Fillable Service connections application A. Applicant information (City of Guelph)

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Service connections application A. Applicant information (City of Guelph)

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Engineering and Transportation Services Page 1 of 3
519-822-1260 extension 2241 (revised December 2018)
Service connections
application
Remit this form in person with payment (cheque only) to City Hall, Building
Services, third floor.
Project address:
Owner of property:
Use of property/building:
A. Applicant information
Name:
Corporation or company:
Mailing address:
Postal code: Province:
Phone number: Email:
B. Fees
Administration fee: $25.00
Preliminary review deposit: $1000.00
Total: $1025.00
C. Attachments
A proposed site servicing drawing must accompany this application:
Must be signed and stamped by a Professional Engineer (residential services
may be exempt at the discretion of the City).
Must demonstrate all key information such as property lines, buildings,
proposed services, existing conditions, etc.
Design must comply with all applicable design and construction standards.
, t
Approval is subject to review by City of Guelph Engineering (revision and
resubmission may be required).
D. Declaration of applicant
I, (print name) certify hat I am authorized to act as the
agent to the owner.
Page 2 of 3
I am beginning the process to service a site within the City’s Right- -
Of Way
only, as demonstrated on the approved site servicing drawing. I will obtain any
permits as required for all works on private property.
Upon approval of the proposed drawing, City of Guelph Engineering will estimate
the cost of all works proposed within the City’s Right-Of-Way. The applicant:
will be required to supplement the full preliminary review deposit.
will note the estimate does not necessarily reflect the final costs of the
project.
will be responsible for all final costs, including City staff hours. Upon
remittance of the deposit for the estimated costs of the project, the applicant
is advised to contact City of Guelph Engineering to discuss the applicant’s
options to progress to the construction stage.
may be required to provide a further supplemental deposit if the tender
closing value is higher than the total deposit.
Upon completion of all works within the City’s Right-Of-Way and acceptance of all
works by City of Guelph Engineering, the project will be accounted for all costs
incurred by the City of Guelph in the performance of the applicant’s proposed
works. Costs incurred by the City could include, but are not necessarily limited to;
contractor costs, City administration and inspection staff hours, and City of Guelph
Traffic Services, Water Services or Operations Department staff hours. The City will
provide the applicant a final accounting document demonstrating all costs incurred
by the City of Guelph in the performance of the applicant’s proposed works, and the
applicant will receive either a refund or an invoice for the difference between the
deposit and the total final costs.
Date:
Signature of applicant:
Inquiries concerning this application should be directed to:
Jason Robinson, C.Tech, rcji, Construction Engineering Technologist 2
Technical Services, Engineering and Transportation Services
City of Guelph
519-822-1260 extension 2241
jason.robinson@guelph.ca
Collection of Personal Information
Personal information is being collected and will be used for the purposes of verifying
property ownership, communicating with the applicant and connecting them to
payment.
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Page 3 of 3
Personal information, as defined by Section 2 of the Municipal Freedom of
Information and Protection of Privacy Act (MFIPPA), is collected under the authority
of the Municipal Act, 2001, and in accordance with the provisions of MFIPPA.
If you have questions about the collection, use or disclosure of this personal
information please call 519-822-1260 extension 2349 or email privacy@guelph.ca.
Alternate formats of this document are available as per the Accessibility for
Ontarians with Disabilities Act by contacting Building Services at 519-837-5615 or
email building@guelph.ca.
For use by Principal Authority
Folder Number:
Date Received:
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Service connections application A. Applicant information (City of Guelph)

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Completed 6 May 2021

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