BUILDING SERVICES SHUTDOWN REQUEST

H:\Airport Development\SHUTDOWNS-HWP - CIA\Forms\2013 Forms\Word Format 2013\External Services Shutdown 2013.docx

For Office Use Only Permit #

EXTERNAL SERVICES SHUTDOWN REQUEST

Date: Send Request To: Project Name:

Original Request: Revised Request:

Planning & Engineering

Email: permits@yyc.com

Project Number:

Calgary Airport Authority Contact:

CIP Number:

Company Requesting Shutdown: Name: Email: Phone: Cell: Sub-trade Performing Work: Name: Phone: Cell:

Scope of Work to be Completed: Is work Airside Yes No

Is work is being conducted within the jurisdiction of: City of Calgary MD of Rockyview

Has the City of Calgary/Municipality been notified? Yes No System Shutdown Requested: Domestic Water Supply Electrical Distribution Sanitary Sewer System Telecommunications Storm Water Collection System Shaw Cable

Airfield Electrical Lighting PLH Fuel Lines Roadway Work – pedestrian, vehicle ATCO Gas Line Other (Describe)

Security Escort Required: Yes No If yes, submit Security Escort Form (see YYC.com) Request Submitted

Requested Date of Shutdown: Maximum 1 week Start: End:

Requested Time of Shutdown: 24 hour clock MUST be used

Start Time:

End Time: