APPLICATION GUIDELINE

Organization Name:
Primary Contact Information:
Last / First / Middle
Telephone: / ( ) / Fax: / ( )
Mailing Address:
City/ Town / Province / Postal code
Registered Address:
(If Different than Mailing) / City/ Town / Province / Postal code
Type of Application: / (Check only one)
New Application / Modified Accreditation / Reinstatement / Name Change
Type of Organization: / (Check only one)
Municipality / Joint Municipalities / Corporation / Agency
Discipline: / (Check all applicable)
Building / Elevators / Gas / Passenger Ropeways
Electrical / Fire / Plumbing / Amusement Rides
APPLICATION FEES
# of Disciplines / Fee / Total
New Accreditation / X $150.00
Modified Accreditation / X $150.00
Reinstatement / X $150.00
Name Change / X $150.00
Total Payment Required
PAYER INFORMATION
Name: / Telephone:
(If different than Applicant)
Address:
City/ Town / Province / Postal code
PAYMENT METHOD / (Check One)
Mastercard / Visa / Debit / Cheque / Cash
Payable to Safety Code Council / Do not send cash via Mail
Card Holder Name / Card Number
Signature / Expiry Date
DECLARATION
I hereby certify that all the necessary documentation is complete and accurate.
I acknowledge that any misrepresentation or false claim made as part of this application may result in rejection or cancellation or suspension of any certificate granted. /
Printed Name: / Date:
Signature:
Municipality: / A municipality may be accredited to administer all or part of the Safety Codes Act for one or more disciplines in their jurisdictions.
Joint Municipality: / Two or more municipalities may become accredited to jointly administer all or part of the Safety Codes Act in their jurisdictions.
Corporation: / An organization seeking accreditation for the property it owns or controls is considered a corporation under the Safety Codes Act.
Agency: / An organization seeking to provide compliance monitoring services to accredited municipalities, accredited corporations or the province is required to be accredited as an agency under the Safety Codes Act.
New Application: / Initial application by a municipality, corporation, or agency to administer part(s) of the Safety Codes Act for any discipline or disciplines
Modified Accreditation: / Application by an accredited organization to change the Accreditation scope of accreditation in any discipline or disciplines.
Reinstatement: / Application to reinstate an accreditation that has been suspended or cancelled.
Name Change: / Application to change name of accredited organization. Does NOT refer to name change of contact person.
Fee Calculation: / The fee for new accreditation, modified accreditation, or organization name change is $150 PER discipline. The fee for reinstatement after suspension or cancellation is $150 PER discipline.
Payment Method: / Payments are accepted by Credit Card, Cash and Cheque. Please make cheques payable to Safety Codes Council.
Declaration: / An authorized representative must sign the application form.
NOTE: Application received without applicable fee will not be processed.
Fees will not be refunded should the application not be approved.
SEND COMPLETED APPLICATION TO:
Safety Codes Council
1000 – 10665 Jasper Ave NW
Edmonton, Alberta T5J 3S9
If you require further information, please call:
Phone: 413-0099, or toll free in Alberta 1-888-413-0099
Or visit the website at www.safetycodes.ab.ca