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HomeMy WebLinkAboutPermit Building 1992-10-21 ~ ./ . . '........... RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 . dlSO \,... 1S1/,,(Pn100 2'7 /~ 11- ltl ~ BLOCK' ~"'A~' :\ :;;/1<../ S;; 'i 1.. ,,,,ci<< Ie VtV' # L ~o.,; vte<-he./ d LOCATION OF PROPOSED WORK: ASSESSORS MAP: /713 '2, LOT' OWNER: ADDRESS: CITY: JIll d ",{w L,)YV'<>V STATE: -illf/{> DESCRIBE WORK' seA u,w hlll:'ihli..CV -/-G-,.,..P- ~ 'I' hJ -:;0 I NEW'/' ADDITION REMODEL ELECTRICAL' DEMOLISH OTHER . 5'2/4'~r'n f JOB NUMBER ~. 225 Fifth Streel Springfield, Oregon 97477 ~ cd i--- TAX LO-r. -1~t17'J SUBDIVISION' PHONE: 7d.6 ~o.S"c;7 , ZIP: c>"]Ir 7' 7 * CONST. CONTRACTOR' EXPIRES PHONE - OFF\~~ - .. " QUAD AREA: \R\\W LAND USE: \ '- ( FLOOD PLAIN: - K) . OF BLDGS: l . OF UNITS: J ZONING CODE: ~ ~I CONSTR. TYPE:_AJ OCCY GROUP: . OF BDRMS' . OF STORIES' HEAT SOURCE: tE SECONDARY HEAT: r..J l'~ , \AA( ) WATER HEATER: RANG~' SQUARE FOOTAGE: CONTRACTOR'S NAME ADDRESS GENERAL:_llff"lt.....k\.e._C\~rc~ /Q..5/) M",,, ,\r S->O",-,..,.~ PLUMBING:_C-V"1 L_b",""""" .,.:._. . 7'11-Koob I~() S' 7'31-"- ~VV(ch..,j,rzl:::" MECHANICAL: ^ .1 \..'J\.C'i.L0() \'(\ ~~~p,\J<?\~?-F' ,( n q,"~, II II ~ - - . I ,., ,. ,I .1,: ~~ ;... I 1\ h ,"J ; , 1-': i'l l;' b " h I: I' :' .',,: t,: I' I- I'. " f:. ~.~, I i. 1'1 ,. , '. , '. I i' ., , ' ,. t.:. " :.; ,'1' ,. r'. ,. ";. ':'1 ,. ... ;.: ;':, ,: " " .. ". .. ,1 v: . .' l.~~ t..: i '" .., '. I. j'; :' " f.:I ..1 ". i,~li hi (f I:~ . r ''/ ~. !',' !~ H:, I" :~ 10"' f'- " ,> ~ ,.. :-'1 " I" m ~ ,.. I ~ jl I: ',' To request an Inspection, you musl call 726.3769. This Is a 24 hour recording. All Inspections requesied'before 7:00 a.m, will be made tho same working day. Inspections requested after 7:00 a.m. will be made the following work day. . REQUIRED INSPECTIONS o Temporary ElectrIc o SlIe Inspection - To be made after excavation, but prior to setting forms. o Underslab Plumblng/Electrlcall Mechanical - PrIor to cover. o Footing - After trenches are excavated. o Masonry - Steel location, bond beams, grouting. o Foundation - After forms are erected but prior to concrete placement. o Underground Plumbing - Prior 10 filling trench. o Underfloor Plumbing/Mechanical _ Prior to Insulation or decking. o Post and Beam - Prior to floor Insulation or decking, o Floor Insulation - Prior to dacklng, . ~ Sanitary Sewer - Prior to filling '-P trench. . o Storm Sower - Prior to 111 ling trench. ""-~ Waler Llno - PrIor to filling ~ trench. o Rough Plumbing - Prior to cover. o Rough Mechanical - Prior to cover. o Rough Electrical - Prior to cover. o Electrical Service - Must be approved to obtaIn permanent eleclrlcal power. o Fireplace - Prior to facIng materials and framing Insp. o Framing - Prior to cover. o Wail/Ceiling Insulation - Prior to cover. o Drywall - Prior to taping, . , . . ..,. "...h/./>... o Wood Stove - After In'stallatlo~. . .." o Inaert - After fireplace approval and Installation of unit ,. O .", , . Curbcut,& Approach - After forms are erected but prior to placement of concrete. o Sidewalk & Driveway -After excavation Is complete, forms and sub.base material In place. o Fence - When completed, . .' , ., ': ~ .' 