The URL can be used to link to this page

Home My WebLink AboutPermit Building 1994-10-6 LOCATION OF PROP~E'?... WORK: . ~3 4 p, ASSESSORS MAP' \'d..)~O\rAJ:) .. ..~\ OWNEP' c)\\\. ucLQ,f\ ?- f\to ffi \\ ~ ADD~E~:;(>~j:J 3rQ fY1 Y,,~. CITy:~1\ \ (\\ W;V~ STATE: X"zp1'\ DESCRIBE WORK:~f\'l\^ <1, ~Q N\J..U c, \ ~Q J:\\c1 Q(1~ NEW ~ REMODEL ~ADDITION . OEM ~ISH RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 - LOT: . BLOCI'"' ~OB NUMBER 44-\~1'L 225 Flllh Slreel Springfield, Oregon 97477 TAX LOT:\1lD ("y"')q(y)_ SUBDIVISION! fu"l~; t-\'-\L\ .\d--{ ~ Ii; OTHER ZIP: 01'\, <'f) CONTRAci~'~ NAM~ E J' ADDRESS. GENERA" q'\.i..t J.( 1 Qf\ 1\\1.. .. PLUMBIN; ~)f(\Qrt \ ):l\~OQ " MECHANICM ~ ~.J.-\rt 0 f\ T.N-). \ ELEcTRICA;\' cA \ \..i.t'\ t( _~ 0 l'11\i {' j CONST. CONTRACTOR' ~\ 1IC\t;\ 5 \'\ ?ll B\.'\C\S t n~'l~ f..HqN,E\ q~j'Id~' v:>~~t \ lo l C\? ?;ld~ L\1~.AI~ QUAD AREA: ~ S,Q J . OF BLDGS: \ OCCY GROUP'. ~ ?, -\ lv\ \ '( -' · OF STORIES: WATER HEATER: - OFFICE USE - LAND USE: \ \ \\ · OF UNITS: \. , CONSTR. TYPE: 'IV IV HEAT SOURCE: f___ RANGE: EXPIRES lj.\~. q. \.4. tj:\Q.. l\4 FLOOD PLAIN' ZONING CODE: ll)\C..., . OF BDRMS' SECONDARY HEAT' SQUARE FOOTAGE: -1J 0'1.:3 To request an Inspection, you musl call 726.3769. This Is a 24 hour recording. All Inspections requesled before 7;00 a.m. will be made the same working day, Inspections requested after 7:0p a.m. will be made Ihe following work day. REQUIRED INSPECTIONS r'iI1 R~ugi. M.echanlcal ...:. Prior to L..O.t coYer. o TemporarY Electric o Site Inspection - To be made after excavation, but prior to setting forms. o Underslab Plumblng/Eleclrlca" Mechanical - Prior to cover. ~ Footing - After trenches are ~ excavated. . D Masonry - Steellocallon, bond baams, grouting. ~Found8t10n - After forms are erected.but- prior to.concrete placement. o Underground Plumbing - Prior to IIIl1ng trench. .' ~ Underfloor Plumbing/Mechanical -.Prlor 10 Insulation or decking. ~ Post and Beam - Prior to 1I00r ~ Insulation or decking. IZ:l Floor Insulation - Prior to decking. fV1 Sanitary Sewer - Prior to filling L...O.l trench. . ~ Storm Sower - Prior to (lllIng trench. ~ Water Line - Prior to IIll1ng lL:S.. trench. ~ Rough Plumbing - Prior to ~ cover. .' I'Vl Roug.'" .Electrlcal - Prior. to . ~ cover. C2I. Electrical Service - Musl be approved to obtaIn permanent olectrlcal power. D Fireplace - Prior to facing malerlals and framing Insp. ~ Framing - Prior to cover. ~ Wail/Ceiling Insulation - Prior to cover. !:ZlDryWSII - Prior to taping. D Wood Slovo - After I~stallatlon. D Insert - After fireplace approval and Installation of unit. C29 Curbcul & Approach - After forms are erected but prior to placement of concrete. ~ Sidewalk & Driveway - After excavation Is completo, forms and sub.base material In place. . 0 Fence - When completed. o Street Treoo - When all required , trees are planted. . ~ Final Plumbing - When all - plumbing work Is complet.e. ~ Final Electrical - When all . electrIcal work Is complete. @Flnal Mechanical - When all mechanical work Is com~lete. r=1l Final Building - Whan all l..2:l"""'fequlred Inspections have been. approved and building Is completed. o O~~er MOBILE HOME INSPECTIONS D Blocking and Sel.Up - When all blocking Is complele. D Plumbing Connections - When home has been connected to water and sewer. D Electrical Connection - When blocking, sel-up. and plumbing Inspections have been approved and the home Is connected to the service panel. D Fln.1 - After all required Inspections are approved and porchos, skirting, decks, and venting have been Installed. Lot faces Lot sq. ftg. Lot coverage Topography Total height ~ BUILDING PERMIT ITEM ..