Blasting and Rock-breaking Regulation Bylaw No. 619-2023

Belcarra, British Columbia

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VILLAGE OF BELCARRA SCHEDULE "A" TO BLASTING REGULATION BYLAW NO. 619, 2023 APPLICATION FOR A BLASTING PERMIT OR ROCK-BREAKING PERMIT 1. Date: _________________________________ 2. This application is for a (check one) Blasting Permit Rock Breaking Permit 3. I, __________________________________________, of (Print full name of Owner) ________________________________________ _____________________ (Address) (Daytime Phone) am the registered Owner of the following lands: ________________________________________________________________________ (street address) ________________________________________________________________________ (legal description) 4. I hereby authorize _________________________________________________________ (Print full name of Owner's Agent) of _____________________________________________ _________________ (company name) (phone no.) to act as my agent pursuant to this bylaw. 5. The purpose of the blasting and the rock removal is (check all relevant) road and utilities utility connections house or garage coach house power pole driveway or parking area other (describe) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Village of Belcarra Blasting Regulation Bylaw No. 619, 2023 Schedule "A" - Application for a Blasting Permit or Rock-breaking Permit Page 2 of 4 6. Estimated total volume of rock to be Blasted ________________________m3 7. Expected date of starting of drilling _____________________________________ 8. Estimated start date of Blasting ________________________________________ 9. Estimated end date of Blasting ________________________________________ 10. Estimated start date of On-Site Processing of Blast Rock ____________________ 11. Estimated end date of On-Site Processing of Blast Rock _____________________ 12. The fee as required by the Village of Belcarra Fees and Charges Bylaw is enclosed. 13. The following documentation is provided in support of this application: a) a completed and signed Application; b) a title search conducted within the past 30 days for the property where the Blasting is to occur; c) a copy of a valid Blaster's Certificate issued to the Blaster by WorkSafe BC for all persons completing the Blast (the original of which must be produced for inspection if required by the Building Official); d) an Indemnification Form executed by the Owner, which will at a minimum provide that the Owner will: i. indemnify and defend the Village from all claims and damages related to or arising from the Blasting; ii. waive all claims for contribution and indemnity against the Village for losses related to or arising from the Blasting; and iii. pay for all damage that results to third party structures and property as a result of the Blasting. e) a certificate of insurance acceptable to the Building Official in the minimum amount of $5,000,000 naming as named insureds the Blaster, the Owner, and the Village providing defense and indemnity protection against all liability for property damage or personal injury arising from or relating to the proposed Blasting; f) a completed Assurance Form; g) a Blasting Plan that is prepared by or under the supervision of the Blasting Engineer that must include, without limitation, (i) a diagram of the blasting pattern; (ii) a plan indicating the full extent of the Blasting Area; (iii) the sequence of detonation and the maximum weight of explosives to be detonated per delay; (iv) the specific safety measures to be taken; (v) the specific measures taken to minimize the effect of the Blasting on third parties; (vi) Maximum Peak Particle Velocity and Frequency Response; (vii) area requiring notification to Neighbouring Owners; (viii) the Pre-Blast Inspection Area; and (ix) Placement of Blasting signage; (x) Test blasting requirements; (xi) Pre-blast survey radius; (xii) Drill log records; (xiii) Rock removal and (xiv) work sequence.; Village of Belcarra Blasting Regulation Bylaw No. 619, 2023 Schedule "A" - Application for a Blasting Permit or Rock-breaking Permit Page 3 of 4 h) a plan indicating the Blast Area; i) a plan indicating the Pre-Blast Inspection Area, and should this area be less than 100 meters from the edge of the Blast area, the Blasting Engineer must provide justification for the reduction; j) a Control Measures/Blasting Plan, prepared by the Blaster and accepted by the Registered Professional Engineer, which shall consist of a sketch of the blasting pattern and include the sequence of detonation and the maximum weight of explosives to be detonated per delay and shall specify measures designed to minimize potential injury to any person and avoid, control, or minimize the impact of the Blasting. If Blasting is not proposed within 150 meters of any structure, utility line, railway, public or private road, street, lane, driveway, or walkway, or is not expected to produce a rock cut over 3.5 metres high, then the Building Official may waive the requirement for a Control Measures/Blasting Plan. During the continuance of the permit, the Building Official may authorize amendments to the Control Measures/Blasting Plan which are approved in writing by the Registered Professional Engineer. k) a report from the Blaster detailing how drill rigs and compressors are to be muffled, note the Building Official may require use of equipment or techniques to reduce or control noise and dust levels; l) a description of any On-Site Processing of Blast Rock that is to