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Application for a Plumbing Permit Inspection Services Phone: William Street, Cobourg

Application for a Plumbing Permit Inspection Services Phone: William Street, Cobourg For use by Principal Authority Application number: Permit number
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Application for a Plumbing Permit Inspection Services Phone: William Street, Cobourg For use by Principal Authority Application number: Permit number (if different): Date received: Roll number: Application submitted to: rthumberland County (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 Project value est. $ Area of work (m 2 ) B. Purpose of application New construction Proposed use of building Addition to an existing building Alteration/repair Current use of building Demolition Conditional Permit 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. Telephone number Fax Cell number D. Owner (if different from applicant) Last name First name Corporation or partnership Street address Unit number Lot/con. Telephone number Fax Cell number E. Builder (optional) Last name First name Corporation or partnership (if applicable) Street address Unit number Lot/con. 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 Plan Act? If no, go to section G. ii. Is registration required under the Ontario New Home Warranties Plan Act? iii. If yes to (ii) provide registration number(s): G. Required Schedules i) Attach Schedules 1 through 4 where application is for plumbing works. H. Completeness and compliance with applicable law i) This application meets all the requirements of clauses (5) (a) to (d) of Division C of the 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 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, resolution or regulation made under clause 7(1)(b) of the Building Code Act, iii) This application is accompanied by the information and documents prescribed by the applicable bylaw, 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. I. Declaration of applicant I (print name) declare that: 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, 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) 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. Telephone number Fax number Cell number C. Design activities undertaken by individual identified in Section B. [Building Code Table 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 (print name) declare that (choose one as appropriate): I review and take responsibility for the design work on behalf of a firm registered under subsection 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 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 (1) (c).of Division C, Article of Division C, and all other persons who are exempt from qualification under Subsections and 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. Schedule 2: Owner s Authorization To authorize an agent to act on the owner s behalf Date: Project municipal address: Proposed work: This document shall serve to notify rthumberland County that I am/we are the legal owner(s) of the property described above and do authorized the person indicated below ( authorized agent ) to act on my/our behalf on all matters pertaining to the building permit application and authorize the authorized agent to sign all related documents on my/our behalf. I understand that I shall be responsible for the terms and conditions contained in the permit. Name of property owner(s): Mailing address: City: Postal code: Telephone: Signature of property owner(s): Name of authorized agent: Company name: Mailing address: City: Postal code: Telephone: Signature of authorized agent: te: All registered owners of the property shall sign an Authorized Form. Use additional sheet if necessary. A new Authorized Form shall be submitted to rthumberland County if ownership of the property changes prior to issuance of the building permit or before final approval is granted. Personal information contained in this form 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 Act, and the OBC. Questions about the collection of personal information may be addressed to the Senior Plumbing and Sewage System Inspector of rthumberland County. Schedule 3: Commitment to general reviews, architect/ engineers To be completed by the owner or owner s authorized agent, and signed by all consultants retained for general review PART A- OWNER S UNDERTAKING WHEREAS the Ontario Building Code requires that the project described above be designed and reviewed during construction by an architect, professional engineer or both that are licensed to practice in Ontario; NOW THEREFORE the Owner, being the person who intends to construct or have the building constructed hereby warrants that: 1. The undersigned architect and/or professional engineers have been retained to provide general reviews of the construction of the building to determine whether the construction is in general conformity with the plans and other documents that form the bases for issuance of a building permit in accordance with the performance standards of the Ontario Association of Architects (OAA) and/or Professional Engineers Ontario (PEO); 2. All general review reports by the architect and/or professional engineers will be forwarded promptly to the Senior Plumbing/Sewage System Inspector, and 3. Should any retained architect or professional engineer cease to provide general reviews for any reason during construction, the Chief Building Official will be notified in writing immediately, and another architect or engineer will be appointed so that general review continues without interruption during construction. The Undersigned herby certifies that he/she has read and agrees to the above Name of Owner: Date: Address of Owner: Telephone: Signature of Owner: Print Name: Fax: (or Officer of Corporation): Coordinator of the work of all consultants: Telephone: Address: Fax: PART B- CONSULTANTS The undersigned architect and/or professional engineer(s) herby certify that they have been retained to provide general reviews of the parts of construction of the building indicated, to determine whether the construction is in general conformity with the plans and other documents that form the basis for the issuance of the building permit, in accordance with the performance standards of the OAA and/or PEO. MECHANICAL SITE SERVICES SHADED PARTS TO BE COMPLETED BY CONSULTANTS Consultant Name: Signature: Print Name: Telephone: Address: MECHANICAL INTERIOR PLUMBING Consultant Name: Signature: Print Name: Telephone: Address: MECHANICAL OTHER (SPECIFY) Consultant Name: Signature: Print Name: Telephone: Address: Permit Number - Municipality: Date: Applicant's Name: Applicant Applicant's Phone: Project Address: Application for a permit to construct or demolish to be attached This permit is for: Fixtures Total Inspections Required by Code Extra inspections 6 50 ICI re-inspect after 2 1. Sanitary, Storm sewers & site drainage 50 failed inspections/hr 2. Domestic and Fire Main Service Residential re-inspect after 2 failed inspections/ hr Sanitary and storm building drains 4. Under slab building drain and branches 5. Rough in above ground drains, Building without a vents, water piping, rain water leaders 100 permit 6. Final inspection (all systems complete and Revisions after permit operational and all fixtures installed) issuance: Fixtures 17 Fee 100 Alternative Solution 500 NOTE: Fee includes a maximum of 6 Backflow Preventer if not related to permit. 125 New or replacement. NOTE: Base Fee Transfer of permit 125 Re-activation fee Review Fee 100 Basic Fee 150 Total County of rthumberland PLUMBING PERMIT (special) inspections. Extra inspections are made payable to the County. Each extra inspection: $50.00/hr, 1 hour minimum Ontario Building Code Act, Section 36 (4) - Penalties. A corporation who is convicted of an offence is liable to a fine of not more than $500,000 for a first offence and to fine of not more than $1,500,000 for a subsequent offence. For inspections, including testing requirements and procedures contact: Phone: or ext Applicant: (if applicable) Permit Granted: (Building Official signature required)
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