The pipeline is designed to ship up to 900,000 barrels of diluted bitumen per day from near Fort McMurray, Alta., to the Edmonton area.
Several of the conditions deal with the pipeline's route and others deal with enhanced environmental monitoring and mitigation to better protect wildlife and wetlands.
The approval follows two weeks of hearings this summer.
The hearings were boycotted by the Athabasca Chipewyan First Nation, an aboriginal group that lives in Alberta's oilsands region.
The First Nation criticized the process as too rushed and skewed in favour of the oil industry.
Landowners along the proposed route raised similar concerns.
The Grand Rapids hearing was the first by the Alberta Energy Regulator since it replaced the Energy Resources Conservation Board last year and took over duties from the province's Environment Department.
The Grand Rapids pipeline is a 50-50 partnership between TransCanada Corp. (TSX:TRP) and a unit of PetroChina.
The Athabasca Chipewyan has called it the "mother of all pipelines", with a capacity nearly double what the proposed Northern Gateway pipeline would ship to the B.C. coast.
The First Nation has said more high-profile projects such as Energy East and Keystone XL would not be able to go ahead without volumes from Grand Rapids.
TransCanada has disputed that characterization, saying Energy East and Keystone XL don't hinge on Grand Rapids being built.