insulation disclosure form

BUILDING AND PLUMBING CODE REGULATION BYLAW NO. 583-2018

Information

Company Name(Required)

Phone(Required)

Installer & Certification #(Required)

Property Information

Permit No.(Required)

Job Site Address(Required)

Street Address City Province Postal Code

Owner's Name(Required)

First Last

Consent

Job sheet required to be submitted prior to occupancy permit

Initial(Required)

I hearby confirm that (check all that apply):(Required)

CAN/CGSB-51.25-M “Thermal Insulation, Phenolic, Faced”

CGSB 51-GP-27M “Thermal Insulation, Polystyrene, Loose Fill”

CAN/ULC-S701 “Thermal Insulation, Polystyrene, Boards and Pipe Covering”

CAN/ULC-S702 “Mineral Fibre Thermal Insulation for Buildings”

CAN/ULC-S703 “Cellulose Fibre Insulation (CFI) for Buildings”

CAN/ULC-S704 “Thermal Insulation, Polyurethane and Polyisocyanurate, Boards, Faced”

CAN/ULC 706 “Wood Fibre Thermal Insulation for Buildings”

Initial(Required)

I hereby certify that the installation of all insulation at the address as indicated above is installed and tested in accordance with Section 9.25 and Section 9.36 of the current B.C. Building Code. Completion of this form in no way waives responsibility to request inspection by the Authority Having Jurisdiction.

Installer Name(Required)

Installer Signature(Required)

Date(Required)

Personal information requested on this form is collected under the authority of Section 26 of the Freedom of Information and Protection of Privacy Act, as amended. The information gathered will be used to deliver or evaluate the program or activity of the Village of Anmore that is associated with this form. Questions about the collection, use, and disclosure of this information should be directed to village.hall@anmore.com