HomeMy WebLinkAboutPermit Building 2007-10-10
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2007-01133
ISSUED: 10/10/2007
APPLIED: 07/31/2007
EXPIRES: 10/10/2008
VALUE: $ 122,711.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 340 54th St
ASSESSOR'S PARCEL NO.: 1702333100303
Springfield
TYPE OF WORK: Single Family Residence
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Single Family Residence, Parcell
Owner: DA VID AND LAURIE DUKES
Address: PO BOX 71095
EUGENE OR 97401
Phone Number: 541-747-3130
I CONTRACTOR INFORMA nON I
Contractor Type Contractor License Expiration Date Phone
General DA VID DUKES 541-520-2215
Electrical EASTSIDE ELECTRIC INC 117770 10/04/2009 541-915-9828
Mechanical COMFORT FLOW 460 06/2712009 541-726-0100
Plumbing DENNIS SCOTT EGGERS 142776 05/0512010 541-459-0110
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
3
# of Stories: 1
Height of Structure: 14.50
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Gas
Energy Path: Path 1
Sprinkled Building: nla
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
5,037
1,070
1
R-3
U
VN
463
I DEVELOPMENT INFORMA nON I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
36.00
5.00
13.00
16.00
7.50
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage: 20.10
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
I PUBLIC IMPROVEME~~tNTION: Oregon law requires you to
Stre&J,(TAA~.e. ments: follow rul€Sid\rtMtelIljrJ,Mhe Oregon Utility
NU 1\11:; Notification Center. Those rules are set forth
StoI"f.li.~'Pf~ftI~ALl EXPIRE IF THE WORK in OAR 952~'Y!Ue?e~Rfd~oAR 952-001.
Spe'AtfTAtl~=UNDER THIS PERMIT IS N()T 0090. You may obtain copies of the rules by
('OMMJ:I\H~J:n Q!QJ~.ARANnnN.J:D ~nR.. . calling the center. (Note: the telephone
Not~. 'S'fuffii'Wilt t 'd\'lhh~td'''l}''a'8sl(Ie dirch' via pnvate storm pipe. nurnber for the Oregon Utility Notification
ANY 180 DAY PERIOD. Center is 1-800-332-2344).
Pal!:el of 4
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01133
ISSUED: 10/10/2007
APPLIED: 07/31/2007
EXPIRES: 10/1012008
VALUE: $ 122,711.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriotion I
Dwellin!!s
Gara!!e
V Wood Frame
Gara!!e
$ Per Sq Ft
or multiplier
$103.00
$27.00
Square Footage
or Bid Amount
1,070.00
463.00
Value
Date Calculated
Description
Tvpe of Construction
Total Value of Project
$110,210.00
$12,501.00
$122,711.00
07/31/2007
07/31/2007
~
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $458.37 7/31/07 1200700000000000981
~Mech Iss 2+ Appliances~ $40.00 10/10/07 1200700000000001292
+ 10% Administrative Fee $135.58 10/10/07 1200700000000001292
+ 5% Technology Fee $74.21 10/10/07 1200700000000001292
+ 8% State Surcharge $102.33 10/10/07 1200700000000001292
2 Baths One or Two Family $280.00 10/10/07 1200700000000001292
Addressing Assignment $35.00 10/10/07 1200700000000001292
Appliance Vent $7.00 10/10/07 1200700000000001292
Building Permit $705.18 10/10/07 1200700000000001292
Dryer Vent $7.00 10/10/07 1200700000000001292
Exhaust Hoods $10.00 10/10/07 1200700000000001292
Fire SF Fee - Residential $76.65 10/10/07 1200700000000001292
Furnace - up to 100,000 btu $14.00 10/10/07 1200700000000001292
Gas Outlets 1-4 $5.00 10/10/07 1200700000000001292
Plan Review Major - Planning $205.00 10/1 0/07 1200700000000001292
Residence Wiring 1000 Sq Ft $117.00 10/10/07 1200700000000001292
Residence Wiring Ea Addtl 500 $42.00 10/10/07 1200700000000001292
Sanitary Sewer - Improvement $448.89 10/10/07 1200700000000001292
Sanitary Sewer - Reimbursement $590.33 10/10/07 1200700000000001292
SDC MWMC Administration $10.00 10/10/07 1200700000000001292
SDC MWMC Improvement $961.52 10/10/07 1200700000000001292
SDC MWMC Reimbursement $91.61 10/10/07 1200700000000001292
SDC SanitarylStorm Admin $138.78 10/10/07 1200700000000001292
SDC Transpo Admin $70.85 10/10/07 1200700000000001292
SDC Transpo Improvement $862.25 10/10/07 1200700000000001292
SDC Transpo Reimbursement $195.48 10/10/07 1200700000000001292
Storm Drainage Impervious Area $1,032.44 10/10/07 1200700000000001292
Storm Sewer Each Addtll00' $16.00 10/10/07 1200700000000001292
Temp Power 200 amps or less $55.00 10/10/07 1200700000000001292
Vent Fan $21.00 10/10/07 1200700000000001292
Willamalane Single Family $2,303.00 10/10/07 1200700000000001292
Total Amount Paid $9,111.47
Pa!!e 2 of 4
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01133
ISSUED: 10/10/2007
APPLIED: 07/31/2007
EXPIRES: 10110/2008
VALUE: $ 122,711.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Initial Review
Plannin!!: Review
Public Works Review
08/01/2007
08/01/2007
08/01/2007
I Plan Reviews I
08/01/2007 APP
08/21/2007 APP
08/02/2007 APP
LLH
TAJ
TSS
Storm water drains to roadside
ditch via private storm pipe.
