Fillable Electrical Permit Contractor Application (City of Victoria)

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Electrical Permit Contractor Application (City of Victoria)

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March 11, 2021 0006TEMPL ELECTRICAL PERMIT APPLICATION CONTRACTOR 1
Permits and Inspections Division
1 Centennial Square
Victoria, BC V8W 1P6
T 250.361.0344
E permits@victoria.ca
www.victoria.ca
Electrical Permit
Application
Contractor
Site Address:
Contractor/Company:
Contractor/Company Address:
Email:
BP No.: MyCity:
Phone:
UNIT NUMBER STREET
4 DIGIT ACCESS CODE
NAME
REGISTRATION NUMBER
UNIT NUMBER STREET CITY PROVINCE POSTAL CODE
PERMIT AND CORRESPONDENCE WILL BE SENT TO THIS EMAIL
Field Safety Representative:
NAME
FSR NUMBER
Job Value: $
Signature:
Permit Fee: $
INCLUDE ALL MATERIALS & LABOUR SEE PAGE 2 FOR PERMIT FEE APPLICANT/CONTRACTOR
Permit Type (Note: for different types of work, use separate forms)
□
Electrical Installation (see Page 2)
□
SFD Security Alarm Systems, Pre-wire ($36)
□
Residential Survey ($40)
□
Temporary Construction Permit ($40)
□
Complete SFD Alarm Systems ($61)
□
Non-residential Survey ($66)
□
Other or Special Permits (refer to Bylaw 01-43)
□
Non-SFD Alarm Systems (see Page 2)
Category of Work:
□ Residential □ Retail □ Office □ Café/Restaurant □ Warehouse/Manufacturing □ Assembly
I am submitting this application for an Electrical Permit as agent for and with the consent and knowledge of the owner of the property to which the
Electrical Permit applies. I have read and understand the Waiver, Release and Indemnification Agreement on the reverse side of this Permit Appli-
cation Form, and by signing this Permit Application Form, I agree to all of the terms contained in the Waiver, Release and Indemnification Agree-
INITIALS
□ Added value and revised scope of work (please describe above)
Detailed Description of Electrical Installation: (include part of building and all scope of work)
Service Volts Amps
Plans and load calculations at time of, or prior to, making application for
permit as follows:
1) Installations in excess of 750 volts
2) Load calculations for change of use or increased load
3) Installations in hazardous locations
4) For fire alarm and electromagnetic locks, engineering drawings and Letters
Existing
New
OFFICE USE ONLY EP NO.
This application is not a permit and does not authorize the commencement of this work.
TURN OVER
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signature
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March 11, 2021 0006TEMPL ELECTRICAL PERMIT APPLICATION CONTRACTOR 2
Total value of installa-
tion (all work)
Fee
Total value of installa-
tion (all work)
Fee
$1.00 - 300 $36
$701 - 1000 $61
$301 - 500 $43
$1001 – 20,000 $61
$501 - 700 $50
($61 +$20 for every
$1000 over $1001)
+
$20,001 or more (Base rate of $441 plus 1.25% of total
value over $20,001)
$441 +
1.25%
Calculation of Fees:
WAIVER, RELEASE AND INDEMNIFICATION AGREEMENT
BY SUBMITTING THIS PERMIT APPLICATION, YOU ARE GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING
THE RIGHT TO SUE, AND ASSUMING CERTAIN OBLIGATIONS, SUCH AS THE OBLIGATION TO INDEMNIFY
THE CITY OF VICTORIA
PLEASE READ THE FOLLOWING PROVISIONS CAREFULLY
In consideration and as a condition of the City of Victoria (the “City”) granting the Electrical Permit being applied for (the “Permit”),
the Applicant agrees as follows:
Waiver – I hereby waive any and all claims whatsoever that I may have, or may have in the future, against the City, its
directors, officers, elected officials and employees (collectively, the “Releasees”) as a result of the issuance of the
Permit or any work undertaken pursuant to the Permit or for any inspection or other action undertaken as a result of
the Permit, due to any cause whatsoever, including but not limited to negligence or breach of any statutory or other
duty of care.
Release – I/we hereby remise, release and forever discharge the Releasees from any and all claims, actions, demands,
obligations, liabilities, costs and expenses whatsoever, whether direct or indirect, including without limitation with
respect to any damage to person or property, that I may suffer or incur, due to any cause whatsoever including neg-
ligence or breach of any statutory or other duty of care, as a result of the issuance of the Permit or any inspection or
action undertaken by the City as a result of the Permit.
Indemnity – I hereby agree to indemnify and hold harmless the Releasees from and against any and all claims, actions,
demands, obligations, liabilities, costs or expenses whatsoever and howsoever arising, including arising out of or
with respect to any damage to any person or property incurred by myself, the party for whom I act as agent, or any
other party, which may in any way arise or accrue against the Releasees as a result of or incidental to the issuance
of the Permit.
No Representations, Warranties or Guarantees –The City has not made any representations, warranties or guaran-
tees with respect to any matter relating to the Permit or any work to be undertaken pursuant to the Permit, including
without limitation compliance with City bylaws or any other provincial or federal act or regulation in force in the City.
I hereby agree that I will be solely responsible for ensuring that all work carried out pursuant to the Permit is in com-
pliance with all applicable City bylaws and any other provincial or federal act or regulation in force in the City. I fur-
ther agree that I do not rely on the City to notify me of any defects in this permit application or supporting documen-
tation and that any inspection or other actions undertaken by the City are not intended to ensure and will not ensure
that any work complies with the applicable City bylaws or any other provincial or federal act or regulation in force in
the City.
I agree to conform to all applicable requirements of City of Victoria bylaws and all other applicable provincial or federal
statutes in force in the City of Victoria.
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Electrical Permit Contractor Application (City of Victoria)

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Completed 5 April 2021

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