HomeMy WebLinkAbout2022 Committee of Adjustment - Application for Change of Conditions2022Page 1of 3
COMMITTEE OF ADJUSTMENT
APPLICATION FOR CHANGE OF CONDITIONS
(Section 53of the Planning Act)
th
Planning Division –200 King Street West, 6Floor
P.O. Box 1118, Kitchener ON N2G 4G7
519-741-2426; planning@kitchener.ca
Office Use Only:
SUBMISSION NUMBER: CC(to be assigned by staff)
1.ADDRESS OF SUBJECT PROPERTY:
Have you previously consulted with staff on this application?
If yes, name and date of consultation:
Date Stamp
2.FOR YOUR INFORMATION:
It is recommended to consult with staff prior to submitting your form. Applicationswill not be accepted as
complete unless all legislated requirements have been met and will not be processed until all necessary
information has been provided.
In addition to the submission requirements found on the application form, it is imperative that the applicant
provide all the planning evidence necessary in support of the request being made. Depending on the
nature of the application, this evidence may be in the formof photographs showing the existing
streetscapes, contextual plans (in context with adjacent structures), historical information and/or detailed
location plans (windows, openings, accessory structures) of the abutting properties. This will assist the
Committee in making an informed decision regarding your application.
The owner and/or agent must attend the Committee meeting in support of their application. Information
on the meeting date/time will be forwarded to the applicant. A deferral fee will apply onapplications
requiring re-circulation for failure to attend meeting or requesting postponement.
This is YOUR application -make sure that you know the exact details of why you are applying. You must
identify exactly what is being requested, particularly as it relates to easements, rights-of-way or partial
discharge of mortgage. It is your responsibility to provide a complete and accurate application. Staff are
available for consultation, but they arenot permitted to complete the formon your behalf.
3.SUBMISSION REQUIREMENTS:
Complete applications shallbe submitted by email to planning.applications@kitchener.ca(maximum 10 MB).
Original, signed& commissioned applicationform, including plans, and cheque(payable to the City
of Kitchener) mustbe deliveredtoCity Hall-Planning Division,Attention: Manager of Development Review,
within one week of the digital submission deadline(you may send by mail, courier or drop off in person).
Application form(completed and signed)
Written authorization ofthe owner(s) is required if the application is signed by an agent on their behalf.
Affidavit –applicant’s signature has been witnessed and form signed by a commissioner, notary or lawyer
(if you require commissioning services, please make an appointment with City staff at:
https://outlook.office365.com/owa/calendar/CityofKitchenerServiceCounters@kitchener.ca/bookings/
-select “Planning: Commissioner Signature for Development Application Affidavit”)
Notice of Decision of original consent application
Other supporting documentation, if any
Application fee of$762.00(non-refundable)
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4.REGISTERED OWNER(S)
Name(s):Phone:
Company (if applicable):Extension:
Street Address:Email:
City/Province:Postal Code:
5.AUTHORIZED AGENT (if different from registered owner)
Name(s):Phone:
Company (if applicable):Extension:
Street Address:Email:
City/Province:Postal Code:
6.PROPERTY INFORMATION
Street Address:
Closest Intersection:
Legal Description (from Survey or Plan):
Lot(s) No:Registered Plan No.:
Lot(s) No:Reference Plan No.:
Part(s) No:
7.SUBMISSION NUMBER OF PROVISIONAL CONSENT:
8.NUMBER ASSIGNED TO THE CONDITION(S) FOR WHICH YOU ARE REQUESTING A CHANGE:
9.PLEASE PROVIDE DETAILED REASON(S) FOR THE REQUESTED CHANGE:
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10.AUTHORIZATION
If this application is being made by an agentthat is not the owner of the subject lands, written authorization
of the owner is required, as below:
I/we, , owner(s) of the land that is the subject of this application,
hereby authorize to act on my/our behalf in regard to this application.
Signature of Owner:Date:
Signature of Owner:Date:
11.ACKNOWLEDGEMENT
I understand that receipt of this application by the City of Kitchener -Planning Division does not guarantee it
to be a ‘complete’ application. Further review of the application will be undertaken and I may be contacted to
provide additional information and/or resolve any discrepancies or issues with the application as submitted.
Once the application is deemed to be fully complete, the application fee will be deposited and the application
will be processed. Submission of this application constitutes consent for authorized municipal staff to enter
upon the subject property for the purpose of conducting site visits, including photographs, which are
necessary for the evaluation of this application.
I further acknowledge that a City-issued notification sign must be posted at the front of the subject property
in a location that is visible from the street. Staff will advise when to post the sign and it shall remain in place
for 20 days after the Committee decision has been issued.
Signature of Owner or Agent:Date:
12.AFFIDAVIT (to be completed in personin the presence of a Commissioner of Oaths)
I/we,, of the Town/City of ,
in the County/Regional Municipality of , solemnly declare that all of the above
statements contained in this application are true and I make this solemn declaration conscientiously
believing it to be true and knowing that it is of the same force and effect as if made under oath and by virtue
oftheCanada Evidence Act.
Signature of Owner/AgentSignature of Owner/Agent
Declared before me at the
Town/City of inthe County/Regional Municipality of
Thisday of, 20 .
Signature of Commissioner of Oaths
*Commissioner/Notary –please affix stamp
*Lawyer –please print name beside signature