See documents for Plan review
comments
Structural Review
08/01/2007
08/1312007 APP
DLM
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
~eouirecUnsnections .
ErosionlGrading Inspection: Prior to ground disturbance and after erosion measures are installed.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing andlor
foundation inspection.
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in
place but prior to concrete.
Post and Beam: Prior to floor insulation or decking.
Floor Insulation: Prior to decking.
Shear Wall Nailing: Before covering sheathing with finish materials.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
Final Building: After all required inspections have been requested and approved and the building is complete.
Underslab Plumbing: Prior to filling the trench and including required testing.
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
Underfloor Plumbing: Prior to insulation or decking.
Underfloor Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing.
Water Line: Prior to filling trench and including required testing.
Pa!!:e 3 of 4
CITY OF SPRINGFIELD
Status
Issued
Building/Combination Permit
PERMIT NO: COM2007-01133
ISSUED: 10/10/2007
APPLIED: 07/31/2007
EXPIRES: 10/10/2008
VALUE: $ 122,711.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Sanitary Sewer Line: Prior to filling trench and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plumbing work is complete.
Underfloor Mechanical. Prior to insulation or decking and including required testing.
Underslab Mechanical. Prior to insulation or decking and including required testing.
Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance.
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
Rough Mechanical: Prior to Cover.
Final Gas: When all gas work is complete.
Final Mechanical: When all mechanical work is complete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
Underslab Electric: Prior to cover
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY wHl be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 wHl be used on this project. I
further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans wHl remain on the site at all
t;m"dUringCOo~~ ~~k?
~er ~r Contractors Signature Date
Pal!:e 4 of 4
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUTV ALENT = DRAINAGE FIXTURE UNITS 1
(NOTE: FOR REMODELS, CALCULATE ONLY TIIE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 1 0 3 = 3
DRINKING FOUNTAIN 0 0 1 = 0
IFLOOR DRAIN 0 0 3 = 0
IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
IINTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
ILAUNDRY TUB 0 0 2 = 0
I CLOTHES WASHER / MOP SINK 1 0 3 = 3
CLOTHES WASHER - 3 OR MORE (EA) 0 0 6 = 0
MOBILE HOME PARK TRAP (l PER TRAILER) 0 0 12 = 0
RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 3 = 3
SHOWER, SINGLE STALL 1 0 2 = 2
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
I SINK: COMMERCIAL BAR 0 0 2 = 0
SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0
SINK: SINGLE LAVATORYIRESIDENTIAL BAR 2 0 1 2
URINAL, STALL / WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 = 0
TOILET, PRIVATE INSTALLATION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 22
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
-
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR CREDIT RATE/$I,OOO
ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 2
BEFORE 1979 $5.29 (Enter 1 for Yes, 2 for No)
1979 $5.29 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 2
1980 $5.19 (Enter 1 for Yes, 2 for No)
1981 $5.12 BASE YEAR 1979
1982 $4.98
