HomeMy WebLinkAboutPermit Building 1991-1-18
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CITY OF SPRINGFIELD
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INSPECTIONS 726-3769
225 North 5th Street
BUSINESS 726-3753
BUILDING MOVING PER~MIT/BUILDING DIVISION
OLD ADDRESS
3\0'5.9 (1(ll\'\ Q ~ ~ m , R ClCI_~
Legal Description
Building Owner
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~ioving Firm
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Des-citPt\~(\ Of Intenaed Use
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Description of Route
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Address
Address
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Description of Buildin~
,Square FootageJ3fY)O Moving Length
Number Of Section~ Being ~Ioved 4
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NEW ADDRES~~Oni[~eo by
Legal Description -
Building Div.)
Phone
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Exp.
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Phone
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. CITY DESIGNATED JOB NUMBER
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&01.11(.,
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o Moving Width ~ P Height On DollY-DLrL-
Type Of Construction V /\) VALUATION
I CERTIFY TK~T the above information is true and correct, that all re~ired cont
been made ~d a~horizations obtained, that the mov~ will begin~ L1 o'clo
on l~ ('r"J-Loj and "ill be completed by () o'clock am pm on -
and that no changis in the route "ill be made w~out contacti the Building Dlvision. I
also certify that I have been informed that NO PE~4IT WILL BE ISSUED BEFORE 5 WORKING DAYS
HAVE ELASPED. I further certify that my registration with 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:
NAME~S 0:--I{61/? lJvMJltfJ6~ SIGNATUREij~
NOTIFICATION OF ~IOVE: 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.
SEWER CAP: Buildings moved from within the
City limits shall have tbe 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, FEES, AND CHARGES: Prior to receiv-
ing a permit to move a building to property
"ithin the 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 ne" founda-
tion, as well as all plumbing/mechanical
and electrical "ork relating to the re-
located building.
4. Pay Systems Development Charge if appli-
cable.
" SEPTIC TANK REQUIREMENTS: Prior to moving,
owner sball bave all sludge from tbe septic
tank, seepage pit or cesspool removed by a
person holding a sewage dispoal service li-
cense, and shall fill same with clean bar-
run gravel or other material approved by the
Di~ector or his authorized representative.
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DATE '.2- sl.'?J
Flood Plain
FOR OFFICE USE ONLY
Type of Construction \J 0
Occupancy
Group'Q~* ~ \
I Square Footage
Paid \t\. Q\ ,ctO
l.Q( ) au
Zone U') R
Stories ~
Li ving Uni ts
Application fee $18.00 Date
Permit fee $60.00 -- Date Paid
Number of Blocks over
~0~erWE? Cap $10.00 + 4~o
~olice Department
~ ire Department
Northwest Gas
OTHER -- specify
6 @ .60~
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VALUE
Receipt Number
Receipt Number
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\4 \ r1 )
Amount
State Surcharge -- Date Paid
Willamalane Park and Recreation
-Pacific NW Bell -
~ane Transit District
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_Rainbow Water / SUB
_Group W Cable
_Lane County A. & T
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BE R-,f'.s~~S 18LL FdL.- A't.-L 7724-PAc
$II'€. /hvo f21tPtJff ~ ~(!
~. BvA.Je~ Date 1//@!9/
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BUILDING MOVING ttMIT
I. Applicant to furnish (except as indicated)
A. Old address for building
B. Legal Description
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. A description of proposed route
I. A description of the building
II. Applicant to contact property owners if trees
involved, and secure authorizations from
other jurisdictions as necessary.
III. A site or plot plan, and foundation plan must
be submitted for the new site (2 sets)
IV. Plans must also be submitted for any other
work relatin~ to the relocated building.
V. Fees & Charges:
A. Application fee due and payable at time
of application .
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 check data collected
B. Copies of application to appropriate
divisions, departments and agencies
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TRAFFIC DIVISION REPORT:
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ENGINEERING DIVISION REPORT:
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411JERM~T VALIDATION
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PERMIT CLER
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ADDITIONAL PROJECT INFORMATION:
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By'D.Q f2~ Date 1-\"O~91
By . Date