HomeMy WebLinkAboutGas Permit Application - Homeowner
Homeowner Gas Permit (GS) Application
For Single Family Dwellings Only
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City of Maple Ridge Revised 2016-10-20
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 only at: permits@mapleridge.ca
**Heat Loss Calculations are required at time of permit application for new installations only and changes in
type of heating system; or applications will not be accepted.**
DATE:
Construction Address:
Legal Description: Lot: Plan No.:
Registered Owner: Tel
Sub Type: Check One
Single Family Dwelling Detached Garden Suite Garage Accessory Building
Other , Please specify
Work Type: Check One New Adding Repair Replacing
Is the home going to contain a: Rental Suite Temporary Residential Unit N/A
**If yes then you must hire a gas contractor to do the work.**
Furnace BTU’s # of Appl. Dryer BTU’s # of Appl.
Hot Water Htr BTU’s # of Appl. Space Heater BTU’s # of Appl.
Boiler BTU’s # of Appl. Log Lighter BTU’s # of Appl.
Range BTU’s # of Appl. Pool Heater BTU’s # of Appl.
F/P Complete BTU’s # of Appl. Roof Top Unit BTU’s # of Appl.
F/P Only BTU’s # of Appl. Unit Heater BTU’s # of Appl.
F/P Piping Only BTU’s # of Appl. U/G Gas Line BTU’s # of Appl.
BBQ BTU’s # of Appl. Fire Pitt BTU’s # of Appl.
Wall Htr BTU’s # of Appl. Other BTU’s # of Appl.
Applicants Name: Applicants Phone #:
Applicants email: Permit No.:
Applicant’s Signature________________________ Permit Fee: $
PLEASE TURN PAGE OVER
Office use only:
Homeowner Gas Permit Statutory Declaration
For Single Family Dwellings Only
Page 2 of 2
City of Maple Ridge Revised 2016-10-20
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 only at: permits@mapleridge.ca
IN THE MATTER OF AN application for a gas permit, I
(Please Print)
DO SOLEMNLY DECLARE:
THAT, I am the owner or one of the owners of lands and premises located at:
(Street Address)
THAT, I solemnly declare that said building is a "Single Family Dwelling";
THAT, I reside or intend to reside at the premises described in paragraph 2 and hereby apply for a
permit to do certain GAS work therein;
THAT, the GAS work will not be carried out by anyone other than myself or other owners of the lands
and premises;
THAT, no person shall be paid to assist me in doing the work under this permit;
AND I MAKE this solemn declaration conscientiously believing it to be true and knowing it to be of the
same force and effect as if made under oath and by virtue of the "Canada Evidence Act".
DECLARED before me at the City of Maple Ridge, in the Province of British Columbia.
Date: Registered Owner’s Signature
Witness