1983 $4.80 CREDIT FOR LAND (IF APPLICABLE) I'
1984 $4.63 VALUE / 1000 CREDIT RATE
1985 $4 .40 $0.00 x $5.29 = , $0.00
1986 $4.07
1987 $3.67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
1988 $3.22 VALUE /1000 CREDIT RATE
1989 $2.73 $0.00 x $5.29 0
1990 $2.25
1991 $1.80
1992 $1.59 TOTAL MWMC CREDIT = $0.00
1993 $1.45
1994 $1.25
1995 $1.09
1996 $0.92
1997 $0.72
1998 $0.48
1999 $0.28
2000 $0.09
2001 $0.05
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
COM2007-01133
David Dukes
340 54th Street
17-02-33-31-00300
SINGLE F AMIL Y RESIDENCE
1 BUILDING SIZE (SF: 1944.75
JOURNAL OR JOB NUMBER:
NAME OR. COMPANY:
LOCATION:
TAX LOT NUMBER:
DEVELOPMENT TYPE:
NEW DWELLING UNITS
1. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x COST PER S.F. CHARGE
I 2983.75 $0.346 I = I $1,032.44
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. x COST PER S.F. x I DISCOUNT RATE
I 0.00 $0.346 I 50%
ITEM 1 TOTAL - STORM DRAINAGE SDC I $1,032.44
LOT SIZE (SF):
o
DISCOUNT
$0.00
$1,032.44
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
NUMBER OF DFU's x
22
B. IMPROVEMENT COST:
NUMBER OF DFU's x
22
COST PER DFU
$26.83
COST PER DFU
$20.40
$1,039.22
$590.33
. $448.89
I NUMBER OF UNITS x
I 1
x I NEW TRIP FACTOR
I 1.00
COST PER TRIP
20.43
B. IMPROVEMENT COST:
I ADT TRIP RATE x NUMBER OF UNITS x I COST PER TRIP
I 9.57 1 I $90.10
ITEM 3 TOTAL-TRANSPORTATION SDC = I $1,057.73
x NEW TRIP F ACTORI
1.00 I
I
$195.48
$862.25
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
NUMBER OF FEU's I x COST PER FEU
1 \ $91.61
B. IMPROVEMENT COST:
INUMBER OF FEU's x
I 1
I COST PER FEU
i $961.52
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATNE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC . = I
SUBTOTAL (ADD ITEMS 1, 2~ 3, & 4) =: I
5. ADMINISTRATIVE FEE:
SUBTOTAL x 1 ADM. FEE RATE 1=1
$4,192.52 I 5% j I
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
$1,063.13
=
$91.61
= I
.
I
I
$961.52 .
$0.00
$10.00
$4,192.52
CHARGE
$209.63
-~.. --
.--
Todd Singleton
PREPARED BY
TOTAL SDC CHARGES
DATE
138.78
$70.85
= l $4,402.15
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I; 1091
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11092
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1093
1094
1054
1055
1054
1056
1079
1078
Date
ZON '-(~)_
INITlALS 10 WV
DATE 1(\- i 1--0\
SOURCE (Y\ ~ ~'21
. \ 0 e to" 01
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FA.,'X: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ~ zen 0 .7 - (') / / } 7
1.
\\Wi::;!'f?)'?>;"~:i";;;f':":;:"'.:'2+;F-':';,~/X?r-1,:'{;;,;;-;';"\/:'j;>\.;';,~:::;;<~' ":"::::":"_' "', " ',-''?';'
. NOFINSTALLATI
~ 4rJ;;n??:fA",~7:
LEGAL DESCRIPTION:
1702 3~1.1 m-Sl)'J
JOB DESCRIPTION:
.5;;:.RH, f ~~de-
Permits are non-transferable and expire if work is .
not started within 180 days of issuance or if work is
Suspended for 180 days.
'}"/
2.
Electrical Contractor
EAS15/fJ~ 6Lf-CTfC/L
Address . 31\ d.. 5'"3
80S (AGf ClJ sP~(.o
7Y/~ /1/79
City 5r~LO
Phone
Expiration Date
Y7:l75
)0 -1- 0 ~
Supervisor License Number
Constr. Contr. Nu~ber
. I /7770 .
I (] ~ j- u g
Expiration Date
Signature of Supervising Electrician
OU2jJ{ ~.
1\..0). I
J)A1/~ IJ~~
Address fi?/')~ /ljJ~~
_" '10 -.
City .fi/q OUt! Phone .7.47--3/30
Owners Name
OWNER INST ALLA nON.
The installation is being made o~ property I own which
is not intended for sale, lease or rent.
Owners Signature:
- ....)
Inspection Request: 726-3769
.3.
A,
. Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
. Feeder
.~$117.00 1/7~
2 $ 2LOO 426-tf)
$55.00
B.
. 200 A~s0d3HsION: Oregon law reauir$@<o/-Q0.l to .
