Application for LP Gas Installation/Alteration Permit

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Personal information on this permit application is collected under the Boiler and Pressure Vessels Act, Regulations, s. 9.19 subsection (1) as it relates directly to and is necessary for the Propane, Natural and Manufactured Gas Inspection Program. If you have any questions about this collection of personal information, you may contact the Chief Boiler Inspector, Inspection Services, 31 Gordon Drive, PO Box 2000, Charlottetown, PE C1A 7N8. Telephone: 902-368-5567.

Identification

Business/Organization Name

Contact First Name

Contact Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone 1

For example 902-555-5555

Telephone 2

For example 902-555-5555

Fax Number

For example 902-555-5555

Email Address

This is an application for an:

Provide details of the alteration

Mechanical Contractor License Number

Year License Expires

Name of LP Gas Technician

Provide the name of the technician who is responsible for the work.

LP Gas Technician’s License Number