HomeMy WebLinkAboutPermit Electrical 1994-2-1
" RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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SPRINGFIELD
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ASSESSORS MAP'
LOT: JJ",,,,J -#.1
LOCATION OF PROPOSED WORK'
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OWNER'
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ADDRESS' ?li'n
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5'0.-.1:'-. rod)
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CITY'
BLOCK'
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STAT'"
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DESCRIBE WORK'
;Vew
S'N'; /" I~_ :/~ j),-J/',,",~
NEW
)(
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAl' t(';)iJl!",z, {(IUO",,, .,..4!1<1L.
PLUMBING:
('.A~...It.....t OL'.'-....AI~.......CO.
MECHANICAl' 1"V1",,,,"_1I < O:l...T-..L
ELECTR1""'^ I. R. AI;"'c
~A...,~C.;c..
QUAD AREA: .....t::)R~ ~
. OF BLDGS' \
OCCY GRoup:.H <:)1- jV\
c<{
. OF STORIES:
WATER HEATER:
DEMOLISH
OTHER
-JOB NUMBER-94ln LUL
225 Fifth Street
Springfield, Oregon 97477
LA^iJ //4~i-"f D'"- ~
9]-Po'l'l..O
#-
TAX LOT' 10000
SUBDIVISION' 5"..-.1 4..!,j,;';.:" ~ ._
I,AI."........,.,.._ """'''''''''l. 1;..,.-.. SJ
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PHONF'
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ZIP:
<:I"N?r
ADDRESS
\111,. &'.:'(1'1 E~
5o~ s:. fA" 1l"~J
'\111 E If" <".?ll.
CONST.
CONTRACTOR'
5'"'131..(
OO'l'f}
Sr- .
EXPIRES
fl-"-f if
1')-1>--'--;
11..->-3-71
I 0 - I -, f
PHONE
Y.I'I/-J"'2.3c"
3>{1{ -1\11,1.-
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REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
o Rough Electrr~al - PrIor to
cover.
o Electrical Service - Must be
approved to obtaIn permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o FramIng - Prior to cover.
o WalllC'elllng Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Stove - Af~r In~allatlon.
0' Insert - After fireplace approval
and Installation of unit. '.' ..
o
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
- OFF'fi ;SE -
LAND USE: !
. OF UNITS' \ )
CONSTR. TYPE: -J/ ^-
HEAT SOURCE:
RANG~'
-. '
FLOOD PLAIN'
ZONING CODE: ffi/<::'...J
. OF BDRMS' 5
SECONDARY HEA1: . itP,rD(10CY1i......
SQUARE FOOT~GE: ~etJ '
To request an Inspection, you must 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 requested after 7:00 a.m. will be made the followIng work day.
g( Temporary Electric
o
Slto 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
placeme~t.
o
Underground Plumbing - PrIor
to filling trench.
o
Underfloor Plumbing/Mechanical
._ ~rlor to insuJatlcn or decking.
o
Post and Beam - Prior to floor
InsulatIon or decking.
o
Floor Insulation - PrIor to
decking.
o
Sanitary Sewer - Prior to fillIng
trench. .
o
Storm Sewer - Prior to filling
trench.
o
Water Line - Prior to filling
trench.
o
Rough Plumbing - PrIor to
cover.
o SIdewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
o Fence - When completed.
o Street Trees - When all required. :
trees are planted,
o Final Plumbing - When all
plumbing work Is complete.
o Final ElectrIcal -.When all
electrical work Is complete.
o Final MechanIcal - When all
mechanical work Is compl~t~.
o Final Bulldin9 - When all
required Inspections have been
approved and building Is
completed.
o Other
, .
. ,.
M.OBILE HOME INSPECTIONS
. .' '7'
o Blocking and Set.Up'7 When,all
blocking Is compl.~te:. ": . . . .
I.,;. '4,
o Plumbing Connections - When
home has been connected to ..oj-., .
water and sewer. ("',: .... ," .
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,c.
o Electrical Connectl~n -~ When.
blockln9, set.up. and plumbing
Inspections have been approved
and the home Is connected to
the service ~anel.,""""'''~ .
o
Final - After all required' .
