Application for a Permit to Construct or Demolish This form is authorized under subsection 8(1.1) of the Building Code Act, 7992

Application for

a

Permit to Construct

or

_Demolish

This formis authorized under subsection 8(1.1) ofthe Building CodeAct,7992

3

_For

_use

_by

_Principal

_Authority

Application

number:

Permit number

(ifdifferent):

Date received: Roll number:

Applicationsubmitted to:

TOWNSHIP

OF NIADAWASKAVALLEY

(Name of municipality, upper-tier municipality,board of healthorconservationauthority)

A.

Project information

Building number, street name

_{Unit number}

_Lotlcon.

Municipality

Postal

code

Plan

number/other description

Project value est. $ _{Area of work(rn )}

B.

Purpose

of

application

_?_ _

New construction

Addition

toan Alteration/repair

Demolition

Conditional

existingbuilding

_Permit

Proposed use of building

_Current

_{use ofbuilding}

Description ofproposed 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

Ielephone

number N

fax

)

fell

nu)mber

)

D,

_{Owner (if}

_{different from}

_applicant)

Last

name Firstname Corporation orpartnership

Street

address

_{Unit number}

_Lotlcon.

Municipality _{Postal code}

_Province

_E-mail

Zelephgme

number

fax

)

(Cell

number

l

E. Builder

_(optional)

Last

name _{Firstname Corporation or partnership (if}

applicable)

Street address

_Unit

number Lot/con.

Municipality

Postal

code Province

Email

i

Telephone number

Fax

_Cellnumber

l

) (

_i

_{( )}

F.

_{Tarion Warranty Corporation (Ontario New Home Warranty Program)}

i4 ls proposed construction for a new

home

as

de?ned

inthe

OntarioNew Home Warranties

Plan Act? ifno,goto section G.

ii. is registration required under the OntarioNew Home

Warranties

Plan Act’?

._.. ____,-_ ___.____ i._. Yes 3 No Yes No

.-L

iii‘ifyesto (ii) provide registration number(s):

G. Required Schedules

i)

Attach Schedule

1 for

each individualwho 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}

5) This application meets all the requirements of clauses 13.1.3 (5) (a) to (d) of

Division

C of the

_Yes

_No

Building Code (the application

_{is made in}

_{the correct formand by the owner orauthorized}

agent, all applicable

?elds

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

7

application is made.

;

i ii)

This

application

is

accompanied by

the

plans and specifications prescribed bytheapplicable by—law.

_Yes

_No

l

resolution or

regulation

made

under

clause

7(1)(b) of

the

Building

Code

Act, 1992.

M‘

____M__

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 CodeAct, 1992

which enable

the chief building of?cialto

determine whether

the proposed building, construction or

demolition

will

,

contravene any applicable law.

’_ 4 W»

5

iv)

The

proposed building.

construction

or

demolition

willnot

oontravenewany

applicable law. yes

No

____._._L_

Yes No

l.

Declaration

of applicant

1 declare that: (printname)

1

The

information

contained

in

this

application, attached schedules,

attached

plans and speci?cations,

and

other

attached

documentation is true to the best ofmyknowledge.

2. if the owner isa corporation orpartnership, lhave the authority to

bind

the corporation or partnership.

Date _{Signature ofapplicant}

Personal informationcontained inthisformandschedules is collectedunder the authority _{of subsection 8(1.1) of the Building CodeAct, 1992, and willbe} used intheadministrationandenforcementofthe BuildingCode Act,1992. Questions aboutthecollectionofpersonal informationmaybe addressed to: a) the Chief Building Official ofthemunicipalityorupper-tier municipality towhich thisapplicationis beingmade, or, b)theinspector havingthepowers and

dutiesofachief buildingofficialinrelationto sewage systems _{or plumbing}foranupper-tier municipality.boardofhealthor conservation authority towhom

this application ismade, or, c)_{Director, Building and Development Branch, MinistryofMunicipalAffairs}

and Housing 777 Bay St, 2ndFloor.Toronto,M5G

2E5 (416) 585-6666.

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

Buildingnumber, street name "_l

E

Unit no.

.1

Lei/con.

Municipality

Postal code

Plan numberi other

description V

B. individual

who reviews

and

takes

responsibility

for

design activities

Name

_Firm

Street address I _Unitno.

!Lot/con.