occur including the how noise and dust is to be controlled and a schedule for the processing work, note the Building Official may require the use of equipment or techniques to reduce or control noise and dust; m) a description of the purpose of the Blasting; n) the schedule for Blasting and any planned On-Site Processing of Blast Rock prepared in a manner that will minimize the duration of the impacts of noise and dust to the adjacent areas, note the Building Official may alter the schedule to minimize the impact to the Neighbouring Owners; o) a statement of the amount of material that is proposed to be removed; p) a report on where and how notice of Blasting, the Pre-Blast Inspections, the procedure to be used to notify Neighbouring Owners and the steps a Neighbouring Owner is to take in the event that Blasting causes any damage to land or buildings on the land; q) the name and contact information for the Blasting Engineer; r) the name and contact information for the Registered Professional Engineer; and s) the permit fee and damage deposit as set out in the Fees and Charges Bylaw. The damage deposit shall be security for all requirements under this Bylaw and may be used at any time by the Village to secure completion of any of these requirements. A permit extension fee will be required for all permits that exceed their permit expiry date as determined by subsection 3.1.3. Extension will be granted from permits based on the discretion of the Building Official. Village of Belcarra Blasting Regulation Bylaw No. 619, 2023 Schedule "A" - Application for a Blasting Permit or Rock-breaking Permit Page 4 of 4 14. The information provided in Schedule "A" is certified to be correct: ___________________________________________ (Owner's name(s) __________________________________________________________________ (Owner's signature(s) or Authorized Signatory if a Corporation) _____________________________________ (Date) _________________________________________________________________ (Owner's Agent's Signature) ______________________________________ (Date) The Village of Belcarra is collecting personal information in accordance with Section 26(c) of the Freedom of Information and Protection of Privacy Act. The personal information collected on this form is collected for the purposes of processing a Blasting or Rock-Breaking permit and for administration and enforcement. Questions about the collection, use and disclosure of this information can be directed to the City's Privacy Officer at Village of Belcarra, 4084 Bedwell Bay Road, Belcarra, BC V3H 4P8. Phone 604-937-4100 or email [email protected] SIGN VILLAGE OF BELCARRA SCHEDULE "B" TO BLASTING AND ROCK-BREAKING REGULATION BYLAW NO. 619, 2023 INDEMNIFICATION FORM 1. Date: _________________________________ To: The Building Official The Village of Belcarra 4084 Bedwell Bay Road Belcarra, BC V3H 4P8 Re: ______________________________________________________________________ (Address or Description of Project Location) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ The Owner hereby agrees to indemnify and defend the Village of Belcarra and its agents and employees with respect to all actions, causes of actions, claims, demands, awards, judgments, costs and expenses (including legal fees) arising from or in any way relating to the Blasting or Rock-breaking and related activities on the above referenced property or location for which a Blasting Permit or a Rock-Breaking Permit is applied for pursuant to Blasting and Rock- Breaking Regulation Bylaw No. 619, 2023 including without limitation any acts or omissions of the Owner, the Blasting Engineer, the Blaster, the undersigned agent or the employees and agents or any of them . The Owner further undertakes to pay for any and all damage that results to third party structures and property as a result of the Blasting. _______________________________________________________ (Owner's name(s) _______________________________________________________ _________________ (Owner's signature(s) or Authorized Signatory if a Corporation) (Date) _______________________________________________________ _________________ (Owner's Agent signature) (Date) The Village of Belcarra is collecting personal information in accordance with Section 26(c) of the Freedom of Information and Protection of Privacy Act. The personal information collected on this form is collected for the purposes of processing a Blasting or Rock-Breaking permit and for administration and enforcement. Questions about the collection, use and disclosure of this information can be directed to the City's Privacy Officer at Village of Belcarra, 4084 Bedwell Bay Road, Belcarra, BC V3H 4P8. Phone 604-937-4100 or email [email protected] SIGN SIGN VILLAGE OF BELCARRA SCHEDULE "C" TO BLASTING AND ROCK-BREAKING REGULATION BYLAW NO. 619, 2023 ASSURANCE FORM CONFIRMATION OF COMMITMENT BY OWNER AND BY BLASTING ENGINEER 1. Date: _________________________________ To: The Building Official The Village of Belcarra 4084 Bedwell Bay Road Belcarra, BC V3H 4P8 Re: Verification of Control Measures/Blasting Plan and Monitoring of Blasting by a Blasting Engineer at: ______________________________________________________________________ (Address or Description of Project Location) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Dear Sir: The undersigned Owner has retained ___________________________as a Blasting Engineer to review a Control Measures/Blasting Plan and to monitor the Blasting as required by Blasting and Rock-breaking Regulation Bylaw