HomeMy WebLinkAboutPermit House Move 1998-8-28
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CITY ASSIGNED JOB NUMBER'
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
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BUILDING MOVING PERMIT
COMMUNITY SERVICES DIVISION
Structure BeIng Moved From
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.City
Lane County Reference Number
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Structure BeIng Moved To . /6
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Tax Lot Number'
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Lane County Reference Number.
Tax Lot Number'
Building Owner
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MailIng Address Po
CIty' 646....~
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State:
Phone ~umber: S Y f". t :Jof
~~l: PI~one Number .5 20,,- 0 7/ L
97tClo
Zip:
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MOVIng Contractor )( t:,., ~ /' ~ l/p.r~cI- L~.A .Phone Number. 1'1;;: t:Jo.F
Constr"otwn cnn,,,,;o", Reg"trnhnn N"mb" " \ \ 4G q () Expi"s 'I- ~ - C(0
MaIling Address' P, {J. '1' / / 76 '1 Cell Phone Number.52 0... c> y: z-
Clty.1,"",) 6-. t.. D /" q 7 ,,~ State' (1 f Zip: r
Plumbmg Contractor Ai I) Phone Number'
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Construction Contractors RegistratIon Number
Expires'
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Descnption of BuIldIng to be Moved
Square Footage
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MOVIng Length .A", ~J' / c;)C) MOVIng Width: I1..~Jo 2f rJ
C" f / "'. "'e:lp........
# of SectlOn~eInW Moved' J Type 0 Constr' """""
LIVIng Units ~7}.1 ,if,I"''''Vd1lue of Structure(s): '-
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'i / J 0 ~ '". BeginnIng at. ':6 c
1/7p f
am/pm
Height on Dolly
Square Footage
Proposed Date of Move
Completion Date of Move:
. Endmg at
/ Z .f 06
am/pm
DescnptlOn of Proposed Route (Please.attach map with route outlined WIth directional arrows) - \\"
Sqj/(; -10 hlA./luv (S:Jv-'.'l1d) A~/lf.V-!o ;J6"l,u/hJk(J/~ {&.'oo-6:i6h.m,
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{J ;~h~e.~ fJ (w y..fo 5o.J)L. 11 (b .'30 .. 7/ tJo ) St)J'/t., 1/ but./ !, J)<jl!.
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'NOTIFICATION OF MOVE The CommunIty Services DIVISion wIll route copies of thIs applicatIOn to all appropriate diVISIOns,
departments and agencIes However, the applicant must contact property owners If trees are mvolved m the proposed move In
additIOn, the applicant must secure the approval of all appropriate muniCipal, county and state authorities should the move origmate or
termmate outSide the CIty ofSprmgfield, or along any street owned by the state or the county withm the Cltys boundaries.
PLANS, FEES, AND CHARGES. Prior to receivmg a permit to move a bUIlding mto the City of Springfield, the applicant or theIr
representative shall
Y' SubmIt two (2) copies of site or plot plan for new site -----
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.-- Submit two (2) copIes of the foundation plan for the relocated buildmg ,....-
;,.- All applicable permit and system development fees shall be paId prior to any moved
,II"" Any applicable permits and mspectlons for sanItary sewer cap or septic pump and fill ---
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By my SIgnature below, I certIfy that the above mformatlon IS true and correct, that all requued contacts have been made and
authOrizatIOns obtamed I also understand that the mInimum time to process tIllS permit, because of the number of agencies notified
by the City of Spnngfield, IS seven (7) workmg days .
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Date.,V - I ~
Community Services Division Report:
Foundation/Site Plan Submitte~? Approvei? F~~dati n Pe"."it Number: II \ ~ .
Mnving Permit Approved By: \\;~{t'l~'Of)g t Date. 8.f]8 q?J -y(
E\tiff Fef:>-nLW.. ~e((AA [J~f;~ ~Cf\DLL)\edc'ement~'M
Engineering Division Report: Owner(s) AND Contractor(s) are both responsible for any damages to'pnvate or publIc property.
Moving Permit Approved By: 0 C1l""' ~
Date: ~C:::.c.-'S.i 2..~,,19~40
Traffic Division Report: Contractor is responsible for a safe, effiCIent relocation operation. All signal systems shall be monitored to
ensure they are functioning properly. Any damage to or malfunctions of the traffic signal system shall be reported immedIately to
Gary Weck, Signal Technician, at 343-4902 or Gene Butterfield, Maintenance Supervisor, at 998-3667.
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Moving Permit Approved BY:,p~ ~
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Date:
g -zg-38
Historical Report:
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. Mnving Permit Apprnved By: j ~E AiAA- Lt~1 ~
Date:
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following indicated stages of this J:lr?.i,ecl;.r...---
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oal-Move
To be made once structure has been
moved from SIte and all debns has been
removed.
To request an inspection, a 1 726-3769. Inspections called in before 7 am ade the s'!ffie working day, inspectIOns
. e made the following workmg day. Please leave your City designa
en you will be ready for mspection.
FOR OFFICE USE ONLY
Zone:
Flood Plain:
Type of Constr
Occy Group:
ApplicatIOn fee
Movmg Permit
SanItary Sewer Cap/Septic Pump and FIll
5% State Surcharge
3% Administrative Fee
~ Total Blocks. $.60 per block
Subtotal
$ 18.00
$ 60.00
~ 15.89
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$-94.26-
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$
$
$\ C:O. <60
TOTAL
(if property dnes n.nt need th~ m sewer capped or the :gc tank PCPed and qlled, ~nct applIcable P'it fee)
Date Paid: fZ? ~A '7f") Receipt Number: \ M j B'~ I M
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