gas/propane permit permit - The Town of Calmar

GAS/PROPANE PERMITDate of Application: (Y/M/D)______/______/______PLEASE PRINT INFORMATION CLEARLYTYPE OFOCCUPANCY RESIDENTIAL FARM/RANCH COMMERCIAL INDUSTRIAL OILFIELD/GAS INSTITUTIONALSINGLE FAMILYAPPLICATION ONLY(No. Of Outlets)Furnace_____Water Heater _____Fireplace_____Range_____Dryer_____Room Heater _____Unit Heater _____Boilers_____Conversion _____Replacement Appliance_____Future Outlet _____# Secondary Risers _____Barbeque_____1. Name of Municipality : Town of CalmarTOWN OF CALMAR The Inspections GroupBox 75012010-111 th AvenueCalmar, AB T0C 0V0 Edmonton, AB T5G 0E6Phone: (780) 985-3604 Phone: (780) 454-5048Fax: (780) 985-3039 Fax: (780) 454-5222COMMERCIAL/INDUSTRIALAPPLICATION ONLYTotal BTU ______________Name of Gas Supplier____________________________Brief Description of Installation:________________________________________________________________________________________________________________PERMIT #:________________PROPANEINSTALLATIONNo. Of TanksTank SizeSerial # Vaporizer___________________________ Refill Centre # ofCylinders Service Line from Tankto Building Temporary Heat2. Municipal Address (if applicable) _______________________________________________________________________3. Legal: Lot_____ Block______ Plan____________ or Qtr ____ Sec____ Township____ Range____ W. of ____Meridian4. Subdivision Name (if applicable) _______________________ Lot _____ Block______ Plan _________________________5. Premises owned/occupied by_____________________________________ Telephone No. ______________________6. Does this installation require a service connection? YES NO 7. Permit Type: Residential Property Owner Certified Installer The Permit Holder hereby certifies that this installation will be completed in accordance with the Alberta Safety Codes Act andRegulations and shall be commenced within 90 days and expires after one year without an extension request.Installer Name____________________________________________________________ Installer # __________________Applicant/Contractor Name_____________________________________________________________________________Address:________________________________________City________________________Postal Code ______________Phone No.___________________ Fax No.______________________ Signature__________________________________Type of Payment: ___CASH ___CHEQUE ___OTHERGas Permit Fee $______________SCC Fee $______________SCC Fee 3.5% of Permit Fee or $4.00 (whichever is greater)AUTHORIZATIONIssuing Officer_____________________________________Designation # _____________________________________Minimum Less than or equal to $114.42 - $4.00Maximum Greater than or equal to $14,285.58 - $500.00TOTAL Permit Fees $_____________Date Issued_______________________________________Please contact The Inspections Group at the above number for inspections, allowing two working daysnoticeThe personal information provided as part of this application is collected under Sec. 39 of the Safety Codes Act and Sections 303 and 295 of the Municipal Government Act and in accordance withSection 32.c of the Freedom of Information and Protection of Privacy Act. The information is required and will be used for issuing permits, safety codes compliance verification and monitoring andproperty assessment purposes. The name of the permit holder and nature of the permit is available to the public upon request. If you have any questions about the collection or use of the personalinformation provided, please contact the Town of Calmar at the above noted address/telephone.

GAS PERMIT FEESResidential InstallationsNon-Residential InstallationsNumber ofB.T.U. PermitPermit Fee B.T.U. Input Permit FeeOutletsInput Fee1 $75.00 10,000 $75.00 210,000 $115.002 $85.00 20,000 $75.00 230,000 $115.003 $95.00 30,000 $75.00 250,000 $125.004 $115.00 40,000 $75.00 300,000 $130.005 $130.00 50,000 $85.00 350,000 $135.006 $140.00 60,000 $85.00 400,000 $140.007 $155.00 70,000 $85.00 450,000 $150.008 $170.00 80,000 $85.00 500,000 $155.009 $185.00 90,000 $85.00 550,000 $160.0010 $195.00 100,000 $95.00 600,000 $165.0011 $205.00 110,000 $95.00 650,000 $170.0012 $215.00 120,000 $95.00 700,000 $175.0013 $225.00 130,000 $95.00 750,000 $180.0014 $230.00 140,000 $95.00 800,000 $185.0015 $240.00 150,000 $100.00 850,000 $190.0016 $245.00 160,000 $100.00 900,000 $200.0017 $250.00 170,000 $100.00 950,000 $210.0018 $255.00 180,000 $100.00 1,000,000 $245.001,000,00119 $260.00 190,000 $100.00 to2,000,000$265.0020 $265.00 200,000 $110.00Over 2,000,000Add$ 5.00 per100,000BTUPropane and Small InstallationsPropane Tank Sets (New or Replacements) $ 85.00Temporary Propane/Natural Gas Heating (Includes Tank Set) $ 85.00Gas/Propane Cylinder Refill Centres $ 275.00Replacement Commercial or Industrial Appliances (per unit)1 - 400,000 BTU Input $ 140.00 per Unit400,001 - 3,000,000 BTU Input $ 220.00 per UnitOver 3,000,000 BTU Input$ 325.00 per Unit* NOTE1. Add Safety Codes Council Fee of 3.5% of Permit Fee or $4.00 (whichever is greater) toeach permit.∗ Effective April 1, 2010 - $4.50 to each permit or 4% of permit levy (whicheveris greater)2. When work has commenced without first obtaining the required permit(s); the permitfees will be doubled.