Government of Ontario: Ministry of Transportation

Letter of Clearance in Reference to the Application for Permit to Move Used Buildings on Kings Highway

Owner of Building

       

           
   

   

Moving Contractor

       

           
   

   

Description of building and move (Check appropriate response)

A. Building is the property of Applica

B. Dimension and weight information (Not loaded on vehicle)
   
   

C. Dimension and weight information (Loaded on vehicle)
   
   

D. Present location of building




E. Proposed destination of building







H. Vehicle information
           

           


J. Insurance information:
I hereby certify that I carry Liability Insurance under a Contract of Automobile Insurance with:



This will verify that the undersigned are in agreement to the insurance of a "Permit to move used buildings on Kings Highways" as indicated in the attached application and we agree to take the necessary precautions to protect our interests as required to facilitate the move.

Bell Telephone
Signature

X



Staff will attend



Ontario Hydro
Signature

X



Staff will attend



Municipal Hydro
Signature

X



Staff will attend


Cable Television
Signature

X



Staff will attend



Town Municipality

Signature

X



Staff will attend


Ontario Provincial Police
Signature

X



Staff will attend



.

Conditions

A. All fees must be paid prior to this permit being issued.
B. The Ministry reserves the right to cancel this permit at any time without notice.
C. It is the responsibility of the applicant to obtain all necessary approvals.
D. Moves are restricted to daylight hours on weekdays only.
    Permits are NOT issued for weekends or statutory holidays.
E. It is responsibility of the applicant (or mover) to arrange police escort.
    Time of move at the discretion of the police
F. The applicant is responsible to notify all emergency response units
    (such as ambulance, fire department) in the area of intended travel and must
    provide the date of the proposed move and the planned route.

We, the applicant(s) understand that under the provisions of subsection 5 of section 110 of The Highway Traffic Act of Ontario, the owner , operator or mover of any vehicle, object or structure who has obtained a permit is nevertheless responsible for all damages that may be caused to the highway and/or structures by reason of the driving, operating or moving of any such vehicle, object or structure.

Signature of Applicant

X


Permit to be dispatched by (Check appropriate response)




Note: The owner of the building is responsible for contacting all parties concerned in the event of a change of date, time or information of the intended move. See attached list providing names and addresses of contact people for the above required signatures.

Note: The above application must be Fully completed and all signatures obtained before the application can be processed. Fourteen (14) working days notice is required forthe issuance of this permit.

Note: All Municipal Permits and OPP confirmation must be submitted prior to Ontario Permit being issued.

SR-E-135E (02/2007)

© Queen's Printer for Ontario, 2007