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Home My WebLink AboutPermit Building 2003-08-19Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00619ISSUED: 0811912003APPLIEDz 0711412003EXPIRES: 1211712004VALUE: $ 139,923.00 SITE ADDRESS: 308 S 4TH ST ASSESSOR'SPARCELNO.: 1703353400400 PROJECT DESCRIPTION: Rebuild SFR after fire damage Springfield TYPE OF WORK: Fire Damage TYPE OF USE: Repair Owner: DAyIE LAWRENCE E & AMYJ Address: 35690ZEPIIYRWAY PLEASAIITHILL OR 97455 Expiration Date 02n6t2005 Residential Phone 5417269905 PhoneNumber: 541-746-9495 Contractor Type General Electrical Contractor BELFOR USA GROUP INC OWI\ER EUGENE EXCAVATION & PLUMBING License 146973 CONTRACTOR INFORMATION Heat: Forced Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: 03t07t2005 541-988-0868 Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 1 Air Elect Electric Electric Path I nla 1,316 990 ) REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: 17.00 25.00 30.00 10.00 0.00 AC Mat Yes Storm to ditch on C Street. Notes: Pase 1 of3 L[1,Yt Lt rlYll,N I tt\r(rKrYrArrur\ | Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00619ISSUED: 0811912003 APPLIEDT 0711412003EXPIRES: 1211712004VALUE: $ 139,923.00 Description Bid Amount Bid Amount Type of Construction Use Bid Amount Use Bid Amount $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 70,000.00 69,923.00 Value $70,000.00 $69,923.00 $139,923.00 Date Calculated 08/14l2003 08/14l2003 Fee Description PIan Review Residential -Mechanical Issuance Fee- + l0Yo Administrative Fee + 1oh State Surcharge Building Permit Dryer Vent Exhaust Hoods Fixture Furnace - up to 100,000 btu Plan Review - Planning Plan Review Residential Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan + l0oh Administrative Fee + loh State Surcharge Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl500 Total Amount Paid Amount Paid Total Value of Project Date Paid Receipt Number 120020000000000r750 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 1200400000000000928 1200400000000000928 1200400000000000928 1200400000000000928 $304.30 $10.00 $86.67 $60.67 $69s.65 $6.00 $9.00 $126.00 $12.00 $59.00 $147.87 $sr.63 $67.92 $s.98 $18.00 $16.30 $11.41 $106.00 $s7.00 7fi4t03 8/19/03 8lt9t03 8n9t03 8/19/03 8n9t03 8n9t03 8t19t03 8/19/03 8/19/03 8n9t03 8/19/03 8/19/03 8/19/03 8/19/03 6n7t04 6n7t04 6n7t04 6n7t04 $1,851.40 Fees Paid Plan Reviews Initial Review Planning Review 07nst2003 071t512003 07nst2003 07t3012003 APP APP LLH TAJ 07n7t2003 wE vRJ 2 street trees are required unless they are already in. Contacted Belfor at 7 26*9905, receptionist transfer me to voice mail2:45 711712003. Site plan it not clear, left message to clarify plumbing fixture units and impervious surface. Public Works Review 07n5t2003 Paee 2 of 3 Lj Yaluation Description I Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00619ISSUED: 0811912003APPLIED: 0711412003 EXPIRESz 1211712004VALUE: $ 139,923.00 Public Works Review 07^8t2003 0711812003 APP vRJ Spoke with Brian Joyce of Belfor 711812003,3:25pm. No change in impervious surface. Plumbing fixtures the same except added I lav. sink and I shower, City Plumbing Inspector will verify at time of plumbing inspection. Plans did not show storm drainage, assuming applicant will take roof drainage to ditch on C Street. Structural Review 07115t2003 08/11i2003 APP DLM To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. 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. Final Buitding: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. 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 OCCUPAI\CY will 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 will 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 will remain on the site at all times during construction.L t(- nsnections Owner or Contractors Signature Page 3 of3 Date /7-Z@/ _:tLl Construction Contractors Board Permit #: CitsrZc>O- & bl1 Address: 3og = q+\ >f Issued by:\ 6 Date: 6-17 -Or{ 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:ryfo!3!4 Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3.A' or 38: [f l. I own, reside in, or will reside in the completed structure. &'2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. 3A. My general contractor is (Name)(ccB #) I will instrrct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR X 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the nirme of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information \[,about Construction Responsibilities on the reverse side of this form. (" - / 7'z@/ (Signature of permit applicant) (Date) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 tr \/, \/ Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OYYNERS ABOUT CON$TRUCTION RESPONSIBILITIES IVOIE: Tttis lnforma#on Noffce to Properly Owners aboul Constructian Responsibdrfi'e.s was developad by the Construction Contractors Board in accordance with ORS 7A1.A55{5J, passed by the 1989 Aregon Legislature. If you are acting as your own contractor to eonatruct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being all,are of the follorving responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contact with rvill be "employees" if you use ccntractors not licensed with the Construction Contractors Board to do iabor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's lVithholding Tax Law: As an ernployer, you must withhold income taxes from emplo,yee 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 a State Business ID number, call the Business Information Center at 503-986-2200. 