Application for Municipal Renumbering and Street Renaming, Residential Boulevard Parking, and Part Lot Control Exemption

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Application for Municipal Renumbering and Street Renaming, Residential Boulevard Parking, and Part Lot Control Exemption Development Services 6th floor - 300 Dufferin Avenue Telephone: 519-930-3500 Hours: Monday to Friday, 8:30 AM to 4:30 PM Detach and retain this page for future reference. tes to customer regarding the process 1. This form is to be used for the following applications: i. Municipal number change; ii. Part lot control exemption; iii. Residential boulevard parking; or iv. Street renaming. 2. Prior to filing your application with Development Services, you should consult with a Development Services staff member (519-930-3500). 3. Submit completed application form, attachments and fee to the above address. 4. Application forms containing insufficient or inaccurate information may be returned, with the application fee and attachments, to the applicant. 5. A copy of this application form and copies of other correspondence will be mailed to the contact person identified on your application when the application has been received, reviewed, and accepted complete. 6. The application fee may not be refunded once substantial work has been undertaken. Customer information 1. The customer information section of the form must be completed for all application types. If the applicant is a numbered company, provide the name of a principal of the company. 2. If an agent is handling the application, written authorization from the owner - including original signature and date must accompany the application. 3. Complete the information for the owner if different from the applicant. 4. It is the responsibility of the owner or applicant to notify Development Services of any change in ownership, applicant or authorized agent within 30 days of such a change. SCHEDULE OF FEES Schedule APP-2, Effective January 1, 2019 All fees must be included with application. Make all cheques payable to the City Treasurer. Application Type Fee Municipal number change/reassignment $500.00 Part lot control exemption $200.00 Residential boulevard parking $900.00 Street renaming $500.00 www.london.ca

Application for Municipal Renumbering and Street Renaming, Residential Boulevard Parking, and Part Lot Control Exemption Development Services 6th floor 300 Dufferin Avenue Telephone: 519-930-3500 Hours: Monday to Friday, 8:30 AM - 4:30 PM 1. Application type (only one type per application, use a separate application for multiple choices) Check appropriate box Municipal number reassignment - complete sections 2, 3, 4 and 5 only. Part lot control exemption - complete sections 2, 3, 4 and 6 only. Residential boulevard parking - complete sections 2, 3, 4 and 7 only. Street renaming - complete sections 2, 3, 4 and 8 only. 2. Pre-consultation Have you consulted a City of Development Services staff member regarding this application? - Name of staff consulted: Date of consultation: 3. Customer information Name of APPLICANT Name of principal of applicant s firm/company Daytime contact telephone number E-mail address Name of REGISTERED OWNER Name of firm/company (if applicable) Name of AGENT (if applicable) Name of agent s firm/company Daytime contact telephone number E-mail address Applicant s authorization letter attached? 4. Location and description of lands which are the subject of this application Street address (if individual property; or group or part of properties) Assessment roll number(s) Registered plan number(s), if applicable Lot/Block/Part number(s), if applicable Nearest cross street(s), if applicable NOTE: If subject property is other than a small regular shaped parcel, easily and accurately identified by a municipal number, a recent registered plan, or on a map, a boundary survey may be required. Location map attached Existing use of land and buildings Survey map attached Dimensions of property Frontage in metres Depth in metres Area in sq. metres 5. Municipal number reassignment application Current municipal number Requested municipal number Page 1 of 4

