Revised on August 17, 2020
No
Yes
No
CITY OF RICHMOND HILL
Planning and Regulatory Services
Development Engineering Division
Permit No. SA-2020-
S
ITE ALTERATION PERMIT APPLICATION BY-LAW No. 166-07
LOCATION
Project Type:
Municipal Address:
Lot/Block No.: Plan/Concession No.:
REGISTERED OWNER
Name:
Fax :
Mailing Address:
APPLICANT (if not owner)
Name:
Fax :
Mailing Address:
Phone:
Email:
Phone:
Email:
CONTRACTOR
Name:
Fax :
Mailing Address:
Phone:
Email:
TYPE OF ALTERATION
Site Plan File
Subdivision File
D06-
D03-
Servicing Agreement L03-
Related Consent File B09-
Site alterations for site plan pregrading and preservicing or Tiebacks and for subdivision pregrading
or preservicing require internal clearance from Project or Development Coordinator prior
to permit issuance.
Site within or abutting TRCA screening zone or regulated area.
If yes, applicant to provide clearance letter and stamped approved plan from TRCA.
Alteration to involve an above ground swimming pool with no site grading alterations.
Alteration to impact or remove existing trees on or abutting site.
If yes, applicant to provide clearance from Parks Department.
Swimming Pool proposed within new subdivision not assumed by City.
If yes, applicant to provide grading certification from developer's consultant.
Site Alteration Plan proposes to use existing sanitary or storm service connections.
If yes, applicant to arrange for video inspection by City.
Alteration to include works on abutting lands.
If Yes, applicant to provide permission letter from adjcant registered land owner(s)
Site within or adjacent a protected area under the ORM Conservation Plan or Greenbelt Plan.
If yes, the applicant to submit documentation to demonstrate conformity to ORM Conservation Plan
or Greenbelt Plan.
Yes
Yes
No
Yes
Yes
Yes
Yes
New Infill
Residential Lot
Residential Lot
Below Grou
nd
Pregrade
Pregrade
Addition
Commercial/Industrial
Commercial/Industrial
Other
Other
Above Ground
Preservicing(Municipal Works Only)
Preservice
Residential Lot
Filling/Excavation
Landscaping
Swimming Pool
Site Plan
Subdivision
Tiebacks
No
No
No
Agreement Executed
Agreement Executed
Agreement Executed
Yes
Yes
Yes
No
No
No
Related to Site Plan
Yes
No
Related to Subdivision
Yes
No
Consent Approved
Yes
No
Revised on August 17, 2020
SUBMISSION REQUIREMENTS
to be included with application.
Permit Fee Amount
$
490.00
Receipt No.
Site Alteration Permit Fee
$
1,337.00
Receipt No.
(Site Plan and Subdivision Pregrading or Preservicing)
Pool Enclosure Permit Fee
(if applicable)
Video Inspection Fee
$
79.00
$
680.00
plus HST
Receipt No.
Receipt No.
Landscape Inspection Fee
$
450.00 plus HST
Receipt No.
(not applicable for Site Plan or Subdivision
applications)
Engineering Review Fee
$
Applicable to Subdivision and Site Plan-\ Preserving
Only
(6.1% of Cost of Servicing Works, plus H.S.T)
Security Deposit (amount as per
Receipt No.
requirements below)
Finance Clearance:
$ Receipt No.
LC No.
Signature
Date
Received By:
Digital PDF copy of Site Alteration Plan and other required documentation.
For preservicing or pregrading applications, the applicant shall provide proof of ownership for the site in the form
of a parcel register and a detailed estimate for the cost of servicing works prepared by their engineering consultant.
I hereby grant permission to representatives of the City of the Richmond Hill to enter onto the lands subject to
this application for the purpose of inspection of existing conditions and the site alteration.
No interests on Security Acknowledgement
I hereby acknowledge that I am posting a cash deposit in the above amount in place of a letter of credit for security with
respect to the above noted agreement/undertaking. I further acknowledge and agree that, pursuant to the policy of the
City of the Richmond Hill, no interest will be payable to me on the cash deposit while held by the City of Richmond Hill.
When the security deposit is ready to be released by the City, the cheque will be mailed to he registered owner or
arrangements may be made for pickup.
Signature of Registered Owner Date
SECURITY DEPOSIT REQUIREMENTS
Where required, security shall be in the form of cash, bank draft, money order, certified cheque or an irrevocable
letter of credit in a form acceptable to the Commissioner. The security deposit shall be submitted by the registered
owner prior to issuance of the site alteration permit. The amount for the security deposit shall be as indicated below.
Once the site alteration is complete, including all restoration, the Owner shall provide a certificate from their
consulting engineer or surveyor stating that the site alteration has been completed in accordance with the site
alteration plan. The certificate shall be in a standard format acceptable to the Commissioner and shall be sent to the
Grading Section in the Development Engineering Division at 225 East Beaver Creek. After the certificate has been
provided to the City, the Owner shall arrange for a City inspection by calling 905-747-6432 or 905-771-2457. The
security deposit will be released once all deficiencies, repairs or other obligations under By-law 166-07 relating to
the site alteration have been completed to the satisfaction of the Commissioner.
click to sign
signature
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signature
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Revised on August 17, 2020
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TYPE OF SITE ALTERATION
Residential Lot - New Infill
Residential Lot Addition
Swimming Pool Below Ground
Swimming Pool Above Ground
Filling/Excavation Residential Lot
Filling/Excavation Commercial/Industrial
Filling/Excavation All Other
Landscaping Residential Lot
Landscaping Commercial/Industrial
Landscaping All Other
Site Plan - Preservicing(Municipal Works Only)
Site Plan - Tiebacks
Subdivision Pregrading
Subdivision Preservicing
SECURITY DEPOSIT
$ 10,000.00
$ 10,000.00
$ 3,000.00
$ 3,000.00
$ 3,000.00
$ 20,000.00
$ 20,000.00
$ 3,000.00
$ 20,000.00
$ 20,000.00
refer to note 1
refer to note 2
refer to note 3
refer to note 1
refer to note 2
Notes:
1. Security deposit for Pregrading: $ 20,000 (Cost of Servicing Works < $250,000)
$ 50,000 (Cost of Servicing Works $250,000 to $500,000)
$ 100,000 (Cost of Servicing Works > $500,000)
2. Security deposit for Preservicing
3. Security deposit for Tiebacks:
20% of Cost of Servicing Works - for Subdivisions
100% of Cost of Servicing Works - for Site Plans
100% of Cost of Tiebacks Works, $20,000 min.
Site Plan - Pregrading
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