~_ F'T: . /o4aln .llW ~lcD Garage Carport Total Value Building Permll Fee State Surcharge Tolal Fee ., ~:~L, \' :1 ,; ': ~ '.:.l >,'r ':'" ~;:,~ '~:1t~?(}"'" Selbacks . HSE GAR Acc'l I I Lol 'lYpe . X Interior " P.L. N' S Iw IE Corne r Panhandle Cul.de-sac X&~aS - ~ J4./~..~ ?J1E:{;g ,'')4y. 10:11+ ~ (A) 0')loHIJ- ' SYSTEMS DEVELOPMENT CHARGE (SDC) i..z~~,/..3 PLUMBING PERMIT ITEM Flxlures Residential Balh(s) Sanitary Sewer Water Storm Sewer Mobile Home Plumbing Permll Slate Surcharga Tolal Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan (B) FEE ~ /itJo.crJ FT. FT. FT. 0;\ /(O().OO +~ + B.CXJ (C) 1]2.. ~() N' ~ 4.8) Cl.CO . Wood Stovellnsert/Flraplace Unll Dryar Vent Mechanical Permit Issuance State Surcharge Total Parmll .r~.OO .50\ /(0.5U 10.00 .f3~ 81S3 (D) MISCELLANEOUS PERMITS Mobile Home State issuance I State Surcharge Sldawalk --9Q ft Curbcut ;:)( () ft Demolition S'tl(l Surch'R~ _ \) _ . , l< g h\ \"\0. t\:u.u o;n . ':::D -,~qD ~qJ Total Mlsca/lanaous Permlls (E) ~l' ILEI 0'6 TOTAL AMOUNT DUE (excluding eleclrlcalY Y /'0(, (A, B, C, D, and E Combined) . : (. THE PROPOSED WORK. IN THE. . ....'HISTO!OiICAL DISTRICT, OR ON THE HISTORICAL REGISTER? . . If yes, this application musl be signed and approved by the Hlslorlcal . Coordinator prior 10 permlllssuance. APPROVED: . BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT , This permit Is granted on the express condition that the said construction shall, In all respects, conform to the Ordinance adopted by Ihe City. of Springfield, Including the Devalopment Code, regulating the construction snd use of buildings, and may be suspended or revoked al any time , upon violation of any provisions of said ordinances. Plan Check Fee: '\~\N..J ./ Dale Paid: .(} ~ Receipt Numberu y Received BY;~- ~S!\;rtiL.ti f).~% Dale Syslams Developmenl Charge Is due on all undeveloped properties within the City limits whIch are being Improved. ADDITIONAL COMMENTS ~f)Qtto ('.1" _~dou'Y1'llli . 'l~~ \'. \C')\.-\}.:D (~ ) '--- ~N\Q)( : \ U\ (On - - ~~ \ .' By slgnalure,l stale and agree, that I have carefully examlnod the compleled appllcallon and do hereby certify thai all Information hereon Is true and correct, and I further certHy Ihat any and all work performed shall be done In accordance wllh Ihe Ordinances of lhe Clly of Sprlng/lold, and Ihe Laws 01 lha Slate of Oregon perlalnlng to tha work described herein, and Ihal NO OCCUPANCY will be made of any structure wlthoul permission of the Building Safely Division. I furl her carmy Ihat. only contraclors and employees who ara In compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required Ins pee lions are roquasted at the proper time; that each address Is readable from the street, that the permll card Is located at the' fr~nt of Ihe property, and Ihe approved sat of plans "':111 remain on Ihe site at all mes during construction. Signature 4~ 1:O/Arad '/ /' / Data VALIDATION: ~( n RECEIPT NUMBER >11! DATE PAID In. ((') . f e. - AMOUNT RECJJ:JD rOt%{". ~A RECEIVED B.f.:J)( IJ) _ ) ,. , . - e The foHowlng project as sub ftted . zonl~g, c:nd does n~t reqUir:Specif~fa~~ following 225 FIFTH STREET apploval. u"€LECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477 Zonina L PL INSPECTION REQUEST: 726-3769 . OFFICE: 726-3759 D.