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 + $170 ($85 each for one pre and one post inspection)
	After construction begins	$570 + all applicable per visit inspection fees ($85 each)
With pavement cut	Before construction begins	$570 + $170 ($85 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 ($85 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.

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Freedom of Information

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email foi@niagararegion.ca or call 905-980-6000 ext. 3779.