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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: [email protected]
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:
