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REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS


OFFICE OF THE CITY BUILDING OFFICIAL
CAGAYAN DE ORO CITY
Tel. No. 858 - 2823 & 587 - 2687
EMAIL ADD. Obo.cdoinfo@gmail.com

PERMIT FOR TEMPORARY/PERMANENT SERVICE CONNECTION


PAID UNDER OR NO. ______________ PERMIT NO. ___________________
AMOUNT ________________________ _______________________________
DATE ____________________________
BOX 1
NAME OF OWNER / APPLICANT LAST NAME FIRST NAME MIDDLE NAME TIN

ADDRESS NO. STREET BARANGAY CITY/MUNICIPALITY TEL/FAX NO.

LOCATION OF INSTALLATION NO. STREET BARANGAY CITY/MUNICIPALITY

BOX 2
PURPOSE :

CONSTRUCTION OF LIGHT & POWER CEMETERY/ LIGHTING& POWER CARNIVAL FIESTA

CHRISTMAS DECORATIVE LIGHTING OTHERS (SPECIFY)


BOX 3
NUMBER OF OUTLET:

LIGHTS _________________________________________________________________SWITCHES________________________

OTHERS ___________________________________________________________________________________________________
__________________________________________________________________________
BOX 4 PERSON IN-CHARGE OF INSTALLATION
PROFESSIONAL ELECTRICAL ENGINEER REGISTERED ELECTRICAL ENGINEER REGISTERED MASTER
ELECTRICIAN
NAME PRC REG. NO. VALIDITY

ADDRESS TEL/FAX

PTR. NO. DATE ISSUED PLACED ISSUED

SIGNATURE DATE SIGNED TIN

BOX 5 OWNER / APPLICANT


NAME SIGNATURE TIN CTC NO. ________________________

DATE
ISSUED
PLACE ISSUED _________________

BOX 6
PERMIT HEREBY GRANTED TO CONNECT TEMPORARY ELECTRICAL INSTALLATION WITH
THE AUTHORIZED LOAD SPECIFIED ABOVE LOCATED AT

FOR A PERIOD _____________________________________________________ DAYS FROM DATE ________________________


AFTER WHICH THE SERVICE SHALL BE DISCONNECTED.
THIS PERMIT SHALL BE SUSPENDED OR REVOKED ANYTIME BEFORE ITS EXPIRATION
WHENEVER ALTERATIONS OR CHANGES IN THE ELECTRICAL WIRING SYSTEM RENDERED IT UNSAFE.

ELECTRICAL ENGINEER OF THE BUILDING OFFICE