Name of Company:

Project Title:

Location:

Contractor:

Type of Application: Electronics Permit to Operate

QUANTITIES:

Communication Equipment

Unit/s (no. of ports)

Unit/s (no. of ports) Main Distribution Frames

Unit/s (no. of ports) Intermidiate Distribution Frame

Unit/s (no. of ports)

Unit/s (no. of ports)

Unit/s (no. of ports)

Unit/s (no. of ports)

Unit/s (no. of ports)

Unit/s (no. of ports)

General Santos City

Cordless/Wireless Telephone Communication System

Intercommunication system

Switch/Hub

PABX/PBX's

Central Office Switching Equipment

DESCRIPTION/DETAILS

Remote Switching Units

Concentrators

Office of the Building Official

ELECTRONIC DATA SHEET

Signature and Dry Seal of PECE in every page

Unit/s (no. of ports)

Unit/s (no. of ports)

Unit/s (no. of ports) Patch Panel

Unit/s Server (IT/Telecommunication)

Unit/s Workstation

Unit/s Voice and Data Outlets

Unit/s Telephone Outlets

Unit/s Telephone Handset/Slave

Unit/s Wifi Access Point

Others:(please specify)

Unit/s

Unit/s

Unit/s

Audio/Visual System

Unit/s Neon Sign Unit/Signage

Unit/s Monitors (LCD, CRT, Plasma, etc)

Unit/s Projector

Unit/s Paging System Amplifier

Unit/s Paging System Switcher

Unit/s Matrix Controller

Unit/s Speakers

Terminal/s Conference System

Others:(please specify)

Unit/s

Unit/s

Unit/s

Switch/Hub

Router

Signature and Dry Seal of PECE in every page

Name of Company:

Project Title:

QUANTITIES:

Photography and Reproduction Machines

Unit/s Printers

Unit/s Photo Machines

Unit/s Plotters

Unit/s Image Scanners

Others:(please specify)

Unit/s

Unit/s

Unit/s

Imaging Equipment

Unit/s X-ray Machines

Unit/s Ultra Sound

Unit/s Magnetic Resonance Imaging

Others:(please specify)

Unit/s

Unit/s

Unit/s

Location/Direction Finding System

Unit/s GPS

Unit/s Land Navigation Equipment

Unit/s Aeronautical Navigational Equipment

Others:(please specify)

Unit/s

Unit/s

Unit/s

Antenna Towers

Unit/s Single Pole

Unit/s Guyed Towers

Unit/s Three-legged Self Supporting Towers

Unit/s Four-legged Supporting Towers

Unit/s Repeaters

Others:(please specify)

Unit/s

Unit/s

Unit/s

Other Auxilliary Equipment and devices

Unit/s Automated Teller Machines

Unit/s Ticketing Machines

Unit/s Vendo Machines

Unit/s Telephone Booths/Pay Phones

Unit/s Coin Changers

DESCRIPTION/DETAILS

Signature and Dry Seal of PECE in every page

Name of Company:

Project Title:

QUANTITIES:

Safety System Equipment and Monitoring Devices

Terminal/s Access Control Main Panel

Terminal/s Access Card Reader Modules

Terminal/s Intrusion System Output Modules

Terminal/s Intrusion System Output Modules

Terminal/s Electronic Barrier System

Terminal/s Card Readers

Terminal/s Motion Sensors

Terminal/s Door Contact

Terminal/s Electro-Magnetic Locks

Terminal/s CCTV Cameras

Terminal/s Building Management System (BMS) Main Control Panel

Terminal/s BMS Humidity Sensors

Terminal/s BMS Temperature Sensor

Terminal/s BMS Actuators

Terminal/s BMS Relays

Terminal/s BMS Contactors

Terminal/s Water Leak Detection Main Control Panel

Terminal/s Water lEak Sensing Cable

Terminal/s Fire Alarm Control Panel

Terminal/s Fire Alarm Speaker/Strobe

Terminal/s Fire Alarm Electric Bell

Terminal/s Smoke and Heat Detectors

Terminal/s Firemans Intercom

Terminal/s Annunciator System

Terminal/s Watchman System

Terminal/s Burglar Alarms

Terminal/s Lighting Controls

Terminal/s Parking Management System

Terminal/s Barrier Controls

Terminal/s CATV

Terminal/s MATV

Others:(please specify)

Terminal/s

Terminal/s

Structures for Radio/TV Broadcasting, Audio/Video Recording & Simulation

Location/s Studios

Location/s Auditoriums

Location/s Theaters

Location/s Audio/Video Reproduction

Location/s Simulation

Others:(please specify)

Location/s

Location/s

DESCRIPTION/DETAILS

Signature and Dry Seal of PECE in every page

Name of Company:

Project Title:

QUANTITIES:

Communications/Electronic Centers

Location/s Transmitter

Location/s Receiver

Location/s Radio Relay

Location/s Operation and/or Maintenace Centers

Location/s Call Centers

Location/s Cell Sites

Location/s Equipment Silos/Shelters

Location/s Navigational Ads Service Centers

Location/s Radar Service Centers

Location/s Telemetry

Location/s Tests and Measurements Services Centers

Location/s Switching Centers

Location/s Control Centers

Poles and Attachments

Number of Poles

Number of Attachments

Prepared by:

PRC NO.:

Validity : Acknowledge:

IECEP NO.:

Validity :

OWNER or Authorized Representative

Important Notes:

1. Assessment of Fees and Electronic Permit shall not be processed for those with incomplete data sheets.

2. Other electronic equipment/devices not otherwise provided for this form, please submit a separate list.

3. Undeclared equipment/devices found without the appropriate permits shall be subjected to 100% surcharge.

DESCRIPTION/DETAILS

PROFESSIONAL ELECTRONICS ENGINEER

(Signature over Printed Name)

Signature and Dry Seal of PECE in every page