Application For A Permit To Construct Or Demolish Page 4
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4Schedule 2: Sewage System Installer Information
A.
Project Information
Building number, street name
Unit number
Lot/con.
Municipality
Postal code
Plan number/ other description
B.
Sewage system installer
Is the installer of the sewage system engaged in the business of constructing on-site, installing, repairing, servicing, cleaning or
emptying sewage systems, in accordance with Building Code Article 3.3.1.1, Division C?
Installer unknown at time of
Yes (Continue to Section C)
No (Continue to Section E)
application (Continue to Section E)
Registered installer information (where answer to B is “Yes”)
C.
Name
BCIN
Street address
Unit number
Lot/con.
Municipality
Postal code
Province
E-mail
Telephone number
Fax
Cell number
Qualified supervisor information (where answer to section B is “Yes”)
D.
Name of qualified supervisor(s)
Building Code Identification Number (BCIN)
E.
Declaration of Applicant:
I
declare that:
(print name)
I am the applicant for the permit to construct the sewage system. If the installer is unknown at time of application, I shall
submit a new Schedule 2 prior to construction when the installer is known;
OR
I am the holder of the permit to construct the sewage system, and am submitting a new Schedule 2, now that the installer is
known.
I certify that:
1.
The information contained in this schedule is true to the best of my knowledge.
2.
If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.
Date
Signature of applicant
Application for a Permit to Construct or Demolish – Effective January 1, 2014
Page 4 of 4
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