Application for a Permit to Construct or Demolish
This form is authorized under subsection 8(1.1) of the Building Code Act,1992
For use by Principal Authority
Application number: Permit number (if different):
Date received: Roll number:
Application submitted to:
The City of Stratford
(Name of municipality, upper-tier municipality, board of health or conservation authority)
A. Project information
Building number, street name Unit number Lot/con.
Municipality Postal code Plan number/other description
2
Project value est. $ Area of work (m )
B. Purpose of application
Addition to an Conditional
New construction Alteration/repair Demolition
existing building Permit
Proposed use of building Current use of building
Description of proposed work
C. Applicant Applicant is: Owner or Authorized agent of owner
Last name First name Corporation or partnership
Street address Unit number Lot/con.
Municipality Postal code Province E-mail
Telephone number Fax Cell number
D. Owner (if different from applicant)
Last name First name Corporation or partnership
Street address Unit number Lot/con.
Municipality Postal code Province E-mail
Telephone number Fax Cell number
Application for a Permit to Construct or Demolish – Effective January 1, 2014 Page 1 of 4
E. 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
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 Yes No
Plan Act? If no, go to section G.
ii. Is registration required under the Ontario New Home Warranties Plan Act? Yes No
iii. If yes to (ii) provide registration number(s):
G. Required Schedules
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.
H. Completeness and compliance with applicable law
i) This application meets all the requirements of clauses 1.3.1.3 (5) (a) to (d) of Division C of the Yes No
Building Code (the application is made in the correct form and by the owner or authorized agent, all
applicable fields have been completed on the application and required schedules, and all required
schedules are submitted).
Payment has been made of all fees that are required, under the applicable by-law, resolution or Yes No
regulation made under clause 7(1)(c) of the Building Code Act, 1992, to be paid when the
application is made.
ii) This application is accompanied by the plans and specifications prescribed by the applicable by-law, Yes No
resolution or regulation made under clause 7(1)(b) of the Building Code Act, 1992.
iii) This application is accompanied by the information and documents prescribed by the applicable by- Yes No
law, resolution or regulation made under clause 7(1)(b) of the Building Code Act, 1992 which enable
the chief building official to determine whether the proposed building, construction or demolition will
contravene any applicable law.
iv) The proposed building, construction or demolition will not contravene any applicable law. Yes No
I. Declaration of applicant
I declare 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.
Application for a Permit to Construct or Demolish – Effective January 1, 2014 Page 2 of 4
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 HVAC – House Building Structural
Small Buildings Building Services Plumbing – House
Large Buildings Detection, Lighting and Power Plumbing – All Buildings
Complex Buildings Fire Protection 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) (c).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 practice, 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.
Application for a Permit to Construct or Demolish – Effective January 1, 2014 Page 3 of 4
Permit Application Information Sheet
HVAC Contractor
Last Name First Name Corporation or Partnership
Street address Unit number Lot/con.
Municipality Postal code Province E-mail
Telephone Cell Fax
Plumbing Contractor
Last Name First Name Corporation or Partnership
Street address Unit number Lot/con.
Municipality Postal code Province E-mail
Telephone Cell Fax
General Information
SERVICING: Water: City Water Private Well Sewer: City Sewer Private Septic System
HEATING SYSTEM: Existing Heating System: Proposed Heating System:
# of BEDROOMS: Existing: New: Total:
RADON: (applicable to low- Option #1 Option #2 Option #3 (dep. system, N/A
rise residential permits) (pipe, testing) (full soil gas barrier) partial soil gas barrier) (addition < 20m²)
GENERAL NOTES:
Permit Fee Calculation
Floor Area: (location & square footage) Cost per square foot, or flat rate: Fee:
TOTAL FEE:
Building Division PAYMENT METHOD:
82 Erie St., 2nd Floor
Stratford, ON N5A 2M4 PAID BY:
519-271-0250 x 345 ACCEPTED BY:
www.stratford.ca