'j.. o Slr.eet.1l"e~s - When all requlied trees are planted. , . o Final Plumbing - Whan all plumbing work Is comple!.e. o Final Electrical - When all electrical work Is complete. " I' I, . -I . o Flnsl Mechanical - When all mechanical work Is complete. I, ~ o Final Building - When all required Inspections have been approved and building Is completed. o Other , . MOBILE HOME INSPECTIONS :y\~~'1 '.....,."_.....~....-.. '1" .':\ q.~t. .-;1: ',,'~'.'I It;'''.,' :'. 'I ", ...' _...........' i.:lj. "I,. \,,',;,.J" ~.2.,'1 . , , ." \', ~.'. 'BIOCkli;g[and':Set,UP - When all ;.~ ~bI07,~~.!:,gil.SI~c;Orr;~lete. ' 5&,' pi~iJ~~'6o~n'e~uon", - 'w~en ~.tlori""e,:~as.,b~en connected to ~ ;~waterC~lOd"sewer.. . ::'" ~",;, . ,~~;<-~' .',;~,:' , ,: \,.' ~.Electrli:al ,con'neetlon - When' . 'blocking, set,up,.arid plumbing , . ~~Inspectlons' have', been:npproved , and the:hoiTjels~connected to the serVice panel: ... " ~';"'nai ......Aft~~,a"..re%ulred . LiI)('~speotfons.,iare\'app'roved ?ahd ..,_,"- '.--~'"._'-~ ~., ~..~,l<\, ., '. porcheai..sklrllng'I,d~9~s.' a~d . ::"ventlng .h'avEi:bee'mlnstalled:' l Lot faces: Lot ~ype .' Interior Lot sq. ftg. Lot coverage .' C6rner Topography Total height Panhandle Cul.de-sac BUILDING PERMIT. I . ,~.: ',' ITEM ' SO, FT:. ... ,X $/SO.' FT. Main < ' Garage CfMN\tU\uQ Carport . '1 , - .., -,,.,;'" -....:. l~ THE PROPOSED WORK IN THE 1 -JISTORICAL DISTRICT, OR ON .....' II THE HISTORICAL REGISTER? If yes, this appllcallon must be signed and approved by tile Historical Coordinator prior to permit Issuance. Setbacks. I P.L, 'HSE' GAR' ACC I .I N . I I S I Iw I I E I VALUE I4CDCV / APPROVED: .BUILDING VALUE, PLAN CHECK 'ANQBUILDING PERMIT This permit Is granted onllle express condlllon thai tile said constructIon shall, In all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and U50 of buildings, and may be suspended or revoked at any tlmo upon violation of any proVisions of said ordinances. ./" V Plan Check Fee: Date Paid: Total Value OJ~.,p)D Receipt Numbcl':_ Building Permll Fee ~~ Received By: State Surcharge Total Fee (A) Plans Reviewed By Dale . SYSTEMS DEV~LOPMENT':CHARGE~DCk.r-- (B) 09LP~ PLUMBING PERMIT ITEM Fixtures Residential Bath(s) Sanitary Sewer N' FT. Water FT, Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood StovellnserllFlreplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk II Curbcut ft Domolltion State Surcharge Tolal Miscellaneous Permits (E) TOTAL AMOUNT DUE-(excludlng electrical) (A, B, C, 0, and E Com-OIllt;lUI FEE A,c:<"CXJ A:=5.CO ,~,ou 12~a.> 3.~5 LoB~ o IO~~ ~O, ..=)~ '1.1.' y ."