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Town of Fort Erie - Brownfield Community Improvement Plan (CIP) Online Application Form

* Applications must be submitted to and approved by the Town before any work begins. Costs incurred before approval are ineligible for financial assistance.

Section 1 – Applicant Information

Applicant name:

Business / corporation name:

Mailing address:

City:

Province:

Postal code:

Telephone number:

Email address:

Applicant type (Select one)

Registered property owner

Authorized agent

Commercial tenant (where eligible)

*If the applicant is not the registered property owner, written owner authorization must be provided where required.

Section 2 – Property Information

Municipal property address:

Legal description:

Registered property owner(s):

Assessment roll number:

Current property use

Vacant or underutilized

Former industrial

Former commercial

Former gas station or automotive use

Former landfill or waste-related

Existing industrial or commercial use

Other

Proposed redevelopment of future property use:

Zoning Designation:

Which environmental studies or reports have been completed or are proposed?

Phase II Environmental Site Assessment

Designated Substances and/or Hazardous Materials Survey

Remedial Work Plan

Risk Assessment

Risk Management Plan

Record of Site Condition preparation or filing

Other

Has a remediation or other applicable environmental work plan been prepared?

Yes

In progress

Not applicable

Unsure

Anticipated project start date:

Anticipated project completion date:

Section 5 – Program Specific Information

Applicants should complete only the subsection(s) relevant to their selected program(s).

A. Environmental Site Assessment (ESA) Grant Program

Which eligible study are you seeking funding for? (Select all that apply)

Phase II Environmental Site Assessment

Designated Substances and Hazardous Materials Survey

Remedial Work Plan

Risk Assessment

Risk Management Plan

Other

Briefly describe the purpose and scope of the proposed study.

Has the proposed study commenced or been completed?

Not commenced

In progress

Completed

Estimated cost of the proposed study, excluding HST:

The ESA Grant may provide 50% of eligible costs, up to $13,000 per study and a maximum of $20,000 per property. Phase I ESAs and studies completed before application approval are ineligible. A Phase I ESA must be completed to demonstrate potential contamination.

B. Brownfield Tax Assistant Program (TAP)

Describe the proposed remediation and risk-management work, including how it will address the environmental conditions at the property.

Estimated eligible remediation costs, excluding HST.

Describe the anticipated timing of remediation and redevelopment:

Has a remediation plan been prepared or approved?

Yes

Record of Site Condition (RSC) status

Filed

In progress

Not yet filed

Not sure whether required

The Town will review the remediation plan and applicable environmental documentation to determine whether the program requirements have been met.

C. Brownfield Rehabilitation Grant Program (TIG)

Describe the proposed redevelopment, including the intended use of the property and proposed buildings, structures or site improvements:

What remediation or site preparation activities are required to support the redevelopment?

Has development commenced or been completed? (select one)

Not commenced

In progress

Completed

Other

Estimated total eligible remediation and redevelopment costs before HST:

If available, upload financial projections or a project feasibility study

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

Section 6 – Project Costs and Other Financial Assistance

Estimated total project cost, excluding HST

Have you received, applied for, or do you expect to receive any other grants, rebates, loans, tax assistance, or financial incentives for this project?

Yes

Section 7 – Supporting Documents

Please identify the supporting documents included with your application and upload the applicable files. Requirements depend on the program(s) selected and the nature of the proposed project. The Town may request additional documentation where required.

Upload supporting documents:

Browse…

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

Applicants should upload documents relevant to their selected program(s). The Town may request additional information where required.

Section 7 – Applicant Declaration and Authorization (required)

I/We hereby certify that the information contained in this application is true and correct. I/We agree to abide by the terms and conditions of the Affordable Housing Community Improvement Plan Program as outlined by the Town of Fort Erie. I/WE hereby certify that property is not in tax arrears and that there are no outstanding orders or any other arrears or charges from the Town, Region or the Province.

Applicant Name:

Signature:

Clear

Date:

Authorization to act on behalf of the owener

AUTHORIZATION: Must be filled in by the owner if the Applicant and/or Agent is not the registered Owner of the lands. Please provide names of all owner(s) of the property, corporation or numbered company.

I/We (Name)

being the registered owner(s) of the lands subject of this application hereby authorize (Name)

of the Town/City of (Town, City or Township)

in the Regional Municipality of

to make application on my/our behalf to the Town of Fort Erie for the Affordable Housing Community Improvement Plan.

Dated at the Town/City of (Town, City or Township)

in the Regional Municipality of

Date:

Owner Signature

Clear

Witness

Clear

Owner Signature

Clear

Witness

Clear