Municipal Consent Form

Please provide the correct information for the contractor applicant or company. Please select your company name from the drop-down list or type it in (you cannot do both), the best phone number and email to contact the applicant that is providing this information, the address of the applicant or company, and an emergency contact name and phone number. If you have questions or need help filling out the application, please contact the Engineering Department at 705-759-5378.

Utility/Property Owner Information

Please provide the utility/property owners information if it applies. This information is not required.

Road Occupancy Location

Please provide the road occupancy location using the street name and number, then please use the calendar to provide the proper date range of road occupancy and the purpose of the work. In the event that the road occupancy is in front of more than one civic address, please use the closest address to the south/west limit of the project.

Road Occupancy Information

Please check the corresponding checkbox for the information you wish to provide, then enter the length and width in (m) of the road occupancy/construction, if any grass/lawn will be effected, and any other information that is needed. Also please fill out all other details of the work that will be done.

Directional Boring

Length

Road Cut

Length

X

Width

Sidewalk Cut

Length

X

Width

Is any lawn effected:

Boulevard

Normal

Other

Other Description

Work Details

Road or Lane Closure

Please select what type of road closure there will be and then the date range it will be closed. If this does not apply please select N/A.

Daily

Full Road

Full Lane

Partial Lane

N/A

Road or Lane Closure (Start/End Dates):

Date

Attached PDF and Image Files

Please include any images or drawings of the project, and any insurance information. Use the 'Ctrl' key to add multiple files (10 file limit).

Disclaimer

                                      IMPORTANT INFORMATION TO THE APPLICANT

1.	Work on City Rights of Way is not permissible without a Road Occupancy Permit
2.	The completed permit application must be received, for processing, by the Engineering Department no later than 5 (five) working days prior to the beginning of the activity. The applicant must also abide by all other time restrictions as outlined in by-law 2008-131.
3.	Application for Road Occupancy Permit requires a minimum of three business days to process
4.	A copy of the approved permit must be available on the job site at the time of construction
5.	The applicant must obtain the necessary approvals from all the appropriate authorities that will be impacted by this application
6.	All barricades, signs, signals, traffic control person(s), traffic control devices, detour design and signing shall meet current Ontario Traffic Manual – Book 7 for Temporary Conditions requirements and shall be the sole responsibility of the applicant
7.	The applicant assumes all maintenance and liability for temporary repairs until such time as permanent repairs are completed for the work described herein
8.	When unforeseen circumstances require an extension of the permit or a change in any of the conditions under which the permit was issued, the holder of the permit shall apply for such change at least 24 hours in advance. Failure to do so will render the permit void
9.	Applicant must notify the Engineering Department prior to commencing work and before any backfilling operation on City property begins by email.
10.	It shall be the applicant's responsibility to request marking or other location information to determine the location and provide safeguards for all utilities, both public and private, in accordance with current regulations.
11.	Insurance requirements
Proof of Insurance must be presented at the time of the permit application. Without valid proof of insurance, this application will not be processed and a permit will not be issued.
The completed work must reference the following insurance coverage:
Insurance against public liability for the bodily injury and property damage in respect of such work in the minimum amount of $5,000,000.00 and be endorsed to provide that the policy will not be cancelled, or allowed to lapse without 30 days prior written notice to the City and keep in force all liability insurance policies in respect of such work for a period of twelve months from the date of final completion and acceptance by the city 
12.	Payment will be billed by invoice.

I have read and understand all of the above information and agree to your guidelines and I’m aware that failure to comply may result in increased costs or possibly having our Municipal Consent revoked.

Application for Municipal Consent

Application Information (Contractor)

Utility/Property Owner Information

Road Occupancy Location

Occupancy Time (Start/End Dates):

Road Occupancy Information

X

X

Is any lawn effected:

Road or Lane Closure

Road or Lane Closure (Start/End Dates):

Attached PDF and Image Files

Disclaimer