Fillable Application for a Permit to Construct or Demolish

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Application for a Permit to Construct or Demolish

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The Application for a Permit to Construct or Demolish form is 4 pages long and contains:

  • 3 signatures
  • 35 check-boxes
  • 109 other fields

Country of origin: OTHERS
File type: PDF

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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.
For use by Principal Authority
Application number:
Permit number (if different):
Date received:
Roll number:
Application submitted to:
City of Clarence-Rockland, 1560 Laurier St. Rockland, Ontario K4K 1P7
A. Project information
Building number, street name
Unit number
Lot/con.
Municipality
Plan number/other description
Project value est. $
Area of work (m
2
)
B. Applicant Applicant is:
Owner or
Authorized agent of owner
Last name
Corporation or partnership
Street address
Unit number
Lot/con.
Municipality
Province
E-mail
Telephone number
Fax
Cell number
C. Owner (if different from applicant)
Last name
Corporation or partnership
Street address
Unit number
Lot/con.
Municipality
Province
E-mail
Telephone number
Fax
Cell number
D. 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
E. Purpose of application
New construction Addition to an
existing building
Alteration/repair Demolition Conditional
Permit
Proposed use of building
Current use of building
Description of proposed work
NS
NS
NS
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. Attachments
i. Attach documents establishing compliance with applicable law as set out in Article 1.4.1.3. of Division A.
ii. Attach Schedule 1 for each individual who reviews and takes responsibility for design activities.
iii. Attach Schedule 2 where application is to construct on-site, install or repair a sewage system.
iv. Attach types and quantities of plans and specifications for the proposed construction or demolition that are prescribed by the
by-law, resolution, or regulation of the municipality, upper-tier municipality, board of health or conservation authority to which
this application is made.
H. Declaration of applicant
I __________________________________________________________________________________________certify 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.
Additional Information required:
Water Service:
Private (well) ❒
Municipal water ❒ (curb stop existing on property)
❒ Reque
st a permit for city water main connection
Sanitary Sewer Service:
Private (septic system)
❒
Municipal sanitary sewer ❒
❒ Reque
st a permit for connection to sanitary infrastructure
wood appliance: Yes ❒ No ❒
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signature
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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
E-mail
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]
House
Small Buildings
Large Buildings
Complex Buildings
HVAC – House
Building Services
Detection, Lighting and Power
Fire Protection
Building Structural
Plumbing – House
Plumbing – All Buildings
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) d).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 authorization, 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.
NS
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Schedule 2: Sewage System Installer Information
A. Project Information
Building number, street name
Unit number
Lot/con.
Municipality
Postal code
Plan number/ other description
B. Sewage system installer
Is the installer of the sewage system engaged in the business of constructing on-site, installing, repairing, servicing, cleaning or
emptying sewage systems, in accordance with Building Code Article 3.3.1.1, Division C?
Yes (Continue to Section C) No (Continue to Section E) Installer unknown at time of
application (Continue to Section E)
C. Registered installer information (where answer to B is “Yes”)
Name
BCIN
Street address
Unit number
Lot/con.
Municipality
Postal code
Province
E-mail
Telephone number
Fax
Cell number
D. Qualified supervisor information (where answer to section B is “Yes”)
Name of qualified supervisor(s) Building Code Identification Number (BCIN)
E. Declaration of Applicant:
I _______________________________________________________________________________________declare that:
(print name)
I am the applicant for the permit to construct the sewage system. If the installer is unknown at time of application, I shall
submit a new Schedule 2 prior to construction when the installer is known;
OR
I am the holder of the permit to construct the sewage system, and am submitting a new Schedule 2, now that the installer is
known.
I certify that:
1. The information contained in this schedule 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
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Application for a Permit to Construct or Demolish

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Completed 7 March 2022

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