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Winnipeg:

508 - 401 York Avenue, R3C 0P8

(204) 945-3322

Fax: (204)948-2089

Brandon:

1601 Van Horne Avenue East, R7A 7K2

(204) 726-6855

Fax: (204)726-6847

Dauphin:

Box 8 27-2

Avenue, R7N 3E5

(204) 648-7413

Fax: (204)622-2309

LETTER OF ASSURANCE SCHEDULE A (PART A AND B)

PART A: ASSURANCE OF PROFESSIONAL DESIGN AND COMMITMENT FOR INSPECTION

(Both Part A and B must be submitted before issuance of a building permit.)

DATE: _

PERMIT NO:________

(Office use only)

Re: Description of Project:

The undersigned hereby gives assurance that, to the best of his/her knowledge the design of the (initial applicable

item/ or items)

Part 3 & 5 Manitoba Building Code (MBC) (Incl. MECB: Part 3)

Part 4 MBC

Part 6 MBC (Incl. MECB: Part 5)

Part 7 MBC (Plumbing) (Incl. MECB: Part 6)

Electrical (Incl. MECB: Parts 4 & 7)

Fire Suppression Systems – Automatic Sprinkler System

Exhaust & Suppression System

Fire Alarm & Detection System

Manitoba Energy Code for Building 2013 (MECB) (Coordinating Registered

Professional)

Components of the project as shown on the plans and supporting documents prepared by this registered professional

conform to all the applicable requirements of all applicable Acts, Regulations and By-laws. Further, the undersigned

will be responsible for inspections of the above-referenced components during construction, as required by Manitoba

Building Code Amendment, Article 2.2.7.2 (1) – Review of Construction.

The undersigned also assured competence in the necessary fields of expertise to undertake the project on the basis

of training, ability and expertise in the appropriate professional and technical disciplines.

As used herein, inspections shall mean such reviews of the work at the project site and at fabrication locations, where

applicable, as the registered professional, on the basis of professional discretion, considers necessary in order to

ascertain that the work conforms in all respects to the plans and supporting documents prepared by this registered

professional for which the Building Permit is issued. This includes keeping records of all site visits and any corrective

action taken as a result thereof. Copies of the inspection reports will be provided to the authority having jurisdiction

upon request.

Name (print)

Address

Telephone

Affix seal with signature and date

If the Registered Professional is a member of a firm, complete the following:

I am a member of the firm ____________________________________ and I sign this letter on behalf of myself and

the firm.

(Print name of firm)

Note: The foregoing letter must be signed by a registered professional who is registered in the Province of

Manitoba as a member in good standing in the Manitoba Association of Architects or the Association of

Professional Engineers and Geoscientists of Manitoba.

Letter Of Assurance Schedule A (Part A And B) Form - Office Of The Fire Commissioner

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