Construction Data Report for Piping Systems Manufactured Outside BC Form 1330

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505 Sixth Street, Suite 200 New Westminster British Columbia V3L 0E1
Phone: (778) 396-2027 Toll Free: 1-866-566-SAFE Fax: (778) 396-2064 www.safetyauthority.ca
The information on this form is collected to administer the provisions of the BC Safety Standards Act. If you have questions about the collection, use or disclosure of this information, contact the Records, Information, and Privacy Analyst for the BC Safety Authority at telephone toll free 1-866-566-7233.
CONSTRUCTION DATA REPORT FOR PIPING SYSTEMS Manufactured Outside British Columbia
In accordance with the requirements of the Safety Regulation and CSA B51 Clause 4.8.1 & 4.16.2
1.
Constructed By:
Name of Licensed Contractor Address
Job # __________________
Provincial Licensed Contractor No: 2. 3. 4. 5. 6. Constructed For:
Name and Address
Expiry Date: ______________ Job # __________________
________
Owner and location of installation Provincial Piping Design Registration No.
Provincial reg. weld proc. nos. and company WPS nos.: ___________________________________________ ASME Code for Pressure Piping: B31.1 B31.3 ⃞ - Fluid Service Category: B31.5 ⃞ B31.9 ⃞ Nonboiler External Piping ⃞ Normal ⃞ D⃞ M⃞ Boiler External Piping ⃞ High Pressure ⃞
Other ________________________________________________________________ Revision Number
P & I D or Isometric Drawing Numbers
Line List Document Numbers
Revision Number
FRM-1330-00 (2011-03-11)
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Complete this table when Line List is not available.
Line Numbers Fluid (air,stm. etc.) Design Press (psi) Design Temp o ( F) Test Press (psi) Test Medium Pipe Spec & Grade CA (in) Pipe NPS & Schedule Flange Spec & Rating PWHT/ Preheat Temp o ( F) RT % Other NDE
Remarks: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ___________________________________________________________________________________
CERTIFICATE OF COMPLIANCE
We certify that the statements in this Data Report are correct and that the piping described in this Data Report was constructed in accordance with the applicable sections of the ASME Code for Pressure Piping and British Columbia Safety Standards Act and Regulations. Date: ______________ ____________________________ (Print) Authorized Representative __________________________________
(Signature) Authorized Representative
CERTIFICATE OF INSPECTION
I, the undersigned, employed by ____________________________________ have inspected the piping described in this construction data report and state that, to the best of my knowledge and belief, the Contractor has constructed this piping in accordance with the applicable sections of the ASME Code for Pressure Piping and British Columbia Safety Standards Act and Regulations. By signing this certificate, neither the inspector nor his or her employer makes any warranty, expressed or implied, concerning the piping described herein. Furthermore, neither the inspector nor his or her employer shall be liable in any manner for any personal injury or property damage or a loss of any kind arising from or connected with this inspection.
Date: ______________
____________________________
(Print) Provincial / Authorized Inspector
_____________________________________
(Signature) Provincial / Authorized Inspector
Note: An Authorized Inspector is a National Board Commissioned Inspector or an Inspector employed by the provincial regulatory authority in which the piping system was constructed.
FRM-1330-00 (2011-03-11)
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