Inspections are approved and
porches, skirting, decks, and .,.....,. ,.
venting have been,I~.~:~lIed.. ':,
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W: 223 LANE COUNTY DEPT ENV MGT RECEIPT C 15894 DATE 011394
. APPLICANT LEMOIGNE, scon ADDR 3853 JASPER RD., SPRINGFIELD, OREGON.
~LC 1802061310000 SUBDIV. LOT BLK
NEW BLDG TYPE USE R BD~MS 0 UNITS 001 STORIES OBLDGS 001 PHONE 747 2857
_ OWNU( NME L.EMOIGNE, scon ADDF, 3853 JASPEF: r~D., SPRINGFIELD, OF,EGON.
CODE APPLNO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAYS
)1:~:"'!':15
~lP . ~
BP a
~P .
F'L' ~
CFIX/BATH: .SWR: FT. WTR: FT. RAIN: FT
.tlECH MECHANICAL. FEE .I~
~UR STATE SURCHARGE 5% ~
PCK PL.AN CHECK FEE 25% I
.SDS LC 15894 SDSS . gll
SDEQ FEE SDSS
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0.00 CI< · r
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CATG:
.,EQU:
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SDS
1
EST. COMPLETION DATE
ELE
PCI<
ISS
2
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BY F,LH
DEPOSIT ,x..~
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. , ,c;'{:' '.' ~EWAGE :DISP.QS~~Jl;EJ;.VitlU.~119N. " .' . CS,c; ~6 \. '
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API!L.:I.tA..Ni.;'.~.iNAMEANDM)DREss':' J I"";?:~ ~ \.< ).;j.;:}ijM.:':'~'~:~>.~'''\':~r.-:s:(,' :]('o::'^~':" ~ J ;;!.Phone~'1. -?:~7
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OWNERis.... AND .6oRESs " ,..., ,,'" .. ,. <;,. n". . . . ,..,,- ..
, u ",!~~~~Nii<~~!l"~ . , ,,0, :~;t.'~ A. .'RO'?-EU US.oF"f"'ERTY II.. " ..J. ~"~
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: ereby.certllytheUhe above statements are true and accurate, and that I have the following 'egallnto,est In the property: _owner of record; _contract purchaser; -potential buyer;
. ~."".' ':'~.';''''. '.-1;.~,~~o~,fgent;,I, tUf\~~rc.'rtlly'. ~~;W'...~,~~~. ~.''''':".. -,~' ..."iB7!~'''~'~~'' ~'I. " : '. :"., ..
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:t~~.S'.' I.T. .E. M,E,ETS,...STATE STANDARDS YES NO ' ", . YES NO
.. LAND USE COMPIi.IANCE
":~"tA,."""d By",,,,, . ." ..... 0 lOW P."'. 0...'"'''' oar,"
. '~;lMFI'''''; '6-"" ,.': 0'. 0"" "'"'"' Th"' " 0 0 .~"~ M_' ~J'"
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I:' ~{TH'S IS /SlPRF.LIMINA~; REPORT'W~;~H DOES NOT ENSURE THE ISSUANCE OF A FUT~RE
ry;/".BUILDING PEflMIT. ANy~NS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
:'j;~..J' ~RE AT ~YOU. ~ 9,WN RI~.K.'. )F(~;rE IS A~P. RO.~ED, SEE REVERSE SIDE.
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\ Compleled
Pending
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FLOODPLAIN, INFORMATION
All or part of this site may be In a flood hazard
area for which 100 year flood levels have not'. '
been established. Extra precautions may be" "
appropriate to assure that the building site will '
be reasonably safe from flooding.
All or part of this site may be in a flood hazard :'
1a a for which 100 year flood levels have been
( ".b ..I.ished. ~~uilding elevation above the 100
. r flood level may be required. ". .~
I! ".''' - .
~.r:part of this site may be In a flood hazard"
a Ih which a floodway has been designated.
, Building may be prohibited subject to . '
demonstration that the cumulative effect of
proposed development will not Increase the
100 year flood level at any point.
