Gas Notification of Completion, Installation or Alteration Form 570 (PDF)

gas_notification_of_completion_installation_or_alteration_frm-0570-09.pdf38.82 KB
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Please refer to our web site, or contact one of the Regional Offices below to locate a BC Safety Authority office nearest you:
Coquitlam 604-927-2041 Fax: 604-927-2047 Kamloops 250-314-6000 Kelowna 250-861-7313 Fax: 250-861-7349 Langley 604-539-3573 Nanaimo 250-716-5200 Fax: 250-716-5212 Prince George 250-614-9972 Victoria 250-952-4444 Fax: 250-952-4458 New Westminster 505-6th Street, Suite 200, New Westminster, BC V3L 0E1 Local: 778-396-2000 Toll-Free: 1-866-566-7233 (SAFE) Fax: 1-888-660-3508 Website: Fax: 250-377-4406 Fax: 604-539-3570 Fax: 250-614-9949 Fax: 778-396-2174
Toll Free: 1 866 566-7233 (SAFE)
Installation Permit Number: Permit Holder: Contractor Name or Homeowner Name: Street Type:
(Use block letters)
On final completion of regulated work immediately deliver to a BCSA or Government Agent Office. Installation Name: Suite/ Unit: Street Name: City: Telephone: ( )
Street Number:
Contractor Licence No.: Date Signed:
I do hereby certify that I have completed the gas system under the above permit; (i) in compliance with the Safety Standards Act and Regulations, and (ii) have left the gas system in a safe operating condition. Placed in service this day of , 20
Homeowner or Gas Fitter Signature: Work Performed By (Please print): Gas Fitter Registration No.:
FRM-0570-05 (2009/10/01)