Heritage Demolition or Removal Permit Application Form

Property Owner's Name *

First

Last

Property Owner's Phone Number *

Property Owner's Email Address *

Property Roll Number

Example 23-01-000-000-00000-0000

Property Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Are you submitting on behalf of the property owner? *

Yes
No

Agent Name *

Agent Phone Number *

Agent Email Address *

Agent Address *

Address Line 1

Address Line 2

City

Province

Postal Code

What is the current use of the property? *

Ex. Business, residential, farming purposes.

A site plan or sketch showing the location of the proposed demolition or removal. *

Click or drag files to this area to upload. You can upload up to 10 files.

Photographs showing the existing building or structure including all elevations, as well as their condition and context. *

Click or drag files to this area to upload. You can upload up to 50 files.

Please explain the current condition of the building or structure (i.e. in good condition, fair condition, roof is falling in etc.) as well as an explanation to the photos uploaded in the previous question. *

Drawings and written specifications of the proposed demolition or removal. *

Click or drag files to this area to upload. You can upload up to 10 files.

As may be required, a building condition assessment prepared by a qualified Engineer of the building or structure or material part thereof which is proposed to be demolished or removed.

Click or drag files to this area to upload. You can upload up to 10 files.

Provide a written statement of the reasons for the proposed demolition or removal. *

Provide a written statement which addresses the potential impacts to the heritage attributes of the property. *

As may be required, a Heritage Impact Statement prepared by a Built Heritage Specialist.

Click or drag files to this area to upload. You can upload up to 10 files.

As per Section 1.3 (d) (i), the Municipal Clerk may require a Heritage Conservation Plan or Heritage Impact Assessment, prepared by a qualified architect and/or engineer licensed to practice in the Province of Ontario or heritage consultant specializing in the subject heritage resource.

Any technical cultural heritage studies that are relevant to the proposed demolition or removal.

Click or drag files to this area to upload. You can upload up to 20 files.

Terms and Conditions:

I have reviewed the submission requirements and understand that incomplete applications will not be accepted.

I agree that I understand that all statements contained in documents filled in support this of this application shall be deemed part of this application.

I understand that submission of this application to the Township of Puslinch does not guarantee a complete application has been received. Further review of the application will occur, and the applicant may be contacted to provide additional information and/or resolve any discrepancies or issues with the application as submitted. The Council shall determine whether the information submitted forms a complete application.

I understand that staff that may require a site visit and may need to enter the property that is the subject of this application for the purpose of evaluating the merits of this application and grant staff permission to visit the property. During a site visit, photographs of the property may be taken for the purpose of evaluating the application. Property entry will be organized by Township of Puslinch staff with the owner or agent prior to entry.

I understand that where an agent has been identified, the municipality is authorized, but not required to contact this person in lieu of the property owner and the agent is authorized to act on behalf of the property owner for all matters respecting the application.

I understand and agree that the proposed work shall be done in accordance with this application and understands that the approval of this application under the Ontario Heritage Act shall only be the Heritage Demolition or Removal Permit and shall not be a waiver of any other provisions of any By-law of the Township of Puslinch or legislation including but not limited to the requirements of the Building Code and the Zoning By-law.

I understand that in the event this application is approved, any departure from the conditions imposed by the Council of the Township of Puslinch, as the case may be, or from the plans or specifications approved by the Council of the Township of Puslinch as the case may be, is prohibited.

I acknowledge that any change to approved drawings, however small, may require an amendment to the permit application and will be used to process heritage permit applications.

I understand that an affidavit or sworn declaration by the Owner/applicant is required to certify that the information required and provided is accurate.

I understand that the propsal must comply with all other application legislation and By-laws and that other approvals if required have been included in the information provided by the owner and/or the agent in this application.

I am familiar with and have read section 69 of the Ontario Heritage Act which makes it an offense to knowingly furnish false information in any application or in any statement, report or return required to be furnished under the Act or the regulations, or to fail to comply with any order, direction or other requirement under the Act.

I acknowledge that personal information on this form is collected under the authority of the Ontario Heritage Act and will be used to process heritage permit applications.

Terms and Conditions Sign Off *

I hereby agree to the above terms and conditions.

Signature *

Clear Signature