:~ "0' Approximate
. Study Area
,.J.;
o Detailed
Study Area
o Floodway
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nnr.r:ntJ
07401, ,( 687-4051)
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. lee! as submitted has the fall
225 ur ,I> STREET ~~~i~~~o:dgd~ not require .pecllle lan<Jffi1!CTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 a"proval. . r7/1l\/\j j
INSPECTION REQUEST: 726-3769 W-a... City Job Number 7~ (0
OFFICE: . 726-3759 . , Zonlno .
. Date..:JJ \44 3. COMPLETE FEE SCHEDULE BELOII
1. J,.OJ:~N 0 STALLAT~N \-<;1), ~
:.3nl- , [) k'.~r ~atur._ 'J:: NeW Kesldentiill-Single or
_ g Multi-Fa,mily per dwelling unit. .
I~LEGAL DESpurr1;ON I. /0 Service Included:
r~0c9n{()f\..) . /0 ff Items CDSt um
C .J~B DE CRIX: _^ /) p clteD 1000 sq.ft. or less I $ 85.00 'f!f;
\.. '1. .Q~ .... YLUU..h OL\" . Each addi tiona1500
. ,(I sq. ft or portion '2 Ac=
Permits e non- ransferablevand expire thereof, , ~ $ 15.00 -r\.. )
if work is not started within 180 days .Each Manuf'd Home or
.of issuance or if work is suspended for Modular Dwelling
180 days. Service or Feeder $ 40.00
2. CONTRACfOR INSTALLATION ONLY B.
Electrical Contractor 'b/:UIJS FU-Gi7Z-/c-
Addresse2.!O I), )fl (JtJJ iU
City_IS J() one (; <{' 7 - / '5 (, Z.
Supervisor 3{') '-(I -..f.-
Expiration Date / D. /. q C:=:)
Constr Contr. Number 7')7 (, L
Expiration Date / 0 . Lo .qj.
City
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DATE~-------~-r~\~-~-------------------
RECEIPT 11: \ I S 1"1
RECEIVED BY: I.C'\P-.
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
$ 50.00
$ 60.00
$100.00
$130.00
$300,00
$ 40.00
C.
Temporary Services or.Feeders
Installation, AlteratiDn or Relocation
Miscellaneous (Service/feeder
-Each installation
Pump or irrigatiDn
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL .
200 amps or less
201 amps to 400 amps
Signit~/,. of YP~s~ Eiectrician Over 401 to 600 amps
(~C<.,~ lit: i"~ Over 600 amps or 1000 volts
.. . 1--A(,.d-t- W ~ I J r,y D. Branch Circuits
Owners Name \..!..J.. ~[)A ~ CAJLIVlt lJ:Y71~
~~c:(~ \~ I ' New, Alteration or Extension Per Panel
AddressL.{ .,^-)... "'\ \,., 'I il.l .
. .' . One Circuit
Phone Each Additional
Circuit or with Service
or Feeder Permit
$ 40.00 1:D
$ 55.00
$ 80.00
see "B" above
$ 35.00
$
2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36 .~~\
f ')f) .UJ
J.-S .Y'l.
rJP'S. N )
L;:"l
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
li~">
.
~.
SPRINGFIELD
I
.
JOB NUMBER q 4lD IlL
225 Fifth Street
Springfield, Oregon 97477
L ."'7 12,A.:~ \)" ,;... LA~. ~4..i-.7'",;;" jj, '/:1 - f' 0,/ 1. 0
TAX LOT ~ I () 0 () 0
SUBDIVISION' See..,..! 1'/..1..1,;';.:... n> ._
1AI.1I"".......~c- ......"1""..'4 ~~....: S,
',I'AGL tA
ASSESSORS MAP'
LOT: -I"''' "A -If.J
LOCATION OF PROPOSED WORK'
\~-O~-Olq-\-'3
OWNER:
S~."'tt- l." """~Ic;tw<.--
ADORE"'" sli'(,~ :::r.. .".... d.l...
CITY' 5' On.l~~ ..,"iJ
DESCRIBE WORK'
#cw
5,~,(<-
NEW
'If
ADDITION
REMODEL
BLOCK'
'1'1 ~?f
STATF'
01'1.<...