<6 Systems Development Charge Is due on all undeveloped properties within 010 City limits which are being Improved. ADDITIONAL COMMENTS By signature, I stale and agree, that I have carefully examined the completed applicatlon and do hereby certify that all Information hereon Is true and correct, and I further certHy that any and all work performed shall be done In accordance with the Ordinances of tile City of Springfield. and the Laws of the State of Oregon pertaining to tho work descrIbed herein, and that NO OCCUPANCY will be made of any structure without permissIon of the Building Safety Division. I further certify Olat only contractors and employees who are In compliance with ORS 701.055 will be used on thIs project. I further agree to ensure tllat all required Inspections are requested at the proper time, that each address Is readable from the street, that the permit card 15 located at tho front of the property, and the approved set of plans will remain on the site at a/l limos during construction. /t Q~/ {I '// q 2- Slgnatui\,..< ti. . I; "l. Date _/~;:J{L.C; VALIDATION: RECEIPT NUrR'l~ ,. . -~ DATE PAID JU-c9..- - - _ AMOUNT FlE~m __ _ ()5.{o RECEIVED 'iA~J ~ ....... ... . . ."mlt No, -3B 14to ~ Address: &L~ thew A(} :#cJ01 Issued bya/.J'{l-~ Date: 10 ,2(.9~~ FOR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued, This state. ment is required for residential building, electrical, mechanical, and plumbing permits, Licensed Architect and Engineer applicants, exempt from registration under ORS 701,010(7), need not submit this statement. This statement will be filed with the permit. Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: ./ 1, I ......... I I own, reside in, or will reside in the completed structure, 2. I I I understand that I must register as a construction contractor if the structure is sold ./ or offered for sale before % upon.completion. 1---.. ~ v I My general contractor is ~ vl\(\ ~ f'\r) D.t\ " )Q (~)\ QJ) ) Contractor registration number /\~:\~ q I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. 3, A.I OR 3, B,I I I will be my own general contractor, If I hire subcontractors, I will hire only subcontractors registered with the Construe. tion Contractors Board, If I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor, I hereby certify that the above Information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. 10/~//9..2-' Date I ( - CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ~ INFOFtATION NOTICE TO PROPERTY OtNERS ABOUT CONSTRUCTION RESPONSIBILITIES ..' ":.. NOTE: 'This Information Notice to Property Owners About Construction Responsibilities . -.... . was developed by the Construction Contractors Board in accordance with ORS 701.055(5), _ passE;!d .bytt)e 1989 Oregon Legislature, , If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern, EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an "employer" and the people you hire will be "employees", As the employer, you must comply with the following: Oregon's Withholding Tax Law: As 'aM employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees, For more information, call the Oregon Department of Revenue at 378-3390, Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees, For more information, call the Oregon Employment Division DHR at 378-3224. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must.obtain workers' compensation, insurance .for your employees. If you fail to obtain workers' compensation insurance,. you' may be subjedto penJalties.andwill be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 373-7434, t . .1. - U,S, Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages, You will be liable for the tax payment even if you didn't actually 'tIithhold the tax. For more information, call the Internal Revenue Service at 221-3960, . OTHER RESPONSIBILITIES AND AREAS OF CONCERN: . Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your atteption through inspections, Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Employees: Make sure you have sufficient time to supervise you'r employees, Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections, If you have additional questions, write to: Construction Contractors Board 700 Summer SI. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89 , " . DEVELOPMENT SERVICES PUBLIC WORKS METROPOLITAN WASTEWATER MANAGEMENT 225 FIFTH STREET SPRINGFIELD. OR 97477 (503) 726,3753 MOBILE HOME AND MP~UFACTURED HOME AGREEMENT UNITS TO BE PLhCED IN A PARK As required by the City of Springfield Development Code and/or the State of Oregon, I understand and agree, as sho.n by my signature on this form, that .ith ~'h Wf.!?'.,'a'-"hthe at. tach,<sl. ,l/AAts for a home to be located at :-II ) n . Vll(lJ ::trDJJ...1::1 ' Springfield, Oregon, Ci ty Job Number _1:::V4Lpll} I .ill meet or exceed the belov listed minimum setbacks. Home Se t ba cks 10 feet from a park building 20 feet from any public street 5 feet from any rear space line or interior space line 5 feet from the edge of a park s tree t 2 feet from the interior edge of a park side.alk hccessory Structure Setbacks 10 feet from a park building 20 feet from any public street 5 feet from the edge of a park street 2 feet from the interior edge of a park side.alk 3 feet from an interior space line or rear space line I further state, by my signature below, that I have been provided with the follo~ing information: Manufactured Home Blocking Requirements Minimum Requirements for Permanent Steps - Electrical Connection si2~ jJt /O/;}J/9~ Date I .jUt) IIU. . ! CITY OF S.ItlGFIELD SYSTEI1S OEVElOrl'l..T WORKSHEET · (C0I111ERCIAL r.. RESIDENTIAL) CHARGE NM-IE' O[t COIWAN\': J,:~Lo.~J"_.;.._,bQMt>. t'A.(}.& L'=.fr'- ~o WI I::. . PA-~ LOCATION: SDC. -t;; I?~ PA-Il) WHV.IJ MOP.->II.-l2:. \-krv\S I":> Mo\ltGDI'-.\. DEVELOpl'lENT TYPE: [JUILOING SIZE: 1. STOR/.l ORA IHAGE .LOT S rzC ,SQ. Ft. Il'lPERVIOUS SQ. n. . X SO.lllG rER SQ. Fr. (See ,Reverse For Runoff Coefficients If Actual Imperv. Area Is 0- Is Unknol-ln) 2. SANITARY SHIER-CITY NO. Or- rr-u's 1<+ . X S311.55 PER rFU (See Reverse To Oetennine Total rrU'S) Is ??9 I~ I 3. rr..r,rlSf'ORTr\TlJ];I. rlo Or: UillTS X T!m' RJ\TE X COST rER TRIr x v "'~0~ r., .\ ..)-".,1'..'. L)_ k 'z/1. "7 0.;:.1 s s -- s 1 (,,;7. 1~ j, .~l!l..~ ::: S3S3.Gl ----.-- v X S333.i:il To Oeteroine Trip Rates) SUl3TOTAl'(ADD ITE11S 1,2, & 3) (See Attachment C 4. ADIHlHSTRAT!VE FEES '[lASE CHARGE (SUBTOTAL ABOVE) X ;05' Is "7'OIj. I TOT,\L-CITY SDC. .S €CO ~ 5. . SANITARY SEWER-H'..!HC ....:"'..:..:'.:.~.'; .:.,-. ;:.