ELECTRONICS AND I.T. SYSTEMS, EQUIPMENT, APPARATUS, DEVICE AND/OR COMPONENT (Specify) __________________________________
PREPARED BY ___________________________________________________________________________________________________________
BOX 3
BOX 4
DESIGN PROFESSIONAL, PLANS AND SPECIFICATIONS
SUPERVISOR / IN-CHARGE OF ELECTRONICS WORKS
Date____________
Date____________
PROFESSIONAL ELECTRONICS ENGINEER
(Signed and Sealed Over Printed Name)
PROFESSIONAL ELECTRONICS ENGINEER
(Signed and Sealed Over Printed Name)
Address
Address
PRC. No
PRC. No
Validity
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)
Date___________________
Address
C.T.C. No.
(Signature Over Printed Name)
Date___________________
Address
Date Issued
Place Issued
C.T.C. No.
Date Issued
Place Issued
BOX 7 TO BE ACCOMPLISHED BY THE PERMITS AND LICENSES DIVISION
RECEIVED BY:
DATE:
FIVE (5) SETS OF 20”X30” & ONE (1) A3 OF ELECTRONICS DOCUMENTS
ELECTRONICS PLANS AND SPECIFICATIONS
COST ESTIMATES
BILL OF MATERIALS
OTHERS (Specify) ____________________________________
BOX 8
PROGRESS FLOW
IN
DATE
OUT
TIME
DATE
TIME
PROCESSED BY:
ELECTRONICS
OTHERS (Specify)
BOX 9
ACTION TAKEN:
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 duly 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 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 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.
PERMIT ISSUED BY:
BUILDING OFFICIAL
(Signature Over Printed Name)
Date ____________________