<:l, 4 r1-j-c1't A jJ ~ COMPLETE FEE SCHEDULE BELOII 1. LOCATION OF INSTALLATi'O~zad Signature ?'~.d.'55 C2Jd>7>>v7J2?. LEGAL DESCRIPTION br-3/_frf:;r~~~;'7~.s . . , - JOB DESCRIPTION "0 ~--",.J ~ P-r 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. CONTRACTOR INSTALLATION ONLY Electrical Contractor--Al1 it.U ~/"'r"-:k.1C Address J"">_ ~ ~ '1< ~j) <:7'" Ci tY-4~tJ-<, Phone--"!? r -::J. J'i'j Supervisor License Number /p/j ~~j Expiration Date /0"" / - ~ '" . Constr Contro Number to 67 YV Expiration Date ?-~ -p?_ Signature of Supervising Electrician il/L.! d], _~ 1. <# Owners Name A/4-y7J$/") z;d Address -;;,"7"7 .-). ~:J.~ ~ Ci ty <]bf-d-n. Phone '?cJa-.d.9k O\INER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: --------------------------------------- ~....'e3_~C/ / ye- ~ V DATE: RECEIPT jI: RECEIVED BY: ~--- ',r . City Job Number 1tJ~/fr'?z... A. New Residential-Single or Multi-Family per dwelling Service Included: Items 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dwelling Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only uni t. Cost Sum $ 85.00 $ 15.00 $ 40.00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less ~ 201 amps to 400 amps , Over.401 to 600 amps Over 600 amps or 1000 volts D. Branch Circuits $ 40. 00 'Ya.-c $ 55.00 . $ 80.00 see "B" above New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 35.00 $ 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Lighting $ 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 5. SUBTOTAL OF ABOVE 90.o.e> 5% State Surcharge --2. ~... 3% Administrative Fee / .~c:> TOTAL 9'':? ?O , . ATTACHMENT Bl ~OB NO. 9?/~r2 CITY OF SPRINGFIELD SYSTEMS.DEVELOP~ CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR COMPANY: J-kyL~. LOCATION:. ?J-I15 Cr~ DEVELOPMENT TYPE: S~L) BUILDING SIZE: lOT SIlF' SQ. Ft. 1. STORM nRA T~ IHPERVIOUS SQ. FT. 2:3 ~ 'if X SO.209 PER SQ. FT. ~?'S}) 2. SANTTARY SFWFR-CJTY NO. OF PFU'S . /~ X S43.26 PER PFU r7~~ (See Reverse) 3. TRAN<;P()RTATT()I~ NO OF UNITS X TRIP RATE X COST PER TRIP / X /,0/ X S436.19 X X S436.19 ..s---#", >'::>) '- ~ S X X S436.19 $ SUBTOTAL (ADD ITEMS 1.2, & 3) $ / -'''S'. iT P 4. SANTTARY SFWFR-MWHC NO. OF PFU'S /i x S17.19 PER PFU + SID HWHC ADHIN. FEE $ ,?/?,-f1.< (Use PFU Total From Item 2 Above) H'WMC CREDIT IF APPLICABLE (SEE REVERSE> $ 3#. (;, 0 . ,"" . IQIAI -MWHr. snr. ,r.z. 'If";, ri"', SUBTOTAL (ADD ITEMS 1.2.3 & 4) s; 1/ 9~_~ D 5. AnMTNTSTATTVF FFF~ r'1'. 5" 2) Date: 1'-;,2.'/'- 9';9' IQIAI snc $ ,2.0fJO./3 B2.SDC . FIXTURE UNIT CALCUlATION TABLE: Number of New Fee:'x Unit Equivalenl = Fixlurc Units (NOTE: For remodels, calculale on~e JiEI additional fixtures) NUMBER OF UNIT FIXTURE FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS Bathtub..................................................................... . Drinking Fountain....:................................................ Floor Drain................................................................ Inlerceptors For Grea se/Oil/Solids/Et c................. Inlerceptors For Sand/Aulo Wash/Etc.................. laundry Tub/Clolheswasher................................... Clolheswasher - 3 Or More..................................... Mobile Home Park Trap (1 Per Trailer).................. Receptor For Refrigeralor!Water SI.ation/Elc........ Receptor For Commercial Sink/Dishwasher/Elc.. Shower, Single Slall................................................. Shower, Gang.. .... .........,.......................................... Sink: Bar, Commercial, Residenlial Kitchen........................ Urinal, StaIlN"all..:.................................................... Wash BasinlLavatory, Single.................................. Toilet, Public Installalion........................................ Toilet, Privale....................................................... Miscellaneous: ,T"'HI TO,/>'$ $.'JoIJ:' z. 2 1 2 3 6 2 6 6 1 3 2 1/Head 2 2 1 6 4 .<. Lt. z.. 2- 2. ~ /X CREDIT CALCULATION TABLE: Based on assessed value. If improvemenls occurred after annexation dale in table, calculale credits separates. ) I ? z. TOTAL FIXTURE UNITS = Year Annexed Rate per $1,000 Assessed Value 1979 or before .. 1980 1981 1982 1983 1984 1985 $3.46 3.38 3.32 3.21 3.06 2.92 2.73 Year Annexed Rale per $ 1,000 Assessed Value 1985 1986 1987 1988 1989 1990 1991 1993 ? -:?tf, X $ /6. &-t)c) = (Rate X Assessed Value) X $ (Rale X Assessed Value) Credit for Pa!cel or land Only If Applicable Improvement lif after annexa lion date) $2.46 2.14 1.77 1.37 0.97 0.61 0.44 0.15 ~ ~ C;O' --- CREDIT TOTAL = $ ""'{~ Gd RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 . .,. SPRINCFIELD OTHER ..- JOB NUMBER 225 Fifth Slreet q4\4'~ " ZIP: CONTRACT~'~ NAM~ E I' ADDRESS. GENERA0J '\'Lv( 1 Qf\ f\'\1. PLUMBING: ~)f(\Qrt \. ):l~~OQ \ MECHANIC~ . ~. .L\ci. OJ'} T f\:l-.. ELEcTRICA;\' cA\ \ 0 A r ~ 0]'1)U' ~ ) CONST. CONTRACTOR . ~\ f1C\l?) 5 \'\ ?{l ~t_'\~~ t n~'l~ )?,H~E q ,:). to~ .";)\ \ ~~~:~~~ EXPIRES 1'").\,<\ . q,\t\. "\:\ Q.. Q4 ,'2f<. ~Q , - OFFICE USE - QUAD'ARi:A: LAND USE: \\\\ FLOOD PLAIN' . OF BLDGS' \ . OF UNITS' \ J ZONING CODE: me- OCCY GROUP'. ~ ?, -\ lv\ CONSTR. TYPE: 'IV . OF BDRMS: ...0; . O~ STORIES' \ HEAT SOURCE: SECONDARY HEAT: ..tJ ~. ~ATER HEATER: _9 -' RANGE: f.- SQUARE FOOTAGE: \ \ rA.~_ To request an Inspection, you musl call 726.3769. This Is a 24 hour recording. All Inspections requested before 7:00 a.m. will be made the same working day, Inspections raquested after 7:0.0 a.m. will be made Ihe following work day. REQUIRED INSPECTIONS r'iI1 R~ugh Mechanical"':' Prior to ~ cover. D Temporary Electric o Site Inspection - To be made after excavation, but prior to setting forms. D Underslab Plumblng/Eleclrlcal/ Mechanical - Prior to cover. ~ Footing - Aller Irenches are ~ excavated. D Masonry - Steel -location, bond beams, grouting. ~Foundatlon - After forms are erected-but- prior to'concrete placement. D Underground Plumbing - Prior to filling Irench. " ~ Underfloor Plumbing/Mechanical -.Prlor to Insulation or decking. rD Posl and Beam - Prior to floor ~ Insulation or dacklng. (g] Floor Insulation - Prior to decking. fVl Sanitary Sewer - Prior 10 IIll1ng ~ trench. . ~ Storm Sewer - Prior to filling