Municipality

_Postal

_code

_TProvince

_E~mail

(Telephpne

number

F(ax

nun)iber

_Cell

_number

C. Design activities

undertaken

by

individual

identified

in

_{Section 8. [Building Code}

_Table

_{3.5.2.1. of}

Division

C]

House _HVAC— House

f

Building

Structural

, _ Small Buildings

BuildingServices

t‘

Plumbing—

House

[WT

Large Buildings _{Detection, Lightingand}

_Power

_Plumbing

— AllBuildings

Complex Buildings

Description

ofdesigners

work

Fire Protection

On-site

Sewage

Systems

D1‘

Declaration

of

Designer

l

declare that (choose one as appropriate): (print name)

if;

i

review

and take responsibility for

the

design workon behalfofa

?rm

registered

under subsection

32144“

Division

C,ofthe Building Code. I am quali?ed, and the

?rm

is registered, inthe appropriate classes/categories.

individual

BCIN:

Firm

BCIN:

lreview

and

take responsibility for

the

design and am quali?ed inthe appropriate category as an“other designer" under subsection 3.2.5.of DivisionC,of the Building Code.

individual

BClN:

Basis

for exemption fromregistration:

if

The design work is exempt fromthe registration and quali?cation requirements of

the

Building

Code.

Basis

forexemption fromregistration

and

quali?cation:

Icertify that:

1.

The informationcontained

in

this schedule is

true to

the best

of myknowledge.

2.

l_{have submitted this application with the knowledge and consent of the}

_?rm.

Date _{Signature ofDesigner}

NOTE:

1. For the purposes of_{C,and all} thisform.‘individual"meansthe "person" referredto in Clause 3.2.A.7(i) (c).ofDivisionC‘Articie3.2.5.1, ofDivision other persons whoare exempt fromqualification under Subsections3,2,4. and 3.2.5.ofDivisionC.

2. Schedule_Association1 is not_{ofArchitects. Schedule}required tobe completed byaholder of a license, temporary license,or a certificate ofpractice, issuedbytheOntario

1is also not required to becompleted byaholderofa license to practice, alimitedlicensetopractice. or a

certificateof authorization, issuedby theAssociationofProfessionalEngineers ofOntario.

Schedule

2:

Sewage System

Installer

information

A. Project information

Building number, street name _{Unitnumber Lot./con}

i

rvlunicipality

_{Postal code Plannumber/other description}

1

l

B. Sewage system

installer

l

is the installer of thesewage system _{engages in the business of constructing}

_on-site.

_{installing, repairing, servicing. ‘cleaning or emptying} sewage systems, in accordance with Building code Article3.3.1.1.Division0?

[I] Yes (Continue to section C) E] No (Continue to Section E)

El

installerunknown at time ofapplication (Continue toSectionE)

l—

_.

_.

_.

.

.

_l

C.

Registered

Installer

information

(where

answer to

section

B

is

‘‘Yes’’)

_i

Name _BCIN

4

Address _{Unit Number Lotlcon.}

]

,

i

Municipality (cilyffcwri) Postal code Province E-mail

.

_.

_«—l

Telephone (include areacode) _{Fax (include areacode) Cell(include}

areacode) l

D. Quali?ed supervisor

information

(where

answer

to

section B is

“Yes”)

Name ofquali?ed supervisor(s) _{BuildingCode identi?cationNumber (BCIN)}

E.

Declaration of

Applicant

l, _Declare

_that:

D

Iamtheapplicant forthe permitto construct thesewage system. if the installeris unknown attime ofapplication. Ishallsubmit anew Schedule2 1

a

priortoconstruction whenthe installer isKnown.

_I

l

93

I] Iam theholder cfthe permit to construct the sewage system, andam submitting a newSchedule2,nowthat theinstallerisknown

f

l certify that:

1. The information contained inthis schedule is true to the best of my knowledge.

2, ifthe owner is acorporation or partnership, l have the authority tobind thecorporation.

Date _{Signature of Applicant}

Schedule

2A: Sewage

System

information

A. A

Proposed Sewage System

IS

FOR:

Residential

use

INSTALLATIONIS:

NEW

Replacement

Test Holes

are

required

for

all new

or replacement Class 4 septic system applications;

Commercial

Use

Alteration

Repair

Are

Test Holes

ready?

NOTE: Class

2,

3

&

5

sewage

systems

have

limited or restricted uses.

C. Design Flow

Calculations

-

Dwellings

_(separate

_calculations

_{required for}

non-residential

structures)

minimum size to be 3 feet (.9 meters)

wide

and 6 feet (1.8 meters) deep. Must be _{[I Yes}

_D

_No

stepped or slopedi

I

B.

Type

of Proposed

_Sewage

_System

Class 2

—

Leaching Pit

Class 3

-

Cesspool

Class

4

—

Sewage System

Class

5

Holding Tank

Record

number

of

_{Plumbing Fixtures}

(include

_{mug-in plumbing}

_eg.

