HomeMy WebLinkAboutPermit Building 1991-3-29
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CITY OF SPRINGFIELD
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225 North 5th Street
BUSINESS 726-3753
INSPECTIONS 726-3769
BUILDING MOVING PE~IIT/BUILDING DIVISION
NEW ADDRESS (~prni?hed by .Building Div.)
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OLD ADDRESS
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Description of Building
Square Footage 1 \4~ r.loving Length 4\
Number Of Secti~ns Being Moved \ Type
Moving Width r:J.f()Height On Dolly ~ \
Of Construction VN 'VALUATION
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PLANS, FEES, AND CHARGES: Prior to receiv-
ing a permit to move a building to property
within the City, the applicant or his/her
authorized representative must:
1. Submit 2 copies of site or plot plan
for new site.
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 electrical work relating to the re-
located building.
4. Pay Systems Development Charge if applt-
cable.
SEWER CAP: Buildings moved from within the SEPTIC TANK REQUIREMENTS: Prior to moving,
City limits shall have the sewer capped at owner shall have all sludge from the septic
the property line a~d inspected one working tank, seepage pit or cesspool removed by a
.... '~"':'_d~y prior to the move. If the inspection person ,holding a sewage dispoal service li-
indicates that the sewer has not been prop- cense, and shall fill same with clean bar-
erly capped, the moving permit will be run gravel or other material approved by the
revoked. Director or his authorized. representative.
'I CERTIFY THAT the above information: is true an.d' correct, that alt required contacts have'
been lDade and au, thorizations Obtained,. that the move will begin at q: ct.J 0' clock (aiil'Opm
on \ ~ .3_.\QQ \. and ,\...ill be completed. by Cf ~3() 0' c~ock @fp~ .c:m. ~ sA\)J\. ~,Tc::rctL,.
and that' no changes in the route will be made without contacting the BuildinE Divysion. I
also certify that I have been informed that NO PERMIT .WILL"BE ISSUED BEFORE 5 WORKING DAYS
HAVE ELASPED. I furtl)er certify that'my 'regi s"/;,rat ion\' with" 'the' Builder'l.s' Board, is' in full'"
force and effect as required by QRS 701.055 and 701.070, and that if exempt the basis is
noted hereon. Basis for Builder's Board Exemption:
NOTIFICATION OF l-10VE: The Building Division
will route copies of this application to all
appropriate divisions, departments and Agen-
cies. HONEVER, 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.
NAME
SIGNATURE
DATE
Zone
Flood Plain
FOR OFFICE USE ONLY
Type of Construction \/J\J Occupancy ~roup ~~,
Stor~es
Living Units
Square Footage
VALUE
Application fee $18.00
Permit fee $60.00 -- Date Paid'
Number of B~ocks over 6 @ .60~
, ": \CS :00 SO/o
Sew en Cap $~O + .4J,;; State Surcharge -- Date Paid
~olice Qepartment. Willamalane Park and Recreation
. .'.0ire Department" Pacific NW Bell
, , VNerthwest Gas \' VLane Transit District
OTHER -~ specify
Date
Paid 3. \ .q l
loO.~
(2)
Receipt Number
\ q3f)q
Receipt Number
Amount { On .uo (~ \ S. \l~ -::: '1 S. '15
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, Group W Cable
v Lane County A, & T
BUILDING MOVING, ~IT
>ERMIT VALIDATION
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 relating 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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PERMIT CLERK~(~
BUILDING DIVISION REPORT:
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TRAFFIC DIVISION REPORT:
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ENGINEERING DIVISION REPORT: - Y
By
Date
3~9/11
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