Township of Tiny Building Department. 130 Balm Beach Road West, Tiny, Ontario, LOL 2J0

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1 Revision The following must be submitted with the application: Telephone or Fax Requirements for submitting a building permit to demolish a structure 1 Site Plan If any existing buildings are to be removed (demolished) a demolition form is required. All (;etzerz1reqtirementc for Obtaining a Building Permit- demo.doc-revision.doc - Jan 25, 2017 As required to determine that the proposed construction conforms to all applicable laws. 8. Other Approvals required to be submitted. Please note that if the property is included on the Municipal Heritage Register as a listed or designated property under the Ontario Heritage Act, a Notice to Demolish or Remove is 7. Heritage Property Fee Schedule By-law The fees are calculated by the Building Department upon receiving an application as per 6. Building Permit Fees property owners must sign this form. For demolition of a dwelling or cottage a Department for applicable form. form must be submitted to the Treasury Department. Please contact the Treasury 5. Demolition Permit Form property owner s behalf an agent authorization form is required. All property owners must sign this form. In the event an authorized person is submitting a building permit application on the 4. Agent Authorization New property owners must submit a copy of the registered transfer deed of land. All sections of application must be completed. All property owners must sign application. 3. Application for a Permit to Construct or Demolish please complete the section on form. Department in issuing the building permit. If a wood burning appliance is being installed This form contains information required from the applicant to assist the Building 2. Municipal Application Law The location of the septic system must also be shown. proposed structures including all details in accordance with the Township Building By Two copies of a sketch to scale showing the property dimensions with all existing and 130 Balm Beach Road West, Tiny, Ontario, LOL 2J0 Township of Tiny Building Department

2 Tmy TOWNSHIP OFICANTON DE The Corporation of the Township of Tiny Municipal Application for Building Permit Roll Number: Please check if a wood burning appliance is being installed: D Woodstove D Fireplace D Fireplace Insert D Masonry Chimney D Steel Chimney Source Protection Plan 1. Is 2. If 3. To 4. the subject yes, Screening property within you must submit Form location to if it is within search a property Please that complete and a Well Head Protection Area see the Source (WHPA)? EJYES DNO Protection Plan Pre-Application a WHPA (vulnerable area) note this application maybe delayed and/or refused if Protection Plan for Bay Lake Protection Region. If application review by Environmental Association (SSEA), Risk Management Office, of is required to development offends the Source Simcoe Source Sound HOW MANY PLACE SIZE OF cover such costs. PROPOSED PROPOSED BEDROOMS the the visit the proposed the Southern Georgian requires detailed a fee the Severn $ CONSTRUCTION FOR EACH OF THE APPLICABLE AREAS TYPE OF CONSTRUCTION SIZE (FT) FT2 SDD* FINISHED BASEMENT SDD* UNFINISHED BASEMENT SDD* FIRST FLOOR SDD* SECOND FLOOR ADDITION DECKS COVERED PORCHES ATTACHED GARAGE DETACHED GARAGE/SHED CARPORT POLE-TYPE BUILDING RENOVATION ACCESSORY BUILDING DEMOLITION OTHER** * SDD Single Detached Dwelling A Commercial, Institutional & Industrial denotes ESTIMATED COST S:Building/Forrns/Municipal Applicalion February 8, 201 7

3 Municipality Efecthie Cell Application number: Appiication for a Permit to Construct or Demolish Ths form is authorized under subsection 8(1 1) of the Building Code Act, 1992 For use by Principal Authority Permit number (if different): Date received: Roll numbein Application submitted to: (Name of municipality, upper-tier municipality, board of health or conservation authority) Prolect information A. Building number, street name Unit number Lot/con. Postal code Z:::e edt. $ 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 Is: Owner or Authorized of owner Last name First name Corporation or partnership Applicant agent Street address - Unit number Lot/con. Micipality Postal code Province i Telephone number Fax ) ( ),( D. Last name Dwner (if different from applicant) Thrst name ( 7 Corporation or partnership number ieet address Unit number LoUcon. Postal code Province Thiephone number Fax Cell number t ) ) - -_- Appicatior br a Perrnt to Construct or Demo en January 1, 2014

4 I - ). ( declare ) j._ ) Municipality Postal code Province Street address Unit number Lot/con. Telephone number Fax Cell number Apptcation for a Perril to Cotslrucl or Demo ish Effective january 1, 201 2E5 (416) t:s application is made, or. c) Director. Buiding and!3eveopment Branch, Ministry of Municipat Affairs and l-ousir.g 777 Bay St., 2nd Floor. T ronto, M5G the Chief Building Official of the municipality or tipper-tier municipality to which this application is being made, or, b) the inspector havi rg the powers and in duties of a chief building official relation to sewage systems or plumbing for an upper-tier municipality, board of health or conservat.on autiority to whom used in trr? administration and enforcement of the Building Code Act, Questions about he collection of personal infor-nalion may be addressed to: a) Dersonal inonnation contained in this form and schedules is collected under the authority of subsection 8(1.1) of the Building Cude Act. 992, and writ be Dale Signaftae of apptcant 2. f the owner is a corporation or partnership. I have the authorty to bind the corpoation or partnership. documentation s true to the best of my knowledge. (print name) that:.deciarationofapplicant Payment has been made of all fees that are required, under the applicable by-law, resolution or contravene any applicable law. law, resolution or regulation made under clause 7(1)(b) of the Building Code Act, 1992 which enable application is made. regulation made under clause 7(1)(c) of the Building Code Act, 1992, to be paid when the resolution or regulation made under clause 7(1 )(b) of the Building Code Act, es No schedules are submitted). Building Code (the application is made in the correct form and by the owner or authorized agent, all H. Completeness and compliance with applicable law G. Required Schedules applicable fields have been completed on the application and required schedules, and an required the chief building official to determine whether the proposed building, construction or demolition will ii. Is registration required under the Ontario New Home Warranties Plan Act? [Yes No iii. If yes to (ii) provide registration number(s): 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. ;) This application meets all the requirements of clauses (5) (a) to (d) of Division C of the IVes No ii) This application is accompanied by the plans and specifications prescribed by the applicable by-law, es No iii) This application is accompanied by the information and documents prescribed by the applicable by- es No iv) The proposed building, construction or demolition will not contravene any applicable law. iyes No 1. The information contained in this application, attached schedules, attached plans and specifications, and other attached Plan Act? If no, go to section G. i i. Is proposed construction for a new home as defined in the Ontario New Home Warranties fres No F. Tarion Warranty Corporation (Ontario New Home Warranty Program) Last name First name Corporation or partnership (if applicable). Builder (optional)

5 Date: Signature of legal Owner(s) Signature of legal Owner(s) to act as my (our) agent and to apply for building permits on this property. Tiny authorize: Lot Plan Concession in the Township of Owner(s)of Municipal Address I/We being the Legal Agent Authorization Tmy TOWNSHIPOFICANTQN

6 _ S :Bu ilding/forms/derno form -February, Date Owner Date Owner facility: The building permit applicant/owner shall retain all records of disposal. disposed of properly. The materials will be disposed of at the following licensed refuse at (structure) (Township address) in the Township of Tiny. (owner s) Demolition Permit Form Tmy TOWNSHIP OFiCANTON DE I, applied for a demolition permit for I acknowledge that the waste materials as a result of the demolition are required to be