_for

_{future basement}

_bathroom)

Number of

l

_ ‘ _

NewI_Proposed

Fixture

_{_}

Description

of Fixture

_Fixtures

_Units

‘

Fixture

Unit Count

Dishwasher

_x

_1.5 = Garbage grinder _{x 3} =

₎

__ Hot tub/Spa _{x 1.5} =

Kitchensink

_{x 1.5} = Laundry

tub

_x

_1.5 =

Toilet

X 4 =

Tub/Shower

(1head) _{X 15} =

Wash

basin x 1,5 = __¢ Washing

Machine

_x

_1.5 = _[

Other— please

spe<1fy;_

x _L =

l

Other— please

specify:

x =

__

TOTAL FIXTURE UNITS:

l

______ TOTAL

FIXTURE

UNITS OVER

20:

Record number of separate dwelling units:

J

l

Application fora Permitto construct orDemolish— EffectiveJanuary 1,2011

Additional

appliances:

_{Water Softener}

_Does

_it

_{backwash into}

_Septic?

_{[] Yes}

_:l

_No

[3 Water

Filter

Does

it backwash into Septic? [] Yes [:I No

I

Record

?nished

floor

area

(insquare

meters) for

the

following:

_ __

l

1*‘

Floor

2"“

Floor

3“

Floor

l

Loft Walkout ’

TOTAL

l

l

D.

Design

Flow

Calculations

for

Dwellings

(separate

_calculation

_{required for non-residential}

_structures)

Where:

A

=

_{Bedroom Flow}

_(1-5

_{bedrooms); B= Bedroom Flow}

_(over

_{5 bedrooms),}

0 =

_LivingArea

_{Flow, D}=

_{Fixture Units over}

_50.

Bedroom Flow

(A)

Select Number of Bedrooms Volume (Litres)

ML

Total Flow

l _{1:) 1}

_Bedroom

₇₅₀ =

D

2

Bedrooms

1100

E

= 1:}₃

_Bedrooms

_{1500 =} 4

Bedrooms

2000 = l

C!

5

Bedrooms

2500 =

TOTAL

(A)

Bedroom Flow

(B)

_>5

_Bedrooms

₍

_Number

_of

_bedrooms

_>5 V°lUm€(Li1reS)

4

‘

:1

Yes

_E

No

i

x ‘ 500(each)

_J

= L

}_

_TOTAL

(B)

Living Area Flow

(C)

# of

increments

of

10m2 over living

Volume

Size of Living

Area

j

area (Litres) Total Flow

0- 200 M2 ’ " O =

Cl

201- 400 M2 ’‘ 10° ’

D

401 -600 M2 ’‘ 75 :

D

>600

M2

i

X 50 =

TOTAL (C)

L ‘

I

Number

_of

Fixture Units over

₂₀

= _{50i_)F'x(}

_u

_'(

Fixture Units

(D)

_{(frompg. 5)} X ' We

m

TOTAL

(D)

E.

Design

Flow (Number of Litres per day) ___ Q=

_A

+

_(the

_highest

of)

B

or

C or

D

= — +

Q

A

(B

or

C

or

D)

Q

= _Litres/day

F. Se

P

tic Tank

Size

Workin

9

Ca aci

P

For

Class

4

S

Y

stem

Existin

9

:]

Replacement

Proposed/Existing

Working

Capacity

Cl

Residential

(3600L)

Minimum

2 x 0

Litres

,

I] Non-Residential (360DL)

Minimum

3xQ

I ___ _~_.. .-

-G.

Other

Treatment Unit

_{Tertiar_y}

_l

Secondary

g

Manufacturer

___

Model

BMEC (Attach to

A_pplicai:io?>___

_{_}

3

l

ApplicationforaPermitto construe! or Demolish— EffectiveJanuary 1,2011

Schedule

2B:

Class

4

Sewage

System

Calculations

i

A. Absorption

Trench

:l

In-ground

E]

Raised

_E

Partially

Raised

L

= _Lengthof

_Distribution

_{Pipe(in metres)}

Q= _{Daily Design}

_Flow

_(inlitres)

T=

_Percolation

_Time

_ofunderlying

_soil

it’

Area

“A"of

effective surface

area

is

greater

than

50 m2:

Howmanycells aretobe installed?

