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Heritage Permit Application

Development Team Office
5 Mill Street South
Port Hope, ON L1A 2S6
Telephone: 905-885-2431
Fax: 905-885-0507
Email: heritageplanner@porthope.ca

1.0 Designation under the Ontario Heritage Act

Please select designation if it applies

Notice of Intention to Designate

Part IV (Individual Property)

Part V (Heritage Conservation District)

2.0 Subject Property

Municipal Address of Subject Property (Street # / Name):

Neighbourhood / General Intersection:

Legal Description (PIN / Concession # / Lot # / Reference Plan # / Part #):

3.0 Applicant Information

First Name:

Last Name:

Company (if applicable):

Street #:

Street Name:

Suite / Unit #:

City / Town:

Province:

Postal Code:

Telephone #:

Email Address:

Owner Information (if different from applicant):

Check if the same

Yes

First Name:

Last Name:

Corporation or partnership (if applicable):

Street #:

Street Name:

Suite / Unit #:

City / Town:

Province:

Postal Code:

Telephone #:

Email Address:

4.0 Scope of Work Proposed

Clearly describe the changes you are undertaking to alter the property.

Attach additional page(s) or a Cultural Heritage Impact Assessment as needed. In this application refer to the relevant sections of a Cultural Heritage Impact assessment if applicable.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

5.0 Reasons for Proposed Alteration, Demolition, or Removal

Clearly describe the reasons why you are seeking to alter the property.

Attach additional page(s) or a Cultural Heritage Impact Assessment as needed. In this application refer to the relevant sections of a Cultural Heritage Impact Assessment if applicable.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

6.0 Description of Porential Impacts to Heritage Attributes

Clearly describe the potential impacts to the heritage attributes of the property and/or how they meet the policies of the John, Ontario & Queen Street Heritage Conservation District Plan or Walton Street Heritage Conservation District Plan.

Attach additional page(s) or a Cultural Heritage Impact Assessment as needed. In this application refer to the relevant sections of a Cultural Heritage Impact Assessment if applicable.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

8.0 Heritage Sign Approval (if applicable)

Type of Signs Proposed (New or Altered). Please refer to the total number of signs permitted before checking more than one item below. See Schedule ‘C’ of Sign By-law 17-2005, as amended).

Directory Board

Ground / Pylon

Wall

Fascia

Retractable Awning

Sandwich Board

Soffit

Window

Door

Type of lettering or font will be:

Type of material(s) supporting structures or fasteners will be:

The proposed message on the sign(s). (Attach additional page(s) as needed). Provide an image with the dimensions shown on the finished signs.

9.0 Architect or Structure / Graphic Designer (if applicable)

Name of Firm:

Contact Person:

Telephone #:

Email Address:

10.0 Contractor / Builder / Sign Maker (if applicable)

Firm Name:

Contact Person:

Telephone #:

Email Address:

11.0 Heritage Colours Proposed (if applicable)

Include actual paint samples for each colour proposed. Identify where these colours will be used. Include manufacturer, colour name, heritage colour number and finish.

Attach files if applicable.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

12.0 Lighting Proposed (if applicable)

Fixture Material:

Fixture Colour:

Wattage:

Mounting Technique:

Describe location on the building and provide a sketch or photo:

Provide an image (brochure) of the proposed light fixtures (attach additional page(s) if needed): Note: luminous, flashing and read-o- graph type signs are not permitted.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Applicant / Owner Declaration and Signature

I hereby declare that the statements made herein are, to the best of my belief and knowledge, a true and complete representation of the purpose and intent of this application.
I have reviewed the submission requirements and understand that incomplete applications may not be accepted.
I also understand that the proposal must comply with all other applicable legislation and by-laws including, Building Permit and Sign Permit.
I acknowledge that any change to the approved drawings, however small, must be re-submitted for approval.
I acknowledge that Municipality of Port Hope staff and members of the Heritage Port Hope Advisory Committee (HPHAC) may visit the property that is the subject of this application for the purpose of evaluating the merits of this application.
I acknowledge that personal information on this form is collected under the authority of the Ontario Heritage Act and will be used to process Heritage Permit Applications and the information may also be released to the public.
I confirm that the owner and/or agent for this property has reviewed this application with Heritage Planning staff.

Applicant’s Signature (required)

Clear

Date:

Property Owner’s Signature (if different from application)

Clear

Date:

Personal information is being collected on this form under the authority of the Municipal Act and the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Please note that personal information collected will form part of the public record and is public information subject to the MFIPPA regulations and may be published as part of Council agenda and/ or public consultation processes. Questions about the collection of personal information may be directed to
the Municipal Clerk at 905-885-4544 or clerk@porthope.ca

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Heritage Permit Application