Inspection Request Form And Declaration Of Compliance
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1Inspection request Phone (604)873-7000
Inspection Request Fax (604)873-7100
Inspection Request Email: CSGInspection.Clerks@vancouver.ca
Inspection Request Form and
CONTRACTOR DECLARATION FORM
Declaration of Compliance
This Declaration is for use only when specifically authorized by the City Electrician in accordance with Sections 6.12 of
the Vancouver Electrical Bylaw #5563 and please note Electrical Safety Regulation 19(4),(6) states regulated work must
not be concealed or energized unless inspected or the inspection has been waived (VEBL No.5563).
THIS FORM MUST BE LEGIBLE AND FILLED IN CORRECTLY TO COMPLETE THE INSPECTION REQUEST PROCESS
Permit Number:EL
Installation Name:
Installation Address:
Street/Ave:
Unit no:
Bldg No:
B. LICENSED ELECTRICAL CONTRACTOR INFORMATION:
Contractors Name:
License No:
Phone:
Fax:
Mobile:
Email:
C. DECLARATION:
I ___________________________, a registered FSR for the above contractor declare that the regulated work under the
above mentioned permit complies with the requirements of the Safety Standards Act and Regulations and City of Vancouver
Electrical By-law.
YY MM DD
FSR No:
FSR Class:
FSR Signature:
20 ____/____/____
D. REQUEST
Electrical Service Inspection
Service type
New Service
Service Repair
Service Upgrade
Temp Service
Ground Electrode Type
Plate or Rods
Ufer
In-situ
Other:________
Service Details
Voltage (Line To Line)
Amperage
Number of Phases
Number Wires
Rough Wire Inspection
R/W Progress
All R/W is Complete
Partial R/W Only/ Location__________________________________________________________________
R/W Details
Ceiling(T-bar)
Pool / Spa Bonding
Raised Floor
Wall(s)
W
a
Slab/Underground
Other: ______________________________________________________________
l
l
Final Inspection
(
All work is Completed (Requesting permit to be closed, no further inspection to be requested)
s
)
The Electrical Installation is left in a safe condition
Partial Final Only (Permitted for Occupancy only)
Partial Final Location_______________________________________________
Permit extension only. Work is in progress and installation is safe (this is not an inspection request)
All non-compliances identified of 20 __________Month __________ Day __________ have been corrected and a re-inspection is
requested.
E. ADDITIONAL REMARKS
Accepted by the City Electrician
YYYY
MM
DD
(DEI’s_______________________________________________________)
_______/ _______/ _______
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