E2123 Final Acceptance Certificate (FAC) Pre-Request Checklist

Final Acceptance Certificate (FAC)

Pre-Request Checklist

E 2123 (R2025-07)

^{ISC: Unrestricted}

Checklist
Inspection Request

Checklist

Maintenance period - Request date is no earlier than three months before the earliest maintenance period expiration date.

Yes

N/A

If the certificate has been split into parts, the following is attached:

a) Development Commitments permission documentation.

Yes

N/A

File Attachment (max 1MB)

b) Approved revised boundary drawings.

Yes

N/A

File Attachment (max 5MB)

The utility has been inspected by the representative of the Consulting Engineering Firm (both named below) and found to be constructed to approved drawing, specifications and requirements.

Yes

N/A

Consulting Engineering Firm

Name of Representative

Any Development Field Orders issued after CCC release are resolved.

Yes

N/A

Email(s) documenting Subdivision Development Inspections acceptance of Consultant's response(s) to all Development Field Orders are attached.

Yes

N/A

File Attachment (max 1MB)

CCTV/Deflection Testing package c/w Declaration Letter has been submitted to Subdivision Development Inspections

Yes

N/A

Outstanding non-essential concrete test results have been reviewed, found acceptable, and are submitted.

Yes

N/A

Service Cards have been submitted to WA-ServiceFAC@calgary.ca, approved.

Yes

N/A

Approval email is attached.

Yes

N/A

File Attachment (max 1MB)

I, the undersigned, certify that all checklist requirements have been reviewed and all statements made herein are correct. I understand incomplete or substandard items will result in additional delays in processing.

Name

Signed Name

Cell #

999-999-9999

The maximum file sizes are outlined for each attachment. The total size of all attachments must be less than 14 MB or the form will not submit. If your file(s) exceed 14 MB, complete this form and email your attachments directly to WaterUtilityInspections@calgary.ca.

File Attachment (max 5MB)

The personal information on this form is being collected pursuant to section 4 (c) of the Protection of Privacy Act for the purpose of Subdivision Development Inspections. It may be used to conduct ongoing evaluations of services received from Planning & Development Services. This information may be used in an automated system to generate content or make decisions, recommendations or predictions. You may direct questions about the collection, use or disclosure of your personal information by the City of Calgary at 800 Macleod Trail SE Calgary, Alberta in relation to this program by contacting the Access and Privacy Program Administrator for Planning and Development Services through telephone at 403-268-5311 or by writing to PO Box 2100, Station M, Calgary, AB T2P 2M5.

Inspection Request

First Request

Re-Inspection Request

Site Info

Date

YYYY-MM-DD

Subdivision

Phase #

Developer

DA#

CD#

Check all that need inspection:

Storm Sewer Mains & Manholes

Sanitary Sewer Mains & Manholes

Water Main Valves & Hydrants

Sewer & Water Service Connections (single family residential)

Stormwater Re-Use (Irrigation)

Paved Roads (PDS Underground Portion)

Sidewalk Curb & Gutter (PDS Underground Portion)

Paved Lanes (PDS Underground Portion)

Graveled Lanes (PDS Underground Portion)

Paved Lanes w/ Graveled Portions (PDS Underground Portion)

Stormwater Storage Facilities (Ponds)

Surface Drainage Facilities

Regional Pathways (PDS Underground Portion)

Text Box