Fillable Application for a Permit to Construct or Demolish (City of London, Ontario)

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Application for a Permit to Construct or Demolish (City of London, Ontario)

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Application for a Permit to Construct or Demolish
This form is authorized under subsection 8(1.1) of the Building Code Act,1992
For use by Principal Authority
Application number:
Permit number (if different):
Date received:
Roll number:
Application submitted to:
(Name of municipality, upper-tier municipality, board of health or conservation authority)
A. Project information
Building number, street name
Unit number
Lot/con.
Municipality
Postal code
Plan number/other description
Area of work (m
2
)
B. Purpose of application
New construction Addition to an Alteration/repair Demolition Conditional
existing building Permit
Proposed use of building
Current use of building
Description of proposed work
C. Applicant Applicant is: Owner or Authorized agent of owner
Last name
First name
Corporation or partnership
Street address
Unit number
Lot/con.
Municipality
Postal code Province
E-mail
Telephone number
( )
Fax
( )
Cell number
( )
D. Owner (if different from applicant)
Last name
First name
Corporation or partnership
Street address
Unit number
Lot/con.
Municipality
Postal code
Province
E-mail
Telephone number
( )
Fax
( )
Cell number
( )
Application for a Permit to Construct or Demolish – Effective January 1, 2014
City of London
City of London
Project will require construction or alteration of a septic system (if yes, download and complete Schedule 2.
CoL form no. 0839 (rev.2018.06)
Page 1 of 3
Application for a Permit to Construct or Demolish – Effective January 1, 2014
E. Builder (optional)
Last name
First name
Corporation or partnership (if applicable)
Street address
Unit number
Lot/con.
Municipality
Postal code
Province
E-mail
Telephone number
( )
Fax
( )
Cell number
( )
F. Tarion Warranty Corporation (Ontario New Home Warranty Program)
i. Is proposed construction for a new home as defined in the Ontario New Home Warranties
Plan Act? If no, go to section G.
Yes
No
ii. Is registration required under the Ontario New Home Warranties Plan Act?
Yes
No
iii. If yes to (ii) provide registration number(s):
G. Required Schedules
i) Attach Schedule 1 for each individual who reviews and takes responsibility for design activities.
ii) Attach Schedule 2 where application is to construct on-site, install or repair a sewage system.
H. Completeness and compliance with applicable law
i) This application meets all the requirements of clauses 1.3.1.3 (5) (a) to (d) of Division C of the
Building Code (the application is made in the correct form and by the owner or authorized agent, all
applicable fields have been completed on the application and required schedules, and all required
schedules are submitted).
Payment has been made of all fees that are required, under the applicable by-law, resolution or
regulation made under clause 7(1)(c) of the Building Code Act, 1992, to be paid when the
application is made.
Yes
Yes
No
No
ii) This application is accompanied by the plans and specifications prescribed by the applicable by-law,
resolution or regulation made under clause 7(1)(b) of the Building Code Act, 1992.
Yes
No
iii) This application is accompanied by the information and documents prescribed by the applicable by-
law, resolution or regulation made under clause 7(1)(b) of the Building Code Act, 1992 which enable
the chief building official to determine whether the proposed building, construction or demolition will
contravene any applicable law.
Yes
No
iv) The proposed building, construction or demolition will not contravene any applicable law.
Yes
No
I. Declaration of applicant
I declare that:
(print name)
1. The information contained in this application, attached schedules, attached plans and specifications, and other attached
documentation is true to the best of my knowledge.
2. If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.
Date Signature of applicant
Personal information contained in this form and schedules is collected under the authority of subsection 8(1.1) of the Building Code Act, 1992, and will be
used in the administration and enforcement of the Building Code Act, 1992. Questions about the collection of personal information may be addressed to: a)
the Chief Building Official of the municipality or upper-tier municipality to which this application is being made, or, b) the inspector having the powers and
duties of a chief building official in relation to sewage systems or plumbing for an upper-tier municipality, board of health or conservation authority to whom
this application is made, or, c) Director, Building and Development Branch, Ministry of Municipal Affairs and Housing 777 Bay St., 2nd Floor. Toronto, M5G
2E5 (416) 585-6666.
Page 2 of 3
Application for a Permit to Construct or Demolish – Effective January 1, 2014
Schedule 1: Designer Information
Use one form for each individual who reviews and takes responsibility for design activities with respect to the project.
A. Project Information
Building number, street name
Unit no.
Lot/con.
Municipality
Postal code
Plan number/ other description
B. Individual who reviews and takes responsibility for design activities
Name
Firm
Street address
Unit no.
Lot/con.
Municipality
Postal code Province
Telephone number
( )
Fax number
( )
Cell number
( )
C. Design activities undertaken by individual identified in Section B. [Building Code Table 3.5.2.1. of
Division C]
HVAC – House Building Structural
Small Buildings Building Services Plumbing – House
Large Buildings Detection, Lighting and Power Plumbing – All Buildings
Complex Buildings Fire Protection On-site Sewage Systems
Description of designer’s work
D. Declaration of Designer
I declare that (choose one as appropriate):
(print name)
I review and take responsibility for the design work on behalf of a firm registered under subsection 3.2.4.of Division
C, of the Building Code. I am qualified, and the firm is registered, in the appropriate classes/categories.
Individual BCIN:
Firm BCIN:
I review and take responsibility for the design and am qualified in the appropriate category as an “other designer”
under subsection 3.2.5.of Division C, of the Building Code.
Individual BCIN:
Basis for exemption from registration:
The design work is exempt from the registration and qualification requirements of the Building Code.
Basis for exemption from registration and qualification:
I certify that:
1. The information contained in this schedule is true to the best of my knowledge.
2. I have submitted this application with the knowledge and consent of the firm.
Date Signature of
Designer
NOTE:
1. For the purposes of this form, “individual” means the “person” referred to in Clause 3.2.4.7(1) (c).of Division C, Article 3.2.5.1. of Division C, and
all other persons who are exempt from qualification under Subsections 3.2.4. and 3.2.5. of Division C.
2. Schedule 1 is not required to be completed by a holder of a license, temporary license, or a certificate of practice, issued by the Ontario Association of
Architects. Schedule 1 is also not required to be completed by a holder of a license to practise, a limited license to practise, or a certificate of
authorization, issued by the Association of Professional Engineers of Ontario.
E-mail
House
Check all that apply.
Page 3 of 3
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Application for a Permit to Construct or Demolish (City of London, Ontario)

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Completed 8 April 2022

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