trench. f'Vl Water Line - Prior 10 filling ~ trench. ~ . . ~ Rough Plumbing - Prior to ~ cover. I'V'I RoughE:leclrlcal - Prior to l...".O.,l cover. . C2l Electrical Service - Must be approved to obtain permanent electrical power. D Fireplace - Prior to facing materials and Iramlng Insp. ~ Framing - Prior to cover. C2I- Wall/C.elllng Insulation - Prior to cover. &DryWalt - Prior to taping. D Wood Slove - After I~stallatlon. D Insert - After fireplace approval and Inslallatlon 01 unit. IZ! Curbcut & Approach - After forms are erected but prior to placement of concrete. ~ Sidewalk & Driveway - After excavation Is completo, forms ' and.sub.base material In place. D Fence - When completed. o Stroel Trooo - When all required trees are planted. C8I- Final Plumbing - When all - plumbing wprk Is complele. r"Zl Final Electrical - When all ~electrlcal work Is complete. @Flnal Mechanical - When all mechanical work Is complete. r=Ll Final Building - Whan all ~equlred Inspections have been approved and building Is completed. OOthe' MOBILE HOME INSPECTIONS D Blocking and Sel.Up - When all blocking Is complete. D Plumbing Connections - When home has been connected to water and sewer. D Electrical Connection - When blocking, sel.up, end plumbing Inspections have been approved and the home Is connected to Ihe service panel. o Final - After all required Inspections are approved and porches, skIrting, decks, and ventlng have been Installed. ~ \ \ '," . Y" ,. ,"J .,.:' ~:>.j ,\",;:1'; 'of' ",.t .,I..r.~A;I;.~l"'" '; ~:'.:. l '.' .... ;; ~ .,0.' Aj, ",',,, ," : " Setbacks. .1 'P.L HSE GAR Acc'1 I I I I LOI faces . L~I Type . ..x InterIor Lot sq. fig. Lot coverage N' Corner Topography Total height S Panhandle ~ Cul.de.sac W IE BUILDING PERMIT ::1: ~.FT' X~~i)-lillLt Garage ,-"SlcQ. /4.10 " ~ Carporl Total Value 'Jl S'JO 344' ~ IO~7t ~ (A) <3'JloH')- , Building Permit Fee Slale Surcharge Tolal Fee SYSTEMS DEVELOPMENT CHARGE (SDC) . (B) 1PPO./.3 PLUMBING PERMIT ITEM FEE Flxlures Resldanllal Bath(s) Sanitary Sewar Waler ~ .tI oO.CIJ FT. FT. Storm Sewer FT. Mobile Home Plumbing Permll Stalo Surcharge TOlal Charge 01.... UOQ.CX? 4.CjJ + 6.00 (C) 1]2.~() MECHANICAL PERMIT Furnace Exhaust Hood 4.m q.CO Vont Fan N' ~ . Wood Stovellnserl/Flreplace Unit Dryer Vent (~.oo Mechanical Permll /(fI.SU 10.00 .A~ ~ Issuance Slala Surcharge TOlal Permit . SOt (D) MISCELLANEOUS PERMITS Moblla Home Slate issuanca I State Surc~~ Sidewalk ~ II Curbcut d.la- II Demolition on . <::t) . \~.C\() S'tt(' Surch'R~ a _ . \. }(~ k\ Y\~ t\. UU 4-UqJ TOlal Mlscallaneous Permlls (E) 'V\A.'} 0'6 TOTAL AMOUNT DUE (excluding eleclrlcal) Gl \""'". (A, B, C. D, and E Combined) '(.THEPROPOSED WORK.tN THE, . . .'.H ISTOJ:lICAL DISTRICT, OR ON THE HISTORICAL REGISTER? . , If yes, this application must be signed and approvad by tho Historical Coordinator prior to permit Issuance. APPROVED' . BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT , This parmllls granted on Iho express condition that the said conslructlon shall, In all respects, conform to the Ordinance adoptad by tho City .of Springfield, Including the Devalopmenl Code, regulating the construction and use of buildings, and may be suspended or ravoked at any time , upon violation of any provisions 01 said ordinances. Plan Check Fee: '\_\f-\ J ./ Dale Paid: . ~ ~ Receipt Numbe(' j Y Received By: ~ ~S:;~,Lili " '). \~ ~ Dale Syslems Developmenl Charga Is due on all undeveloped properlles within the City limits which ara bolng Improved. ADDITIONAL COMMENTS ~ld-mC'X -~~OOH'Yl\L~ .I...