Demolition/Removal Permit Application Form

Planning, Property and Development Department 1 of 3

Unit 31 • 30 Fort Street • Winnipeg Manitoba R3C 4X7
UPDATED: June 1, 2017
APPLICANT INFORMATION:
DEMOLITION No. Street Name Unit No.
ADDRESS:
LEGAL Lot Block Plan or DASSF/DASZ etc.
DESCRIPTION:
Applicant Name: Applicant Address Daytime Phone No.

Email Address: Fax No.

GENERAL INFORMATION:
TYPE OF WORK: Complete Demolition Partial Demolition Removal of:

PROPOSED METHOD OF DEMOLITION: By Machine By Hand

PROPOSED DATES OF DEMOLITION: Start: Finish:

COMMERCIAL BUILDING INFORMATION: N/A

TYPE OF BUILDING: Office Retail Restaurant Residential Industrial Other:

TOTAL AREA OF ALL FLOOR LEVELS OF BUILDING(S) BEING DEMOLISHED: FT2
The total area is required to include the area of all floor levels. For example: a 2-storey building with a
basement would be required to be calculated as a total of 3 floor areas (basement, main, and second floor). M2

TYPE OF FOUNDATION: Shallow (slab on grade, no piles, no basement) Deep (piles, basement)
HEIGHT OF BUILDING: Is the building greater than 1 storey or greater than 3 metres (10ft) high? Yes No

HOUSING BUILDING INFORMATION: N/A

TYPE OF BUILDING: Single Family Dwelling Duplex/Triplex Rooming House Garage/Accessory

IS A REPLACEMENT BUILDING PERMIT BEING PROCESSED ALONG WITH THE DEMOLITION PERMIT?: Yes No

DWELLING UNIT INFORMATION: N/A

DWELLING UNITS LOST DUE TO PROPOSED DEMOLITION/REMOVAL:

WORK DESCRIPTION AREA: (Please describe the proposed demolition/removal work below)

REQUIRED DOCUMENTS: (6 copies for Commercial demos, 3 copies for Housing demos, 2 copies for Housing accessory structure demos)
(Office Use Only)
Status of Title (not required for Housing accessory structure demos) Requested
Submitted
Dated within 6 months of application date.
Include all City of Winnipeg caveats.
Letter of Authorization(Commercial)/Owner Statement(Housing) (not required if owner is the applicant) Submitted Requested
Include signatures from all owners listed on the Status of Title.
Letter/Statement must specifically authorize demolition/removal of building(s).
Site Plan or Building Location Certificate/Survey Submitted

The provided Plan must include the following information:

All buildings on the property. The building(s) to be demolished/removed must be clearly identified.
Dimensions from buildings to property lines and buildings to buildings on the same property (if applicable).
Show and dimension all property lines and buildings.
Indicate what is adjacent to all property lines (other properties, streets, lanes, etc.).
Where the demolition is adjacent to a street, provide details on all items from the property line to the street curb (sidewalks,
boulevards, trees, utilities, etc.).
 Demolition/Removal Permit Application Form
Planning, Property and Development Department 2 of 3
Unit 31 • 30 Fort Street • Winnipeg Manitoba R3C 4X7

SITE PLAN DRAWING: (Use the area below to provide the required Site Plan or attach a separate drawing to your application.)

ADDITIONAL REQUIREMENTS FOR DEMOLITIONS:

Water & Taxes
It is the applicant's responsibility to ensure that City Water is turned off and/or disconnected and City Property Taxes are paid in full for any
demolished buildings. To verify that the water service is turned off and/or disconnected, please call Water & Waste at 204-986-2455 or email at
utilitybill@winnipeg.ca. To verify that taxes are paid, please contact Assesment & Taxation through 311 prior to any building demolition.
Gas & Electricity
It is the applicant's responsibility to ensure that all utilities, including electricity and natural gas are in an appropriate state for the building
demolition. To verify that the electrical and natural gas services are in an appropriate state for building demolition, please contact
Manitoba Hydro prior to any building demolition.
Asbestos
Asbestos presents a potential lung disease hazard when released into the air. It is present in thousands of common building materials used
prior to the early 1990's, and is still used today in some applications. Pursuant to Manitoba’s Workplace Safety and Health (WSH) Act and
WSH Regulations (Part 33 & 37), prior to demolition or alteration activities, owners, contractors or employers must ensure that;
• an asbestos inventory is prepared by a person competent to determine the presence of any asbestos containing material (ACMs),
• asbestos is removed from the area being demolished or altered,
• adequate measures are taken to ensure that ACMs do not create a risk to the safety and health of any person,
• the Director of WSH is notified 5 days in advance of work that may release ACMs into the atmosphere.
http://www.gov.mb.ca/labour/safety/asbestos.html
http://safemanitoba.com or call 204-957-SAFE
Failure to comply with these requirements may result in work stoppages, fines or prosecution.

**DECLARED VALUE FORM ON BACK**

Please submit this completed form including all detailed plans to the Zoning & Permits Branch, Unit 31-30 Fort Street or
Fax to 204-986-6347. For Fax submissions, in addition to plans, all questions and boxes must be completed.

INS PIR ATIO N HU T · 0 . 6CM GRID

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Demolition/Removal Permit Application Form
Planning, Property and Development Department
Unit 31 • 30 Fort Street • Winnipeg Manitoba R3C 4X7

Declaration of Value
The Winnipeg Building By-law 14.2.3 (5) states:

Every person responsible, architect, professional engineer, contractor or builder, having

contracted for or having performed, supervised or inspected any work of construction,
alteration or repairs on any land, or the agent of such person, shall give, in writing over his
signature when requested by the designated employee all the information in his power
with respect to the cost of the work.

DECLARATION

I have read the above noted items and to the best of my knowledge, the total monetary worth of the work

for which this application is made is the sum of $ .........................................................................................

(PLEASE PRINT)

Name: ______________________________________________________________________________

Company Name: ______________________________________________________________________

Signed: ______________________________________ Date: ______________________________

NOTE: TO BE FORWARDED TO DEPARTMENT AUDITOR

(Office Use Only)

REFERENCE FOLDER:

Please Note: The “declared value” set out above will be provided as information for Statistics Canada. It
is a Federal Offence to submit false information to Statistics Canada.

Personal information is collected under the authority of The City of Winnipeg Charter Act, and is used for the administration and enforcement of The City of Winnipeg
Building By-law No. 4555/87. This information will be disclosed publicly in accordance with the disclosure provisions of the Province of Manitoba - Freedom of
Information and Protection of Privacy Act. If you have questions about the collection, use, or disclosure of your information, contact the Corporate FIPPA Coordinator:
by mail to the City Clerk’s Department, Administration Building, 510 Main Street, Winnipeg, MB, R3B 1B9; by telephone to 311; or by email to FIPPA@winnipeg.ca.

Please submit the completed form along with the completed Declared Value Form
to the Zoning & Permits Branch, Unit 31 - 30 Fort Street or fax to 204-986-6347