HomeMy WebLinkAboutGas Permit ApplicationCounty of Newell
PO Box 130
Brooks, Alberta, T1R 1B2
PH: (403) 362-3266
administration@newellmail.ca
www.countyofnewell.ab.ca
The Inspections Group Inc
2825 18 Avenue N
Lethbridge, Alberta, T1H 6T5
PH: (587) 787-4143 TF: 1 (888) 852-3558
Fax: (587) 787-4142
south@inspectionsgroup.com
www.inspectionsgroup.com
Please submit all permit applications to development@newellmail.ca for review and processing.
GAS PERMIT APPLICATION FORM
Building Permit Number (if applicable): Project Value (labour and material): $
Applicant Type: Owner Contractor Work: has not started is in progress is complete
OWNER / APPLICANT: Mailing Address:
City: Prov: Postal Code: Phone: Fax:
Cell: Email:
CONTRACTOR: Mailing Address:
City: Prov: Postal Code: Phone: Fax:
Cell: Email:
PROJECT LOCATION:
Municipality: Subdivision / Hamlet Name:
Street Address:
Legal Land Description: LSD: Part of: Section: Township: Range: West of:
Lot: Block: Plan: Tax Roll Number:
Directions:
BUILDING TYPE:
Residential
Commercial
Industrial
Institutional
Agricultural
Other (specify)
TYPE OF WORK:
New Work
Addition
Renovation, Alteration
Connection
Temporary Heat
Service
Air Test
Annual Permit
Other (specify)
SERVICE INFORMATION:
Natural Gas Propane
Project Total BTUs
NUMBER OF OUTLETS:
Furnaces
Water Heaters
Fireplaces
Dryers
Unit Heaters
Boilers
Barbecues
Ranges
Secondary Gas Lines
Other (specify)
Total Outlets
PROPANE INSTALLATION:
Propane Tank Set Only Yes No
Number of Tanks
Tank Sizes
Serial Number(s)
DESCRIPTION OF WORK:
Journeyperson’s Name (print) Journeyperson’s Certificate Number Journeyperson’s Signature Homeowner’s Signature (homeowner permit only)
I hereby declare that I am the owner of the premises where the work will be
conducted and/or currently reside or intend to reside on the property. I assume
responsibility for ensuring compliance with the applicable Act and Regulations.
OFFICE USE ONLY
PAYMENT TYPE:
Cheque Mastercard Visa Debit e-Transfer Invoice
Permit Fee: $
+ SCC Levy*: $
= Total Cost: $ Receipt #:
* $4.50 or 4% of the permit fee maximum $560.00
APPLICATION DETAILS:
Application Date:
Permit Number:
The personal information provided as part of this application is collected under the authority of the Safety Codes Act, the Municipal Government Act, and in accordance with the Protection of Privacy Act (POPA) and
the Access to Information Act (ATIA). This information is required and will be used for issuing permits, verifying and monitoring compliance with safety codes, and for property assessment purposes. Information related
to your permit application and any permit(s) issued may be disclosed as allowed or required by law. If you have any questions about the collection or use of your personal information, please contact the Privacy Officer
for the County of Newell at administration@newellmail.ca or (403) 362-3266.