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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

2.0 Subject Property

3.0 Applicant Information

Owner Information (if different from applicant):

Check if the same

4.0 Scope of Work Proposed

(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

(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

(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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Indicate all materials provided by checking all applicable boxes below:

8.0 Heritage Sign Approval (if applicable)

9.0 Architect or Structure / Graphic Designer (if applicable)

10.0 Contractor / Builder / Sign Maker (if applicable)

11.0 Heritage Colours Proposed (if applicable)

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

12.0 Lighting Proposed (if applicable)

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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.

Clear
Clear

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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Located along the shores of Lake Ontario and the Northumberland Hills.

© 2023 Municipality of Port Hope

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56 Queen Street.
Port Hope ON L1A 3Z9

Phone 905-885-4544
Fax 905-885-7698

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