Design Registration Application (CRN/PRN/BCLD) Form 1171

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British Columbia Safety Authority Engineering & Research, Operations Design Registration Suite 200, 505 Sixth Street New Westminster, BC V3L 0E1
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Phone: (778) 396-2027 Fax: (778) 396-2064 www.safetyauthority.ca
APPLICATION FOR CANADIAN REGISTRATION NUMBER (CRN)
The information on this form is collected to administer the provisions of the BC Safety Standards Act. If you have any questions about the collection and use of this information, contact the Records, Information, and Privacy Analyst for the BC Safety Authority at telephone 1-866-566-7233.
If information about this design was submitted subsequent to this application, please provide Journal No. CRN Application must include the following:
• For Reciprocal Registration - proof of initial registration in another jurisdiction. CRN (attached) CRN to follow (note 4) • For Fitting Registration - properly completed BC Statutory Declaration or an accepted copy of Statutory Declaration from initial regulatory authority.
Section A – Billing Customer:
Company Name Address Province/State Email Postal/Zip Code Phone #
Date of Application:
Contact Name City/Town Billing Reference # Fax #
Section B – Submitted By:
Company Name Address City/Town Email
Same as Section A
See below
Contact Name
Province/State Phone #
Postal/Zip Code Fax #
Section C – Register To:
Company Name Address City/Town Email
Same as Section A
See below
Contact Name
Province/State Phone #
Postal/Zip Code Fax # Revision #
Section D – Additional Information:
Drawing # Title Applicant's reference (job#, file#, etc.)
Section E – Site / Installation Information: (for piping and used vessel submissions only)
Address Site/Building Name
Registration Type: (please check ONE) New CRN CRN RevisionUpdate New Reciprocal Reciprocal Revision/Update Repair/Alteration Used Vessel Control System
Design Category: (please check one and indicate corresponding volume or heat transfer/surface area) Pressure Vessel (Volume) Heat Exchanger (Heat Transfer) m3 Boiler (Heating Surface) NOTES:
1. 2. 3. 4.
m2 Nuclear Component
m2
Fitting
Piping System (note 2)
For more than one design, please complete a separate application and collate documents by design. Only one set of drawings, calculations & application form is required for each design submittal except for piping registrations where 2 sets of drawings together with one set of calculations & application form are required. Please provide documents in smallest, legible size.
For design submittal with incomplete documentation, file will automatically be put on Inactive Status. File will be put in the queuing system when all documents are received.
FRM -1171-03 (2010/01/27)