~-.;- ,.,..,.,' > . ." . _~:.' '",;-o"iioOF PFU'S"'''I.f- c;"x 513.25 PER PFU.+ 510 1-lWI-IC ADMIN. .fEE S , . .' +:iffEf;.!t~],;i:,~;:,.,~:,,~,';'.{;t::;.~~..;'-""':;"~'-;~-, <:<';- -- '.- .~ ,__;' >,_.,(.",:;,:..-~(UsePFU.}otal Jrom Hell! ,2 ..~bove) .;: -: . ::;:':.~::,:,:,...::~_'~;~;{~"-f~~rii~::iF-~;-~Ei~itli~~kE-V~~SE; ~'.... · ""'p;'S:";' .-{ ;:;l<f: i:""S''-':};:' 'so~i~o~~~~~~~or II I"IC,~ :~'I!~YHT'~~~,/'i'. ; ". "TOTAL-~~~'t'ib'h~ 1"1 c; ~ 1 TOTAL sac'~ qq (.. e ',- .-:.!.'. ',.:' ....~;'...:..;:::::~ ,. -..'.... ..,- .., . ':...~ '-.',,~ "~()" :/)" ..\'....'qlJi. ..... ...,:,;~,.......... ". . ." . ',' \ .' '. ...... '.' .'--' '. ',o, ..., .. . ,: .' ,.'>';tttffJ3') ~.. .~. c. ~ -; .~:,tYi0f'fl~%-ij,:',;~,:.',;.:~,?,~};:":-," :-,.~...-. -. . -.:-;-'-'. - ! CITY OF SiItlGFIELD SYSTEt-tS OEVELorr'lENT WORKSHEET . , . '(COHI1ERCI^L t. RESIDENTIAL) CIIARGE Cf9 10- q ( *~~: tWIE ort COIWAN\': J:to.~:L6.__~QMt>. t'A.fl.&L'=::.f.'- ~OWlI::.' Pl\~ LOCATIO/I: SDC. i;\?G P~HV.~ M Of':> I 1.-1C.\...I-orv\S I":> MO\JtG1> \1....\ . '.' DEVELOPMENT TYPE: [JUILDING SIZE: .LOT SIZE" ,SQ. Ft. 1. STORl'l ORA WAGE mrERVIOUS SQ. FT. X SD.ll3G rER SQ. Fr. (See Reverse For Runoff Coefficients If Actual Imperv. Area Is 0- Is UnknO\m) 2. SANITARY SE~I[JZ-CnY NO. OF rfU'S I'-J- X S38.55 rER Pi-U (See Rcverse To Octenninc Total' rrU'S) Is ??"I"~I 3. TRfdISPOlnr\TT.1}l1 f:O or UiIITS x Tim' RATE x COST PER TRIr ;, . c:,jl..r X S3ES.Gl Is '2.:2.";,0.::.1 x X S3SS.Gl s - v X 5383.Gl Odcroine Trip Rate:;) SU[]TOTAL '(ADD ITEI{S 1,2, & 3) S 1 (p 1.. 1~ (See Attachment C To 4. ADfHNISTRAT!VE FEES. '[JASECHARGE' (SUBTOTAL ABOVE) X ;05 Is "7'OIj. I TOT,\L-CiiY SJe s Seo ~. .' i,:~.':;_~~g:;,:)io'~','OF. P.F~'S "'" J..J- '.n .,. x 513.25 PER PFU .+ 510 m:l-lC Ar'KIN. FEE s I"J c:; ~ ,;_,;,:,?~;:~::::-,;;:,:~:)>..:.~:,,~:,~,,:,,:.,:;:~-:.."";/;c~,c.-~._;:~;::~<:;:.t:':::'.'",' '. . . '., . -"- '" '......... . . "2;:;,;:~~:~~=:1:~ Use ,PFU.J oJ al _, F. rO,m J ~.:,~2 .A~O ve ) .' .... '_-";':'.:.~,~:..'._--'...:.:.:.,~'.:'.~','-:_._:'.. -.:,..'.~.....:_:~.'_~~.......::~.'.,-'......_;.,._;..:~,_:"..:::~'::._' ..~..;...:..,.:'.:.'.....'.;',..'...~.-':'.,:,_:.~._'.:.'..',.~:.::~.:.-.:.,.-'s:.:~.:"..~,....,~'...::.:,;....:,'.~~...-.:.;.:.:...,...:,.-:..:'....~......../ ......:-:..... .' ;-:~.~. ;'. _, .,'. : ", \ .-:..:'~.:~~:-...:.:~~: ~._', "~~-:_'~:~:~.::..:..=_:..:....;.~.:i::(:.:<~:'->:.-;t -....:,. ~:'--=-,.- .,,-- ~ _. .c- '_ ~ - ~ ._' .> <' . ;.;. ;,,;;,;.,. :__HWI1C, CREDIT IF APPLICABLE (SEE REVERSE) "c;.;;;:':'~';":?~::""""'!Ix."/i;' .. 'TOTAl-;"'~;~~ls 11 s ~ I r...}{h/~\;:,',:,,;_.., . qKip [Jurdick . fl.. TOTAL SDC \ qq~ e . .. ," .sac Coordinator d. ,',':-:,""- :.':._-'.';.~';:~"!,.:~~~;:..:.:.,'.:,:. .....~._.' . . ~" ..~.. ..~.. " .:, ." _. .~'.-. -' --~..:-~':.~~' .. . '. .. -- .j:;~';';~;~~~Rji?:t:~~~i':':;::,df~:;;~':\::-;~::';';',<C::'''.''- ...,.. ...,~.,~ ." .:,. 5. SANITMY SEWER-H\-II1C : u";- ',: "':": : :'..t.;,:--.,,;:;' ". .:'\-.-- . .........._.~._.. ~'. .......:.. . ~ ,'. ,--. CITY OF s.Ii.lnUGFIELD SYSTCl-1S OEVELOP/.IENT . WORKSHEET . (COIlllERCIAL I, RESIDENTIAL) CllAnGE NM-IEO[1 COIWAHI': J:Lo.