~~\" \OSJD (~) '- cAN\OX : \ V\ too ~~ \ .........- " By signature, I stato and agraa, lhat I have carefully examlnod the completed application and do hereby certify that all Information hereon Is true and correct, and I furl her certify that any and all work performed shall be done In accordance with Iha Ordlnanc~s of tha Clly of Sprlngflold, and the Laws of tho State of Oregon pertaining to Ihe work described herein, and thai NO OCCUPANCY will be made of any struclure without permission of the Building Safety Division. I furlher certify thai. only contractors and employees who aro In compliance with ORS 701.055 will be used on this project. i I I /- I further agree to ensure that all required Inspections arc requested althe proper time; thai each address Is readablo from Ihe street, that the permit card Is located at Ihe' fr~nl , of tha properly, and the approved sel of plans will remain on~h site a:;:a~ Imes dur~ con4'cl'.?'Q Slg re . ff ~4/~ - - - - - v , Oat" VALIDATION: A n r /1\ RECEIPT NUMBER \~\\(,t DATE PAID \D ,\n Y\4 . AMOUNT RECEIVf~ ,A~lo(P Qf'\ RECEIVED BY ~\ \,'fJ ,. . , "y~'rr~',~~: ~ . '.: .. . ATTACHMENT Bl -. JOB NO. 1-jE/ fl/5 CITY OF ~PRINGFIELD SYSTEHS.DEVELOPH~ CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR C~PANY: //+ L/ LOCATION: ~~.J" cr~ & DEVELOPMENT TYPE: ~L) BUILDING SIZE: I..OT SIZt' -~ ..... SQ. Ft. X SO.209 PER SQ. FT. ~~,0 2. SANITARY SFWFR-rTTY NO. OF PFU' S . / 't (See Reverse) 3. TRANSPORTATTON NO OF UNITS X TRIP RATE X COST PER TRIP I X I,vl X S436.19 X $43.26 PER PFU X X S436.19 X X S436.19 ..'M~X'F'~ ~t7.>v .$ S SUBTOTAL (ADD ITEMS 1.2. & 3) s /rOS'.r'lf 4. SANTTARY SFWFR-MWHC NO. OF PFU'S I ~ x S17.19 PER PFU + $10 HWMC ADMIN.FEE (Use PFU Total From Item 2 Above) KWMC.CREDIT IF APPLICABLE (SEE REVERSE) . ". . - . . IQIAl -MWHr sac SUBTOTAL (ADD ITErS 1.2,3 & 4) ? AnMTNTSTAT1VF FFFS BASE C GE 7{!VEl X ~::e. ~ Ma y Hor i9, P.~ S rdinator '7 -;).9'-"';7 I.OIB' snr B2 . sac . $?/ '1'. ~? $ 3f2:r;,~ rA 8'~' ~ c:-=:> s //70, t; eJ rS?' 7'; >:~ S :2-0 J"O . /..3 - -~~-- JOB NO. 1-ji/ j!/5 CITY ~PRINGFIELD SYSTEHS.DEVEL~ENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) ... "_'"U...'" ~& NAME OR CO~PANY: //~ L./ LOCATION: ~-9.J" 6-~ ~ DEVELOPMENT TYPE: ~)} BUILDING SIZE: lOT SIZE" 1. STORM nRA T..MAG[ IMPERVIOUS SQ. FT. )...3~? 2. .SANTTARY SFWFR-(TTY NO. OF PFU'S . /~ (See Reverse) 3. TRANSPORTATION X SO.209 PER SQ. FT. X 543.26 PER PFU NO OF UNITS X TRIP RATE X COST PER TRIP I X /, vi X S436.19 X X 5436.19 X X S436.19 SQ. Ft. ~,0 '0~?,F'~ c;~~. s-V s s SUBTOTAL (ADD ITEMS 1.2, & 3) s /raS-.r? 4. SANTTARY SFWFR-HWHC NO. OF PFU'S I ~ x S17.19 PER PFU + SID Mh~C ADMIN.FEE (Use PFU Total From Item 2 Above) MWMC.CREDIT IF APPLICABLE (SEE REVERSE) . . -. . IQIAI -MlMr: snr: SUBTOTAL (ADD ITE~S 1.2,3 & 4) 5.. AnMTNTSTATTVF Fill ;;;:: (sU~/1"'VEl X .05 ~: Date: ?-~?'-'J';9' /Marly Hornig, P.t:. ') ,/ Sofuoofdinator "C.-/ IQIAI c;;n.G B2 . SDC . s?/ 9'.~? s 3f2:'" r~ lJ"-r..r~-::> S 117'0, c; t:J <<?- ,.; $"; ~ S 2-0 ,Po ,/..3 -