Application for Construction Encroachment

Applicant Information

* Name:

* Issue Permit to:

* Address:

* City / Town: Select City...Fort ErieGrimsbyLincolnNiagara FallsNiagara-on-the-LakePelhamPort ColborneSt. CatharinesThoroldWainfleetWellandWest Lincoln Other

Specify

* Postal Code:

* Phone Number: xxx-xxx-xxxx

Ext.

Fax Number: xxx-xxx-xxxx

* Email:

Construction Encroachment Fees

Permit Type	Time of application	Fee	Select
No pavement cut	Before construction begins	$285 + $176 ($88 each for one pre and one post inspection)
	After construction begins	$570 + all applicable per visit inspection fees ($88 each)
With pavement cut	Before construction begins	$570 + $176 ($88 each for one pre and one post inspection)
	After construction begins	$1,140 + all applicable per visit inspection fees
Local Area Municipal Access Agreements - emergency repair	Permit obtained within 30 days	N/A
	Permit obtained after 30 days	$285 to $740 + all applicable per visit inspection fees ($88 each)

Work Information

Road Name:

Road Number 1 2 3 3A 4 5 7 9 10 12 14 15 18 19 20 21 23 24 25 26 27 28 29 33 34 36 37 38 39 40 41 42 43 45 46 47 48 49 50 54 55 56 57 58 61 63 65 67 68 69 70 71 72 73 77 81 82 83 84 86 87 88 89 89 90 91 98 100 101 102 112 116 122 124 420 512 525 527 529 581 627 669 681

* Will this work require a lane or full road closure Select one... Right-of-way only Lane closure Full road closure
Provide a traffic control plan or detour plan below if you are proposing a lane closure or full road closure

* Nearest Intersection:

City / Town: Select City...Fort ErieGrimsbyLincolnNiagara FallsNiagara-on-the-LakePelhamPort ColborneSt. CatharinesThoroldWainfleetWellandWest Lincoln Other

Specify

From: Road / Street

To: Road / Street

Nature of Work:

Commencement of Proposed Construction:

Approximate Completion Date:

Insurance Certificate Expiry Date:

Supporting Documents

Attach any supporting documentation that is relevant. Only PDF, JPG, DOC(X), XLS(X), PNG, TXT files allowed only. No more than 5 MB file size, 10 MB total.

File 1

File 2

File 3

Application Guidelines

• A plan or sketch must accompany this application, showing details and the location of the proposed works (must show nearest intersection)
• A current certificate of liability insurance in the amount of at least $1,000,000 to $10,000,000 naming Niagara Region as an additional named insured. This certificate must accompany the application. The amount will be specified by the Region.
• Provide all related drawings and a signed Certificate of Insurance form by emailing roadpermits@niagararegion.ca specifying the permit type and applicant name in the subject line.

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.