HomeMy WebLinkAboutElectrical Declaration of Compliance - Contractor
Electrical Contractor Declaration of Compliance
Fax Declaration to 604-467-7461 OR E-mail to
inspectionrequests@mapleridge.ca OR send via regular mail
Page 1 of 1
City of Maple Ridge April 2016
11995 Haney Place, Maple Ridge, BC V2X 6A9 Tel: 604-467-7311 Fax: 604-467-7461
Inspection Requests: inspectionrequests@mapleridge.ca Web Site: www.mapleridge.ca Inquiries at: permits@mapleridge.ca
Installation (Please print clearly)
Permit Number: Installation Name:
Installation Address: (Unit/Suite #; Civic #; Street Name; City; Postal Code)
Notes/Work Description. You MUST enter the description of work for this particular inspection request.
Registered Electrical Contractor (Please print clearly)
Licensed Electrical Contractor(EC) Name:
License No.:
LEL-
Contact Phone #: Fax: E-mail:
Complete Mailing Address: (Unit/Suite #; Civic #; Street Name; City; Postal Code)
Declaration
Field Safety Representation(FSR) No.: CEL- FSR Class:
“I a field safety representative for the above licensed electrical contractor,
hereby declare that the electrical installation authorized under the above permit has been physically reviewed by myself
and installed to comply with the Safety Standards Act and Regulations of British Columbia.”
Field Safety Representation (FSR) Signature: Date: YYYY MM DD
□
UFER Ground
Installation □ Under Ground
Ducts □ Under Ground
Cables □ 180 Day Safety
Check □ Over Head Cables
□ Electrical installation is ready for connection as noted below:
□ New Service □ Temporary Const. Service Type of Ground electrode:
□ Service repair □ Service change □ Rods □ Plate
Voltage (line to line) AMPS Phase Electric Heat
V A Ǿ KW
□ Rough Wire as noted below is ready for inspection:
□ Complete □ Partial (specify area)___________________ □ Slab (specify area)____________________
□ Final Electrical is ready for inspection:
□ Complete □ Partial (specify area)___________________ □ Slab (specify area)____________________
□ Electrical work complete without Installation Permit in accordance with the provisions of the BC Safety Standards
Act
□ Deficiencies of: Date: YYYY MM DD Have been corrected.
Office use only:
Installation as noted above has been accepted on the basis
of the Qualification of the Electrical Contractor’s Field Safety
Representative.
Name: (Please print)
Date: YYYY MM DD Electrical Safety Officer Signature.