I~- :1'7 2J,-dll_~
DEMOLISH
OTHER
PHON~'
I) I.(~ - 'I.../'r')
ZIP'
"/f)'1?r
.~
5.~
~..xI'1 6...-
J: (..., ])..~.;
~ IT" C:.?/,i,
CONST.
CONTRACTOR #
0132..(
ST". OO'lY]
2.)~')<rO
;z.O-'l.oI'l <:...
PHONE
Yn"J2..3c.,
'3'/\{ -1""'1...
0V'J- t'N<lr
{,.Jh - I 1(. L
CONTRACTOR'S NAME ADDRESS
GENERAl' f{,DUI!".-t .1<'.'UOl<A o:-lhlolL. \1'7(,.
PLUMBING:
(' A""".I\..~ "L.......AI:........ Co.
MECHANICA' .
r'\I1AL.d..._H:s: O:l.LJ;d.
ELECTRICAl'
R'N.:v(
l~l...,~c..;c..
QUAD AREA: '- ~f< ~ ~
# OF BLDGS: \.
OCCY GROUP: H~:.(YTJV\
c!J
. OF STORIES:
'f -/
'-""
WATER HEATER:
'-Ii'll
2t.
lAr"y11 U . Ey Sr.
EXPIRES
Ji-"-fV
f') -1""-1
\1..-).3-fl
10-I-lf
FLOOD PLAIN:
ZONING CODE:W/2..-/
# OF BDRMS: ~
SECONDARY HEAT: Z:oI{()QOi& >:.._
'lL\~
SQUARE FOOTAGE: ~ '
To request an InspectIon, you must 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 requested after 7:00 a.m. wIll be made the following work day.
g( Temporary Electric
o Site Inspection - To be made
after excavatfon, but prior to
setting forms.
o Underslab Plumbing/Electr!call
Mechanical - Prior to coyer. ...~..
~ Footing - After trenches are
excavated.
o Masonry - Steel locatlon, bond
beams, grouting.
~ Foundation - After forms are
erected but prlor'-.to concrete
placeme~t. >.
o Underground Plumbing - Prior
to flllln9 trench.
~ Underfloor PlumbIng/Mechanical
- Prior to Insulatfon or decking.
~ Post and Beam - Prior to floor
Insulation or decking.
~ Floor Insulation - Prior to
decking.
~ Sanitary Sewer - Prior to filling
trench.
~Storm Sewer - PrIor to filling
trench. .
~ Water Line - Prior to filling
trench.
~
g Rough PlumbIng - Prior to
cover.
- OFFli ?E -
LAND USE: I
# OF UNITS' \ '
CONSTR. TYPE: _l / fl/
~p
HEAT SOURCE:
RANGE: _7 ,
REQUIRED INSPECTIONS
~ Rough Mechanical - Prior to
cover.
~ Rough Electrical - Prior to
cover.
. .... :'<.. '
.::~..Electrlc'al 'SerVice - Must be
:.~ approved to obtain permanent
; electrical power. .
o Fireplace - Prior to facing
materials and framing Insp.
.,~ Framing - Prior to cover.
f':;'f Wail/Ceiling Insulation -. Prior to
~ cover.
~ Drywall - Prior to taping.
D ;WOOd Stove - After I~stallat'ion.
o Insert - After fireplace approval
and Installation of unit.
C8! Curbcut & Approach - After
forms are erected but prior to
placement of concre!e.
~Sldewalk & Driveway - After
. excavation Is complete, forms
and s.ub-base material In place.
o Fence - Whe.n completed.
D Street Trees - When 'all~ required
trees are planted. .
I8i Final Plumbing - When all
plumbIng work Is complet.e.
~ Final Electrical - 'When all
JA.l electrIcal work is complete.
~ Final Mechanical - When all
mechanIcal work Is complete.
~ Final BUilding - When all
required InspectIons have been
approved and buildIng Is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
water and sewer,
D Electrical Connection - When
blockln9. set.up. and plumbing
inspectfons have been approved
and the home Is connected to
the servIce panel,
o Final - After all required
Inspections are approved and
porches, skirtIng, decks, and
venting have been Installed.
~
. , r ~
Lot faces Lot Type Setbacks L THE PROPOSED WORK IN THE
Lot sq. Itg. ...L{.. Interlor I P.L. HSE GAR ACC '.'HISTORICAL DISTRICT, OR ON
IN 32.- THE HISTORICAL REGISTER?
