Fillable Electrical Contractors Authorization Planning and Development Department T (City of Victoria)

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Electrical Contractors Authorization Planning and Development Department T (City of Victoria)

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To the Chief Electrical Inspector:
A. Installation
Electrical Permit No.: _________________________________________________________________
Installation name: ____________________________________________________________________
Address: ______________________________________________________________________________
B. Registered Electrical Contractor
Name: ______________________________________________________________ Registration No.: ______________________________________________
Phone: ____________________________ Fax: __________________________ Email: _________________________________________________________
C. Declaration: To the City of Victoria (and supply authority if required)
Field Safety Representative (FSR) Number: Class:
I, ___________________________________________________ , a registered FSR for the above contractor, ensure the regulated work under the
above-mentioned permit complies with the requirements of M58 Electrical Safety Regulation, M63 Safety Standards General
Regulation, BC Electrical Code and City of Victoria electrical bylaws.
FSR Signature: Date:
YYYY MM DD
Work in progress All work is complete Occupancy Installation is safe (6 month safety check)
Rough wiring as noted below may be covered on:
Date:
YYYY MM DD
Complete Partial (specify area): ____________________________________________________________________________________________
Slab Ufer ground Underground
Electrical installation is ready for connection as noted below:
New Service Temporary Construction Service
Service Repair Service Change From: ____________________________________ To: ______________________________________
Type of ground electrode Rods Ufer Plate Other: _____________________________________________________________________
Service Characteristics
Voltage (line to line) AMPS Phase Electric Heat
V A Ø kw
Deficiencies of:
YYYY MM DD
have been corrected
Remarks:
Installation as noted above has been accepted on the basis of the
Qualification of the Electrical Contractor’s Registered Representative
Name (print):
YYYY MM DD
Electrical Safety
Inspector Signature:
Date:
White – (top copy) Applicable safety authority Green – Job site Pink – Supply authority (when applicable) White – Electrical Contractor
City of Victoria
|
ELECTRICAL CONTRACTOR’S AUTHORIZATION 1
Planning and Development Department
Permits and Inspections Division
1 Centennial Square
Victoria, BC V8W 1P6
Electrical
Contractor’s
Authorization
T 250.361.0343
F 250.385.1128
E einspections@victoria.ca
www.victoria.ca
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Electrical Contractors Authorization Planning and Development Department T (City of Victoria)

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Completed 5 April 2021

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