HomeMy WebLinkAboutMiscellaneous Miscellaneous 1994-10-12
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HOUSING INSPECTION APPLICATI~N
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE:
J 0 - I 2. - 'ir'-f
JOB NUMBER: cr'f I $' b 1
ADDRESS OF INSPECTION: Cj 01...3 u MIlILCO l.-~ l'-J.
OIiNER: ~T i.J l,v u.,J'I ck ~A ~L-
PHONE NUMBER: b8'i- S 92-0
miNER'S ADDRESS: 7 0 ~
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APPLICANT: J tV- Tf2-.L't-IrIJ>+ /JI~\LL ~/1- ,r- eed '1 '-/f 10 I
APPLICANT'S ADDRESS: ?-o. c,c)j'- 5?'1i.J( C!.-o b '-<-1'-'1 DILl-- 97'fo?
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FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: ]Y1--Jrg-L (A'i,,-JL 3 "ll - 'i'v.O
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OIINER OF THE PROPERTY TO BE
INSPEjD. _ ~
C;tiJR~TY OWNER -
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FOR OFFICE USE ONLY
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DATE PAID:\\') . \~ . q 4- RECEIPT NUMBER: \ s04( J
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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INSPECT~ONS' 726-3769
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225 North 5th Street
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BUSINESS 726-3753
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BUILDING MOVING PERMIT/BUILDING DIVISION
.r . NEW AWRESS (Furnished +Building q~.) ,
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Address . ~-. Phone ~
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cITY IJEsiJNATED JOB NUMBER
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(0 Stl\M t -\') \ \)~ ~ T
OLD ADDRESS
q{)?...?-\D ,':~2:,~('n1(\/ed
Legal Description'
\ f) \)~300 flCJ~t1)
Building. Owner .
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Moving F}'i-m
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Description Of Intended
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Descript
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Use
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~,-.~J\0rld ~--\-n
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DescriPtion of Building
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.:Square Footage Moving Length '
Number Of Sections Being ~Ioved \
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<\-0 Moving Width 6J) . Height On Dolly Alo
Type' Of Construct LO,n V tV VALUATION
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NOTIFICATION OF MOVE: . The' Building Division
will route copies of this application to all
appropriate divisions, departments and Agen-
'cies. HOWEVER; the applicant' must contact
property owners if .trees are involved in the
proposed move. IN ADDITION, the applicant
must secure the approval of all appropriate
municipal, county and state'authorities
should the move originate or terminate out-
side the City of Springfield.
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. SEWER CAP: Buildings..moved from wi thin the
Ci ty limits shall have the sewer capped at
the property line. and inspected one working
, day prior to the move. ' If the inspection
indicates that the sewer has not been prop-
erly capped, the moving permit will be
revoked. '
PLANS, FEI:S, AND CHARGES: Prior to receiv-
ing a permi t to move a building to property
within tlw City, the applicant or his/her
authorized representative must: .
1. Submit 2 copies of site or plot plan
for new si te.
2. Submit' 2 copies of foundation'plan for
the relocated building.
3. Obtain a permit covering the new founda-
tion, as well as all plumbing/mechanical
and dectrical work relating to the re-
locu.ad building.
4. Pay ':ystems Development Charge if appli-
cable,
SEPTIC T,\NK REQUIREMENTS: Prior to moving,
owner sh:J\ 1 have all sludge from the septic
tank, set'page pit or cesspool removed by a
person h/\! ding a sewage dispoal service li-
cense, 3",1 shall' fill same with clean bar-
run grav.-!. or other material approved by the
Director or his authorized representative.
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I CERTIFY THAT the above information is true and correct, that all required contacts have
been made and authorizat.io~7 obtained, that the mo~e will begin at f) ',DOo'clock (iinjy,.p~.A
on~, ,>,'?--. \0..0,4-' and WIll be completed by ,-Q..C(') ,,'clock am/E)>n ~\-t?~~~l-rr.
and that no thanges in the route will be made without """tacting the Building Divis'ion. I
also certify that I have been informed that NO PERMIT IV' I.L BE ISSUED BEFORE 5 WORKING DAYS
I-lAVE ELASPED. I further certify that my registration wi 1:h the Builder's Board is in full
force and effect as required by ORS 701.055 and 701.070, and that if exempt the basis is
noted hereon. Basis for Builder's Board Exemption:
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NAME
SIGNATURE
, ~...-
DATE
FOR OFFICE USE ONLY
Type of construction__..~Occupancy
_.Zone \j)e..- I'.lood Plain
Stories. ft.~ -:,_.._L_i~ing,_l!.~~,l~_
Group
R~
I Square Footage_..
VALUE .'
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AppUcation fee $18.00 -- Date Paid 12:,.00 r..ceipt N~~ber*T!. to,
"'Permit fee --$60. 00"-- "Date 'Paid (QO .00 I:l'ceipt NumbE t 1
Number of Blocks over 6 @ .60i \0\ . 1 () Amount , ~ .
'se'wer:Gli~ $~C.;;: ',' .;.i'-:;;:u~;; 5~<chargc"-- u:rre-:PlIt'tt-' \D .1lr:J. <:t
v Police Department.. '_::::)Hllamalane Park and Recreatioll VRainbow Water / SUB
vFire Department . V e.aeifie III'! D911"S~ VCO_I' :.: Cd!>l,- \C...\
./Northwest Gas -:7Lane Transit District JLane County A & T
~OTHER --' specinr-
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BUILDING MOVIN(.: iRMIT
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I. Applicant to furnish (except as indicated)
A. Old address for building
. B. . . Lega.l. Description
I. '.'C"'New'address,'.for building
(Building':'Div. will furnish)
D. Legal.Description! _
E. Name, etc. of building owner
F. Name, etc. of moving firm
G. A description of. ,intended' use
H~;:Adescriptiori:of proposed route
I. A"description of, the building
I I. Appl ica'nt 'to contact'property owners if trees
involved,~and-secure authorizations from
. ot~et'juri sdi ctions '"as' necessary.
III.. .A site'.::or p\otr pl,ar, 'and foundation plan must
, : . be subm'itted.for~:the new site (2 sets)
IV. Plans must'lal'so bel sublnitted for 'any other
work relating\to!theirelocated buildt"ng.
.V....Fees & Charges':..",,,--']' '.
A. Application fee du.e and payable at time
:r' , of.applica~ion"i': :
.. !.B. '..Moving permit fees due and payable upon
permit issuance
C. -FEES &.CHARGES.TO BE CALCULATED BY
. BUILDING DIVISION STAFF
. VI. FOR OFFICE. USE ,ONLY. .
A~" Plan,cry~c~ ,~.ata collected , ,
--B. 'Copies of application to appropriate
.. . ... divisions,cdepartments and agencies
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TRAFFIC :DIVISION'.RERORT:'i ,'I.
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'.:-:;.:'PERMIT VALIDATION
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PERMIT CLERK I . .
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ENGINEERING DIVISION REPORT:
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. ADDITIONAL' PROJECT" INFORMATION:
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