What is

the size of each cell’? 8.7.3.1(2) L = _x I200 Q

_T

|_

v.-NOTE:

OR

813.1(3)

With Treatment Unit

or

Pern:itted

by Proprietary

Products

A‘ E L = _QTl3Cl0 L = _x /300 |_ = NOTE: A

B. Filter Bed

%

‘

D

in-ground

_E

R-aised

:3

Partially

Raised

I

1 _L= _{Length of}

_Distribution

_{Pipe (in metres)}

1 Q= DailyDesign

Flow

(inlitres)

T

=

_Percolation

_{Time ofunderlying soil}

EFFECTIVESURFACE AREA

3

i) If Q < 3000 litres/day ii) If Q > _{3000 litres/day}

A = _{QI75 A = QI50}

A = _{/75 OR A =}

/50

A =

m2

_{A =}

_m2

4

WFILTER

MEDIUM BASE AREA

A or/350

A A

I850

Schedule

2C: Soil Design Criteria

and

Site

Evaluation

A. Percolation

Rate

of

Design

Soil

(T)

Percolation

Rate ofDesign Soil Percolation Rate of Mantle Sand

SEE:

Cl

LaboratoryAnalysis

|:}

Lab Report

Attached

T= _min/cm

_T

= _min/cm

Soil is:

Native

C]

imported Soil

is:

(3

Native

imported

I

NOTE:

The MUNICIPALITY

_{willrequire documentation by a certi?ed soil technician}

_{onproposed imported}

_soils

_to

_con?rm

_the

percolation

rate

(“T"-time),

or the

suitability

of ?lter sand or imported ?ll.

A

Dose

Pumpis required

iftotal distribution

pipe

is

150mor more.

Dose Pump required?

_D

Yes C] No

L=

_Total

_{Length of}

_distribution

_{pipe in}

_the

_leaching

_bed

V= _Ef?uent

_volume

_{(in litres) pumped.}

3*’diameter distribution

pipe V= ₃₃

_x

_L =

I

4" diameter distribution

pipe V= 5.9

x

L =

B.

Site

_Plan

rw?t .

PROVIDE THE FOLLOWING INFORMATION:

swimmingpools

Locate and show clearance to all wells (including

those

onadjacent properties) Water courses (eg. lakes,

rivers

etc.)

Swales, slopes and changes ingrad

North

(facing)

arrow

Tank and pump chamber sizes

(inlitres)

Base.

Contact and loading areas (in square meters) Length

of distribution

pipe(in metres)

\\’\\\\\

Please

use the attached template.

Application for aPermittoconstruct or Demolish— EffectiveJanuary 1,2011

/ _{Locate and show}

_{horizontaldistance}

_{from sewage system to}

_all

_{proposed or}

‘

ScAhedu|e

2D: Site

Plan

SEPTIC iNSTALLATlON SITE

PLAN

1

Plan:

ii

Lot:

Con:

I

Tank Size (L) K

I

Pur?fcnambér

Size (L) 7 Base Area

(m‘)L

_ '

Contact Area

(m2)

I

_{Contact Area}

(mg)

~.—.-4

Length of

Distribution

Pipe

(‘r:){

l

lC.

‘l.

10.

Declaration

I

acknowledge

that

any deviation fromthe approved plans and speci?cations after the

permit

is issued

isa

violation

of

the Building

code Act and

agree

to

consult with

a

building

inspector before making anychanges

from the

approved plans. iagree to comply with the provisions of the MunicipalBuilding and Zoning By-laws.

Iagree

that.

neither

the

granting of a permit, norapproval

of

the plans and speci?cations. nor inspections

made

byMUNlClPALlTY

Inspectors

duringworkonthe sewage system,

shall relieve

me from responsibilityforcarrying out

the work in accordance

with the BuildingCode Act,as amended, and the Regulations made thereunder,

l

declare that the informationcontained herein is in

every respect,

fully

and truthfully

stated

tothe

best

of myknowledge and belief.

Iacknowledge

that

l willprovide a pit analysis of

?lter

medium

where

applicable.

lacknowledge

that.

prior toback?lling_

the

stone layer

shall

be protected by covering it with

untreated

building

paper

_or

a permeable geo-textile fabric.

I acknowledge

that

aleaching

bed shall

not

be

covered with any material having ahydraulic conductivity

less

than 0.01m/day.

Iacknowledge that Iwilloperate (if owner), oradvise the owner (ifcontractor) of the operation and

maintenance

required onthe

septic system.

lacknowledge that I willprovide/obtain a

Maintenance

Contract fora

Treatment Unit

and

Class-5

Holding

Tank.

lacknowledge

that should a

temporary entrance

be

required to construct thisseptic system, Iwill

obtain

an entrance approval

it

required by the Public

Works

Department, prior to commencing construction.

Submitted by:

Name

(please

print)

Signature

of Owner or

Agent

₁

Date

I]

PermitGranted

I]

_{Permit Granted}

.

_with

_attachments

_D

_Unable

_{to grant,}

_reasons

_attached.

Name (please

print)

Signature

of

Chief Building Official

or

Date

Designate