201 ArlI~Y~~0I1to\~m~dopted by the Ore!$<313.&0tility
401 A~ll!itl9~Gtp~rhifsnter. Those rules a$(f3~dorth
601 ~1},R ~&firRV001 ~thr_o~~n ~A~I~a~cP~.l-
UUt1U.' y6L,l,mg~ obtam CV!-,'Ci-:> v, tilE} ru ~s uy
Over 10~~rtirBsmgltenter. (NO~3: Ux ~~$eMb6i1c
RecoI1I1(itIn<.fB ~r for the Gregor. ~ti~i~y--N~t~dHiO~
c.
Installation, Alteration or Relocation
200 Amps or less . )
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D,
$ 55.00
$ 76.00
$110.00
L .tHJ
.;;;,..L ~ ~
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Servict< or Feeder Permit
$ 48.00
$ 4.00
E.
!illatIon:"
cs~,~ :~;:",'_'_:'.,;1,\;d.
Pump or irrigation $ 55.00
Sign/<>>t{j~JdC&ing $ 55.00
Limitld1!tSeijb!4If.Mf~I8flIAll EXPIRE IF $ 28.00
LimitAUifrMQRQ<[r@ntJ'NI9ER nw~ "" r~&o~ORK
Minimum61GAdl\400f!t)lUf'F'0 \J ~ Wllslli-JNllles
4. t.[~~.~U.'''~,'::"'HN; Rz/-9S t/O
I 7,/2
"7 -LL4 '0
71J . 70-
, ~3.2-2-
Shared Drive(T:)!Building Forms/Electrical Permit Application 7-07.doc
8% State Surcharge
. 10% Admin.istrati ve Fee
. S% Technology F~e
TOTAL
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-0l133
COM2007-0ll33
COM2007-0II33
COM2007-0II33
COM2007-01I33
COM2007-0I133
COM2007-01I33
COM2007-0II33
COM2007-01I33
COM2007-0II33
COM2007-0ll33
COM2007-0II33
COM2007-0II33
COM2007-0l133
COM2007-0ll33
COM2007-0ll33
COM2007-0II33
COM2007-0I133
COM2007-0l133
COM2007-0 1133
COM2007-0I133
COM2007-0II33
COM2007-0I133
COM2007-0ll33
COM2007-0ll33
COM2007-0II33
COM2007-0I133
COM2007-0I133
COM2007-0ll33
COM2007-0l133
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
1200700000000001292
Date: 10/10/2007
Description
Addressing Assignment
Willamalane Single Family
Temp Power 200 amps or less
Fire SF Fee - Residential
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC SanitarylStorm Admin
SDC Transpo Admin
Building Permit
Storm Sewer Each Addtl 100'
Furnace - up to 100,000 btu
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
~Mech Iss 2+ Appliances~
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Plan Review Major - Planning
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
2 Baths One or Two Family
Paid By
DA VID E. DUKES
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
NJM
045738 In Person
Payment Total:
Page 1 of 1
11:48:19AM
Amount Due
35.00
2,303.00
55.00
76.65
1,032.44
590.33
448.89
195.48
862.25
91.61
961.52
10.00
138.78
70.85
705.18
16.00
14.00
21.00
7.00
10.00
7.00
5.00
40.00
117.00
42.00
205.00
74.21
102.33
135.58
280.00
$8,653.10
Amount Paid
$8,653.10
$8,653.10
10/1 0/2007
Willamalane
Park & Recreation Oistrict
Job. No. 0Jl. \\?1 ~
SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2007
NAME: til_00 *\1l0ne, ~\J~HONE:14-1.3~30
: ADDRESS~D~ l~c,TY 'Wr\0\( STATEOO:..zIP{ 10
LOCATION OF PROPOSED BUILDING SITE:
Street Address: ?At) ~~~ <6\\efA .
\\ (l -)
Plat Name:
Tax Lot Number:
\,
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the
back. )
A. Sinale-Familv Detached \ $ ~W3~U
NO. OF UNITS X $2,303 per unit =
B. Sinale-Familv Attached
NO. OF UNITS _X $2,426 per unit = $
C. Multi-Familv ADartment
NO. OF UNITS X $2,032 per unit = $
D. Sinale Room OccuDancv
NO. OF UNITS X $1,016 per unit = $
E. Accessorv Dwellina Unit
NO, OF UNITS X $1,151.50 per unit = $
WILLAMALANE SDC $ ~oD3.(JO
2. SDC CREDIT (If applicable) SDC payer must furnish proof of tJ
Willamalane Credit approval.) $
3. TOTAL WILLAMALANE NET SDC ASSESSED 1~D~~
(if SDC reduced for Credit) $
Development Services Department
City of Springfield
Date
5