Application for Road Occupancy Permits

Applicant Information

Name: *

Permit to be issued to: *

Address: *

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

Specify

Postal Code: *

Phone: * xxx-xxx-xxxx  Ext.

Fax: xxx-xxx-xxxx

E-mail: *

Road Occupancy 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

Purpose:

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

Specify

From to

What type of installation is required?

 Certificate of liability insurance:
Please 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.

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

Terms and Conditions

• A current certificate of liability insurance in the amount of at least $1,000,000 - $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.
• The applicant shall assume all liabilities and will be responsible for all action, claims, damages and losses whatsoever occasioned by or on account of the issuance of the permit

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.