Lot coverage Corner Is If yes, this application must be signed
S( and approved by the Historical
Top09raphy Panhandle Iw qoordlnator prior to permit Issuance.
Total he(ght c9.....!l..5' Cul'de-sac ..... .,
( 5ff ) IE 30 APPROVED'
BUILDING PERMIT.
ITEM SO. FT.
~9()
4fJD
X $/SO. FT. =\\~~( I}
olUifl I
Main
Garage
Carport
Total Value
\.~,Q 531o
,
Building Permit Fee "51 4, 75
State Su;charge ' 2-1/.-z..'1
Total Fee (A) 5 t'J '8' . 'J 9
SYSTEMS DEVEL:OPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N' 3
~ Sanitary Sewer FT.
./
~ Water'.' J' FT.
;
Storm Sewer FT.
Mobile Home
FEE
/ <j'2..S {J
Plumbing Permit
Iq'l.,SO
Q.63
2-0 2. .I 3
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
(('&0
31T6
fZ-.4-4
C,fJ-6
'3 ",-"
Fu mace
Exhaust Hood
Vent Fan
NO
'-I
Wood Stove/lnsertl Fireplace Unit
Dryer Vent
Mechanical Permit
3o.lJfJ
I ~./J tJ
'/.50
'fISo
Issuance
State Surcharge
Total Permit'
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
It
Demolition
State Surcharge
I
,
~
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excludln9 electrical)
(A, B, C, 0, and E Combined)
f....,7 52 J2
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permIt 15 granted on the express condition that the said
construction shall, In all respects, conform to the Ordinance
adopted by the City of Springfield, Including the
Development Code, regulating the crinstru'ctlon and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisIons of said ordinances.
Plan Check Fee: ,~'S ,m-
Date Paid: r:..5 ~ .
Receipt NUmbqr:--1J.1/{.). q~
Received By:~Fn )
~/H '.' ,
Plans Reviewed By
/~u...!j'Y'
Date
Systems Development Charge 'Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
\ ~{\tr\ \
(mID'r
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 Ore90n pertaining to the work described
herein, and .that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
prolect.
I further agree to ensure that all required Inspections are
requested at the proper time: that each address Is reada~le.
from the street, that the permIt card Is located at the front
of the property. and the approved set of plans will remain
on the site at a tI during 4\onstructlon. .
SlgnatuJ. / -------.
Date .' ~C) LI ~
VALIDATION:
RECEIPT NUMBER
I ISIS.
") - I -0 '--I
~ 1..2J~ .\').
DB.
,j
DATE PAIr'
AMOUNT RECEIVED
RECEIVED BY
... ~ .
o yy'inl!!!!!!~!!~
.
Job No. q 4CO{ (0
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME .!:x-~ 1. ;{,u ~O) PHONE 14'7-:JP.,C,7
ADDRESS ;?,7S(-,~ J~J\~OQ Z2~TATIOCIP q1~~
LOCATION OF PROPOSED BU)!.,DQ SITE: , . '-1 F\!J )
Street Address if Known: d R'c>..""J JIJ.{.JJl.. ' ? j J J-P
-:. ') ()-
Platt Name: n !CL-J Tax Lot Number: J8fj~ ()(/?.A3 /(YYX)
1. DEVELOPMENT TYPE (Check appropriate dwelling(sl. SDC Calculations and dwelling type
definitions are on the back,)
A. Sin\!le Familv - Detached
-l Single Family home
NO OF UNITS I
.
B. Sinple Familv - Attached
NO OF UNITS
C. Multi-Familv Aoartmen!
NO.OF UNITS
D. Manufactured Home Park
NO OF UNITS
WPRD SDC
_ Manufactured home not in a park
$4CO.CO
X $400 PER UNIT =
X $370 PER UNIT =
$
X $277 PER UNIT =
$
X $280 PER UNIT =
$
2. SDC CREDIT Of applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit)
\o~~~~0 D~ I \ I ~c1
City of Springfield D'Jlsion
$ 4-mcD
$ .0{
$ 4ffi.cO