Building Inspection Services, Regional District of Nanaimo
250-390-6530
6300 Hammond Bay Road, Nanaimo, BC V9T 6N2
Building@rdn.bc.ca
Revised March 5, 2020
Page 1 of 2
Building Permit Application
Legal Description:
House Number:
(If assigned)
Road
Name:
OWNER INFORMATION
Primary Contact
Name(s):
Mailing Address:
City/Prov:
Postal Code:
email:
Tel:
Cell:
AGENT INFORMATION Primary Contact
Name(s):
Mailing Address:
City/Prov:
Postal Code:
email:
Tel:
Cell:
CONSTRUCTOR INFORMATION Primary Contact
Name(s):
Plumber
T.Q. #:
Company Name:
Mailing Address:
City/Prov:
Postal Code:
email:
Tel:
Cell:
REQUIRED DOCUMENTS
Certificate of Title (dated within two days of application, including copies of registered covenants, easements and right of
ways), missing documents can be obtained by staff, but additional fees will apply
NO
Agent Authorization
N/A
Preliminary Planning Department Review
NO
Site Plan, two sets complete with all buildings, measurements & setbacks, driveway access
NO
Construction plans two sets of drawings (two sets sealed by P Eng if applicable)
NO
Demolition, Addition, Alteration or Repair of a structure built prior to 1990?
NO
Truss layout c/w factored concentrated loads
NO
BC Building Code Letters of Assurance complete with proof of liability insurance from Professional Engineer(s)
N/A
Residential builder “BC Housing Registration Form” or Owner Builder “New Home Registration Form” (for new dwellings)
N/A
Pre-construction BC Energy Compliance report (Performance paths for Part 9 Buildings)
N/A
Hazardous Materials Declaration for pre 1990 buildings
N/A
Sewerage Filing or Registered Practitioner’s (ROWP) report
N/A
Improvement District Water Service Area Declaration
N/A
Alternate Solution
N/A
Manufacturer’s specification sheet, for mobile or modular home
N/A
Mobile or modular home certification standard and number:
CSA - Z240
CSA - A277
CSA No:
PROPOSED CONSTRUCTION
Detailed scope
of work:
Value of construction
$
Building Area:
Number of stories:
Number of bedrooms:
New Dwelling Commercial
Addition Secondary Suite Industrial
Renovation Accessory Dwelling Institutional
Demolition Manufactured Home Multi-Residential
Moved on Building Accessory Building Other
Plumbing Fire Suppression System Other
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CONSTRUCTION DETAILS (must be shown on plans)
Woodstove Slab Heating System:
Factory fireplace Crawl space Electric Baseboard
Masonry fireplace Finished Basement Heat Pump
Gas fireplaces Unfinished Basement Forced Air
Gas appliances Other In-floor Radiant
Masonry chimney Not applicable None
Factory Built chimney
Not applicable
Electrical fixtures
Plumbing fixtures
Heating Appliance
Garage
Carport
Decks
Verandahs
Retaining Walls
Not applicable
SITE INFORMATION
Has or will blasting be carried out on the subject property?
YES
No
Has or will fill been placed on site?
YES
No
Distance to North Lot Line (metres):
Distance to South Lot Line (metres):
Distance to East Lot Line (metres):
Distance to West Lot Line (metres):
Building Height
Building Separation
Property Contains and/or Adjacent to:
Sea Lake/Pond River/Stream
Ditch Cliff/Bank None
Acknowledgement of Responsibility and Undertakings
The undersigned being the owner/agent for the owner of the property herein described hereby makes application for a permit to undertake
the work as set forth in this application. I agree to conform to all requirements as may be specified by the Regional District of Nanaimo Building
Bylaw and any other applicable Bylaw or Regulation in force in the Regional District of Nanaimo.
Neither the issuance of the Permit nor the approval of the drawings and specifications submitted as part of this application, by the Regional
District of Nanaimo Building Inspection Department or designates thereof, shall, in any way relieve the applicant from the responsibility of
ensuring the construction for which this permit issued, is carried out in conformity with the requirements of the Building Bylaw and any other
applicable Bylaws and Regulations, nor prevent the Building Inspector, or his designate from requiring correction of any errors in construction
or violation of the Building Bylaw or other applicable Bylaw or Regulations.
The issuance of a building or occupancy permit is not a warranty that the building complies in every respect with the Building Code or meets
any particular standard of construction, and that the owner is responsible for ensuring that the building for which application is made complies
with the Building Code and other applicable enactments.
The undersigned owner/authorized agent of the owner makes an application as specified herein, and declares that the information submitted in
support of the application is true and correct in all respects.
Owner (Signature)
(Print Name)
(Date)
Personal information collected on this form is collected for the purposes of processing this building permit application and for administration and enforcement. The
personal information is collected under the authority of the Local Government Act, the Regional District’s Building Bylaw and pursuant to section 26 of the Freedom
of Information and Protection of Privacy Act.
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