~T.;.__.~Q}'J\t>. N:\.9.&l'::,f". ~OWlI::. 'PA-~ LOCATlOll:5DC -ro'7~_e:XJ.JL\01Hv"l M,op.?, I.-~. w.iJrv\~ I":> Mo\JtG" \ <....\ . DEVELOpl'lG1T TYPE: [JUILDING SIZE; 1. STORl'l ORA WAGE LOT SIZE' .SQ. Ft. Il'lpERVIOUS SQ. n. X SO.IBG rER SQ. Fr. (Sce Reverse For Runoff Coefficients 'If t,ctual Imperv. f,rcJ. Is 0- Is UnknOlin) 2. SANITARY SEWER-CITY 1:0. or rrv's I Lj. X $313.55 pm Pi-U (Se~ Rcversc To Octcluinc Total' rrU'S) Is ?,?q I~ I ~. JJYdL~J~D.1~T((iJ.rl'l_ NO Or: IJilITS X T!n,' lV-HE X COST PER TRII' . l~'IL: ~: $322.C1 k 1/1- =;,0'::"1 v x ~:::SS.Gl i, -----.------ -.' (See Attacl:;nc:lt C To Ot2tcminc Trip RJ.tes) SU[JTOTAL . (ADD ITEI-~.S 1,2, t, 3) S v .', X S3S3_Gl - , 1~1..I;'" 4. ADIHlHSTRAT!VE FEE~ 'OtlSE CHARGE' (SUBTOTAL ABOVE) X ~05 Is "7'OIj. I --T" r--" ,-~,~ r r -'0",0 liJjl~.L-'_ll' '::~:'''' '.} 'CL,.. - 5. SANITARY SEWER-HWI'\C ,110. OF PFU'S " I...f- x 513.25 PER PFU .+ 5!0 l1WHC ADXIN. FEE S l"l C; ~ ': -- .' .-.: .... . - ~ . -. ..::",.- ," .". ,". ..' _ ...u. '._ _' . . . .': .~;>.'.:.:(Use PFU Tota.l F,:~,?.Item' 2 Above) . '" -, .~ ~ :......- . .-:.. ...... . --;--, . ", :.",. -.--"~~'.' - ," .. '. . ~lWH~ CREDIT IF ArPLlCABLE (SEE REVERSE) .: ,'....;.......' ."" : .... . ." ." . . .", '. .."- .... ."_. .' -. ,.--.: ~" .....G. Kip [Jurdick SOC Coordinator . <-{- /').-1 /1'2--- ".:...:', ,.; ,.~~..,,'_...-.,:.~ . ,_I..." .......'........ . ..7.-,....'.- ,. . .~. .', I'. '.;'.,:'.\;' .... ':',~~.:., ~'.n:;~~ . ,"~ . , .- ~ .,' :.i' CITY OF 5.' rlGFIELD SYSTG15 OEVELOPl.IENT WORKSHEET . (COMMERCIAL ~ RESIDENTIAL) CIl^IIGE ! tWl['OI( COIWAN\': J':to.~T.;.._lQ.0.0~.9.&L'=f:- ~o,,^1::. 'PA-~ LOCATlOtI: SDC. --r;;?.f_&-,.JL\01!:l~Mt)I"~\ L-lC:.t-I-orv\S I":> Mo\JtG" \ k.\ . DEVELOPMENT TYPE: I. I [JUILOING SIZE: LOT SIZE' SQ. F t. 1. STORr.1 ORA WAGE I/-lpERVIOUS SQ. n. X SO - 18G rER SQ. Fr. (See Reverse For Runoff Coefficients If Actual Imperv. Area Is 0- Is Unknwn) 2, SANITARY SE>IEIZ-CITY 1:0. a:: rEV'S I Lj- X $38.55 pm ,,:'v (Sce Reverse To Oc~tcnninc Total rrU'S) Is ??"1"~ I :.. IC!iL~J~Q.nTDIJJr!. . f;O Or- UUITS X T!~ril !0\TE X COST PER. TRIP .----,- ----...--- -+-- ;, . (::"1'_: v ~i'.:0 rl ... .:-,,-,,-,-'-'- I,s 1.."'2.";,0';' J ----------- -..------.. - - . x v "';00 (,1 .', .)..-",,,.,). i. __pO v X S3S3.Gl (See Attach:nent C To Odemine Trip Rates) SU[JTOTAL . (ADD ITEI',S 1,2, t, 3) S ~ , '/101.. I;" 4. AOI-lTlHSTRAT!VE FEES '[JASE CHARGE' (SUBTOTAL ABOVE) X ;05 Is "7'OIj. I TOTr\L-CliY S0C "'0 r ~C0 ~ 5. SANITARY SEWER-H'..!I'IC ., . NO. OF PFU'S . ',../- x S13.25 PER rFU .+ S10 11I-1HC ADXltl. FEE S I ~ C; ~ -.. ...., ,..._~ .:., . ... "- ~.. . '".-. <:'" ..'i(use PFU Total From lte~ 2 Above) . . .. .0"' :. '. . ......... .... ~ ~~.. :_'~.~:. ~_., . . .-.. .-. .;.--, ~"h'''''''' . U Ki P Burdick SDC Coordinator - o.f- /'J-'l /1 'V . ~ TOTAL -MW~lC SDC Is I ~ C) ~ J Tl)TAL SDC S qq l" e_ HWMC CREDIT IF ArPLICABLE (SEE REVERSE) ,,''''' . . ....:.. i.-'~~::- ,;....-; '.-.. .. '..... :~,~:'~~~~>~:~~.;r'.~~:": .. '.'-"-.. " \,,\ n ..' . \12\cfJ \\)\tb\~~~ .. -' .; - .... . ...:-~ ,.'