Reasons for municipal number change 6. Part lot control exemption application Name and address of Ontario Land Surveyor Description of existing use Description of proposed use Status of any construction on the property Current zoning Is the existing or proposed use subject to An approved site plan An application for site plan approval Neither Please attach a copy of the approved or proposed site plan, together with the site plan agreement, if applicable. Indicate how the access to individual parcels will be improved Indicate why exemption from part lot is being requested Attachments (indicate which documents below are attached) Registered Plan of subdivision (5 copies) Site Plan, if applicable Draft reference plan (5 copies) Development agreement 7. Residential boulevard parking application Site information Municipal address of site Number of existing spaces on site Number of dwelling units at site Number of spaces applied for Width of driveway Lot frontage Documents included Copy of Deed Indicate why exemption from part lot is being requested Survey or detailed drawing (3 copies of) n-refundable application fee: Enclose cheque for $900.00 payable to Treasurer, City of (HST, Registration. R119420883) Return fully completed application to: Planning and Development Department 206 Dundas Street, Ontario N6A 1H3 Check here to indicate your cheque is enclosed/ attached. General information regarding boulevard parking: The application for boulevard parking is used only when the requested parking area is entirely on City property. Determination of the location of the parking area is the responsibility of the applicant in the absence of a survey. If any portion of the proposed parking area is on private property a minor variance will be required and not a boulevard parking agreement. Development Services staff can assist where there is uncertainty. tice of your application for boulevard parking will be circulated to the Residential Boulevard Parking Committee (LRBPC), other relevant agencies, City departments and all property owners within 60 metres (200 ft) of the subject site. The LRBPC will make a decision based on the input of those circulated. Where a decision of the LRBPC is disputed, the application is then taken to a public meeting at the Planning and Environment Committee (PEC). Council s decision, based on PEC s recommendation, is final and binding: Decisions will be made giving consideration to the Council Policy with respect to boulevard parking; a copy of which is available from the Clerks department or by visiting www..ca. Page 2 of 4

If your application is approved, you will be required to enter into an agreement with the City of and to register the Agreement on title. The Agreement will include: Indemnification of the City from any and all liability. A parking plan identifying all works required to be constructed (at the signatory s expense) to the satisfaction of the General Manager of Environmental Services and City Engineer. The ability of the General Manager of Environmental Services & City Engineer to terminate the Agreement at any time at his/her discretion. Should the agreement be terminated, the property owner is required to restore any and all City property to the satisfaction of the General Manager of Environmental Services & City Engineer. Please remember: If any portion of the proposed parking area is on private property, a Minor Variance approval will be required to park there and not a Boulevard Parking Agreement. tice: This application is used only when 100% of the lands available for boulevard parking are City-owned lands. Determination of the location of the parking area is the responsibility of the applicant in the absence of a survey. The applicant acknowledges that, if any portion of the parking area is on the applicant's private property, a minor variance approval will be required. 8. Street renaming Existing name of street Suggested alternative name(s) 1. 2. 3. 4. Reason for street renaming General information regarding street renaming Applications for Street Renaming are submitted to the Subdivision and Condominium Documentation Coordinator (SCDC) through Development Services. The proposed street names are evaluated by the Municipal Addressing Advisory Group (MAAG). The SCDC reports the evaluation of the proposed street name to the Civic Works Committee, (CWC). If the CWC determines that the application meets the basic requirements for name change, the City advises the applicant and advertises/books a public meeting: The public meeting is a statutory requirement for all name change requests. Public notice* of this meeting will be made by Development Services. Following the public meeting the CWC will make a recommendation to City Council regarding the approval (or refusal) of the renaming request based on input from the meeting, MAAG and Staff. If the final decision of Council is to approve the renaming, area property owners, civic departments and affected agencies will be notified by Development Services. The applicant is responsible for assuming the full cost of changing the street name signs** Affected property owners are responsible for notifying other parties (i.e. banks, credit card companies, etc.) of the name change. * The applicant will be responsible for paying for all materials and fees regarding advertising and notification for the proposed name change public meeting regardless of the outcome. ** The applicant will be notified regarding the cost of replacing the streets signs; the approximate cost is $275/sign. te: Applications for street renaming must be accompanied by a non-refundable fee of $171.20 or not accepted. Page 3 of 4

This section must be completed in the presence of a Commissioner of Oaths. Commissioners are located on the 6th floor of City Hall, Monday to Friday, 8:30 a.m.-4:30 p.m. 9. Applicant declaration I,, in the City of, in the County of Middlesex, Name of Applicant/Agent of Applicant solemnly declare that all of the statements contained in this application for, Application type and all supporting documents are true and complete, and I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath, and by virtue of the Canada Evidence Act. Date signed Signature of Applicant/Agent of Applicant Declared before me at, Ontario in the County of Middlesex, This day of,, 20. Signature of Commissioner of Oaths Page 4 of 4