No. 619, 2023 (the "Bylaw"). The Owner and the Blasting Engineer have read the Bylaw. The Owner and the Blasting Engineer acknowledge their responsibilities to each other and to notify the Building Official if the Blasting Engineer ceases to be retained by the Owner either before the date the Blasting Engineer ceases to be retained or, if that is not possible, then as soon possible. The Owner and the Blasting Engineer understand that where the Blasting Engineer ceases to be retained at any time during the project, Blasting and related work on the above project will cease until such time as: a) a new Blasting Engineer is retained, and b) a new letter in the form set out in Schedule "C" to Blasting and Rock-breaking Regulation Bylaw No. 619, 2023 is filed with the Building Official. Village of Belcarra Blasting and Rock-breaking Regulation Bylaw No. 619, 2023 Schedule "C" - Assurance Form Page 2 of 2 The Blasting Engineer hereby gives assurance that the Blasting Plan reviewed by this registered professional in support of the application for the Blasting Permit substantially complies with Blasting and Rock-breaking Regulation Bylaw No. 619, 2023 and other applicable enactment's respecting safety and meets all reasonable criteria for safety of life and property and will provide the further written assurance required by Section 3, and Section 5.6 of Blasting and Rock-breaking Regulation Bylaw No. 619, 2023. The Blasting Engineer hereby undertakes to be responsible for field reviews of the Blasting and all other obligations required in the Bylaw. The Blasting Engineer also undertakes to notify the Building Official in writing as soon as possible if the Blasting Engineer's contract for field review is terminated at any time. The undersigned Blasting Engineer certifies that he or she is licensed to practice as a registered professional engineer under the Engineers and Geoscientists Act of B.C. and is specialized in rock mechanics. Registered Professional Owner ________________________________________ _________________________________ Registered Professional's Name (print) Owner's Name (print) ________________________________________ _________________________________ (Registered Professional's Signature) (Owner's or Owner's appointed agent's signature (If Owner is a corporation the signature of a signing officer must be given here) ________________________________________ (Address) ________________________________________ ________________________________________ (affix Registered Professional's Seal above) If the Registered Professional is a member of a firm, complete the following: I am a member of the firm: _____________________________________________________________ (Name of firm) and I sign this letter on behalf of the firm. The Village of Belcarra is collecting personal information in accordance with Section 26(c) of the Freedom of Information and Protection of Privacy Act. The personal information collected on this form is collected for the purposes of processing a Blasting or Rock-Breaking permit and for administration and enforcement. Questions about the collection, use and disclosure of this information can be directed to the City's Privacy Officer at Village of Belcarra, 4084 Bedwell Bay Road, Belcarra, BC V3H 4P8. Phone 604-937-4100 or email [email protected] VILLAGE OF BELCARRA SCHEDULE "D" TO BLASTING AND ROCK-BREAKING REGULATION BYLAW NO. 619, 2023 BLASTING AND ROCK-BREAKING PERMIT BLASTING PERMIT NO. ___________ ROCK-BREAKING PERMIT NO. ____________ This permit authorizes the Blaster working for the Owner Blaster Owner _______________________________________ _________________________________ (Blaster's Name) (Owner's Name) _______________________________________ (Blasting Firm) _______________________________________ __________________________________ (Address) (Address) _______________________________________ __________________________________ (Daytime phone number) (Daytime phone number) To Blast at the following location: ___________________________________________________________________________ (Address or Description of Project Location) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ for a period of _____calendar days from the date of issue of this Blasting Permit in accordance with: Blasting Engineer Name: _______________________________________________________ Daytime contact #: _________________________ Registered Professional Engineer Name: ___________________________________________ Daytime contact #: ________________ Village of Belcarra Blasting And Rock-breaking Regulation Bylaw No. 619, 2023 Schedule "D" - Blasting Permit Page 2 of 2 Changes from the specifications referred to in the application are listed below and are part of this Permit: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Permit Approved: _______________________________ Date of Permit: ________________ Building Official Extension Approved: _____________________________ Date of Extension: ______________ Building Official The Village of Belcarra is collecting personal information in accordance with Section 26(c) of the Freedom of Information and Protection of Privacy Act. The personal information collected on this form is collected for the purposes of processing a Blasting or Rock-Breaking permit and for administration and enforcement. Questions about the collection, use and disclosure of this information can be directed to the City's Privacy Officer at Village of Belcarra, 4084 Bedwell Bay Road, Belcarra, BC V3H 4P8. Phone 604-937-4100 or email [email protected]