H:\Airport Development\SHUTDOWNS-HWP - CIA\Forms\2010 Forms\BUILDING SERVICES SHUTDOWN REQUEST & HOTWORKS FORM.doc Page 1 of 4

For Office Use Only

Permit #

BUILDING SERVICES SHUTDOWN REQUEST

Date Requested

Original Request: Revised Request:

Send Request To:

Planning and Engineering

Fax Number:

403-735-1283

Email request to: permits@yyc.com Project Name:

CIP #

Calgary Airport Authority Contact:

Shutdown Approval Confirmation Via:

E-Mail Address:

Hand Delivery

FAX #: Company Requesting Shutdown:

Name: Ph: Cell:

Sub-trade Performing Work:

Name: Ph: Cell: Scope of Work to be Completed:

System Shutdown Requested: Sprinkler System Electrical Distribution HTHW System Fire Alarm System Domestic Water System Telecommunications

HVAC System Security Alarm System BMS Controls Xray Other (Describe)

Worksite Location:

Room/Grid#:

See Grid Map on reverse

Mezzanine Level Utilities Level Departures Level Roof Arrivals Level Airfield Other (Describe)

Security/Escort Required:

Yes No

Request Submitted

Requested Date of Shutdown:

Requested time period of Shutdown: 24 hour clock MUST be used for hours of Shutdown / X-Ray / Hot Work Start Time: End Time:

Midnight = 0000 1:00 am = 0100 2:00 am = 0200 3:00 am = 0300 4:00 am = 0400 5:00 am = 0500

6:00 am = 0600 7:00 am = 0700 8:00 am = 0800 9:00 am = 0900 10:00 am = 1000 11:00 am = 1100

12:00 pm = 1200 1:00 pm = 1300 2:00 pm = 1400 3:00 pm = 1500 4:00 pm = 1600 5:00 pm = 1700

6:00 pm = 1800 7:00 pm = 1900 8:00 pm = 2000 9:00 pm = 2100 10:00 pm = 2200 11:00 pm = 2300

H:\Airport Development\SHUTDOWNS-HWP - CIA\Forms\2010 Forms\BUILDING SERVICES SHUTDOWN REQUEST & HOTWORKS FORM.doc Page 3 of 4

H:\Airport Development\SHUTDOWNS-HWP - CIA\Forms\2010 Forms\BUILDING SERVICES SHUTDOWN REQUEST & HOTWORKS FORM.doc Page 4 of 4

For Office Use Only Permit #

HOT WORK PERMIT for Cutting, Grinding, Welding & Soldering

Applies Only to Location Specified Below This Permit Is To Be Renewed On A Daily Basis Until Completion of Work.

Inspection of area to be made immediately prior to hot work and re-inspected if work is interrupted and then restarted. Hot work to stop immediately if a power failure occurs or if the purge air flow is stopped.

PLEASE PUT IN AS MUCH DETAIL, RE: THE JOB SITE / LOCATION / TIME / DATES ETC. AS POSSIBLE. A Shutdown Request must accompany a Hot Work request.

CONTRACTOR: DATE REQUIRED: __________________ HOURS REQUIRED:

____________________________

Original Request: Revised Request: LOCATION/AREA/UNIT: AIRSIDE/GROUNDSIDE – FIRE DEPARTMENT NOTIFICATION REQUIRED: YES: NO:

BRIEF DESCRIPTION OF JOB:

Non-compliance with the conditions of issue of this HWP will result in immediate shutdown of work. A copy of the HWP must be produced to Authority staff upon request.

Yes or N/A Precautions Personal Inspection – Proper Signatures Sprinklers in service Cutting, welding and soldering equipment in safe operating condition Employees in immediate area notified and advised not to look at arc Personal protective equipment used by worker Disabling of smoke detectors ______________________ Authorized Signature Precautions within 50’ of work Combustibles relocated or protected with fire proof material (including floor surfaces) Floor swept clean of combustibles All openings in floors, walls, etc. are protected No combustible material on opposite or in the interior of metal walls, roofs, partitions, etc. Lockout procedure used. Initial __________ Fire watch in effect during and after as documented on the reverse of this permit Additional Precautions for Tanks, Containers, Piping and Enclosed Equipment or Areas Confined space entry permit approved. Initial __________ Ignition sources removed for 50’ until all flammable materials have been purged/removed Total cleaning and purging of all flammable gases, liquids and solids Connections/lines disconnected, plugged or blanked off Visual check of area by _______________________________________ Atmosphere testing meters calibrated by Initial and frequent reading of 02 (oxygen) and LEL (lower explosive levels)

Time Oxygen % LEL % Tested By

Every person welding airside must have, and be familiar with the operation of, a portable 20lb A-B-C rated fire extinguisher on site to control any small fires. This extinguisher must have been checked in the last twelve

months by a recognized company and have an inspection tag attached to it.

I have personally inspected the work area and certify that the checked precautions have been taken and the area is safe for work to proceed.Signature:

H:\Airport Development\SHUTDOWNS-HWP - CIA\Forms\2010 Forms\BUILDING SERVICES SHUTDOWN REQUEST & HOTWORKS FORM.doc Page 5 of 5

For Office Use Only PERMIT #

For Office Use Only PERMIT #

HOT WORK FIRE WATCH AND INSPECTIONS

This form must be returned to Planning and Engineering Reception

upon completion of work with applicable details filled in via: permits@yyc.com or Fax: 403-735-1283

Date

Location / Area

Person Responsible During

Person Responsible After

Yes

No

Firewatch to be provided during and after (as documented below)

Yes

No

Fire extinguisher and/or fire hose on hand

Yes

No

Fire watch and welder trained on use of fire extinguishers

Yes

No

Emergency procedures in place to quickly notify the fire department

Yes

No

Protective shields in place during work

Yes

No

Specified ventilation operational during work Work area and adjacent areas to which sparks and heat may spread (i.e. floors / areas above and below, opposite sides of walls, interior of walls, ceilings or floors) have been inspected as follows:

When Time Inspected by

During and to 60 min after end of work

4 hours after end of work