APPLICATION TO PERMIT: CONSTRUCTION OR ALTERATION 
TO A BUILDING

  TOWNSHIP OF MALAHIDE
87 JOHN ST. S.
AYLMER, ONTARIO N5H 2C3
(519) 773-5344  FAX: (519) 773-5334

ROLL NO.                           

A plot plan showing existing buildings, abutting properties, roads and the proposed construction must 
accompany this application.  This application along with the accompanying documents must be 
submitted to the Chief Building Official, Mr. John Ungar.  The application cannot be submitted 
electronically.  The submission of an application does not constitute approval to build.

No application will be considered, or approved unless the proposed construction site for this building 
permit has been staked out on the property.

OWNER                                                  ADDRESS                                                     
PHONE                              

CONTRACTOR                                      ADDRESS                                                    
PHONE                               

PLANS BY                                              ADDRESS                                                    
PHONE                               

LOT                                  CONC.                        SIZE                      X                        AREA                              

CIVIC ADDRESS:  911#                                                  ROAD NAME                                                            

ZONING AREA                                                       

SET BACKS -Front from Property Line                                                                                                                                                        

Rear from Property Line                                                  

Sides from Property Line                                                                                                       

USE OF BUILDING                                                                                                                            

SIZE OF BUILDING:            W                      L                        H                      

 SQ FOOTAGE                                                                                           

EXISTING  - W                L                 ESTIMATED VALUE                           

FOOTING SIZE                                                                    

THICKNESS OF FOUNDATION WALLS                 POURED                BLOCK                OTHER                 

TYPE OF CONSTRUCTION:   FRAME               MASONRY             REINFORCED CONCRETE               

  STEEL                 OTHER                                                                                   

  BRIEF DESCRIPTION OF WORK                                                                                                                      

________________________________________________________________________________________

________________________________________________________________________________________ 

  WATER SUPPLY -   MUNICIPAL                                OTHER                      

Have you obtained all other necessary Permits?  YES                              NO                 

M.O.H.  Septic Tank & Field Bed Approval Number                                                      

Municipal Water Service Approval                                                                                           

Highway or Street Access Approval                                                                                   

Are you building near a cliff?                            Natural Watercourse?                                   

Is a Municipal Drain located near the proposed construction site?  YES                  NO                 

Type of Drain - OPEN                                CLOSED                                  

Distance to Drain                                                                                          

I hereby certify that the statements contained in the foregoing application are true and made with a 
full knowledge of the circumstances connected with the same and that I am the (owner/authorized 
agent of the owner) named in the application.
It is also agreed that the building mentioned above will be located on the property as indicated by 
the attached sketch in accordance with the applicable zoning by-law and construction will comply 
with the Ontario Regulation 403/97, The Building Code.

                                                             
Signature 

                                                                                                                    
                                                            
Date

                                                                                                            
BUILDER’S REGISTRATION NO.  

PERMIT FEES

If this is a permit for a second house, a civic address sign (911) must be purchased. - $50.00

Houses and Additions            - $ 40.00 Minimum plus 0.23¢ / square foot

Barns , Sheds & Garages             - $ 40.00 Minimum plus 0.05¢ / square foot

Renovations, Grain Bins,

Silos, Manure Tanks, Bulk kilns, Based on Value of Work                         
- $ 40.00 - first $1000.00
- $  4.00 - for each additional $1000.00

The decision of the building inspector in regard to estimated costs on all construction 
shall be final.

                                                                        R. Millard - Clerk

                                                                         J. Ungar    - Chief Building Official

                                                                                             773-5344

PERMIT BECOMES VOID IF CONSTRUCTION IS NOT STARTED WITHIN 
6 MONTHS  OF DATE OF PERMIT ISSUED AND COMPLETED WITHIN A 
YEAR. FEES ARE NON-REFUNDABLE

 
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