Electronics Permit

TIEZA application form for electronic permit

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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 ____________________