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 Department at 503-947-1488. 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' compensahon insurance, you could be subject to penalties and be liable for all claim costs if one of yow employees is injured on thejob. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. 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 withhold the tax. For a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-71 15. Other Responsibilities and Areas of Concerns 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 attention through inspections. Liability and Property Damage fnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and ornissions such as falling tools, paint over spray, water.damage &om pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the shlls to act as your o\*'n general contractor, to coordinate the work of rough-in and finish trades, and to notify building offieials as ths app-ropriate times so they can perfcim the required inspections. If,you have additional questions call the Construction Contractors Boatd (503-3?8-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Properfy_o*,ner.doc 03/ I I /03 225 Fifth Street Springlield, Oregon 97 477 541-726-3759 Phone eT of Springfield Official Receipt - -velopment Services Department Public Works Department RECEIPT#: 1200400000000000928 Date: 0611712004 3:07:5oPM Job/Journal Number coM2003-006r9 coM2003-00619 coM2003-00619 coM2003-006r9 Description Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 + 1oh State Surcharge + l0o/o Administrative Fee Amount Due 106.00 57.00 11.41 16.30 Item Total:$190.71 Payments: Type of Payment Paid By checkNumber Authorization Received By Batch Number Number How Received Amount Paid Check LAWRENCE DAVIE djb 3360 In Person $190.71 Payment Total: -Siro1?f 6lt7/2004 Page I of I IFIMIBD \ CitY of SPringfield 225 Fifth Street, Springfield, Ox.97477 541-726-3759 Phone ' 541-726-3676Fax November 16,2004 DAVIE LAWRENCE E & AMY J 35690 ZEPHYR WAY PLEASANT HILL OR 97455 Job Number: Location: coM2003-00619 308 S 4TH ST Project:Rebuild SFR after fire damage Dear Permit Holder: The Springfield Building Safety Code Administrative Code provides that in order for a permit to remain valid, the work which has been authorized by the permit must begin within 180 days of the date of issuance, and an inspection must be requested at least every 180 days. According to our records, you obtained a permit for a project at 308 S 4TH ST which is set to expire on l2ll7l20}4. Our records indicate that you have not requested an inspection within the past five (5) months. This letter is written to notiff you that your permit(s) will be expiring shortly. If you are ready to request an inspection for your project, please phone the inspection line at 541-726-3769. If you do not request an inspection prior to the expiration date, your permit(s) will expire and additional permit fees will be required in order to complete your project. If you have any questions, please feel free to phone me at 541-726-3790. Sincerely, Lisa Hopper Building S afety Supervisor E 225I'IFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541 ELEC:TRICAL PEr.ITIIT APPLICATION DAIE City Job Number ^006I Date 6 -t7 -C\ outhorized 1.3.30&< q LEGAL DESCRIP'IION 03-3 L{' (frtao JOB DESCRIPTION ZeGttrcx SFL Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. , Electrical Contractor Address Phone Supervisor License Number .eQi' ^*{ Expiration Date p$ r$Constr. Contr. )726i$fr?:s A. Ien ttcsitlcntial - Single or Ntulti-Farnill' per dnelling unit. 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 $50.00 $106.00 1O6.oo 25 $re.oo SZoo $ 63.00 $ 75.00 s 125.00 $ 163.00 $375.00 $ 50.00 CO:\TI*ICIOR I 'S71.lI IATION O;\ZI' B. Services or Feeders * tnstallation, Allerations or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps 60 Amps oltsCity Each '/a-. Owners Name ,-A ur3 t c r1C e I lI m- J)o .,f i .Service or 3567() Ze,cL," rJo, New Alteration or One Circuit E. $ s0.00 $ s0.00 $ 2s.00 $ 4s.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volts see "B" Limited Limited 7o/o State Surcharge l0% Administrative Fee TOTAL -L$\ Expiration Signature Electrician D. Address City olcq>o.r tl.'il Phone'1VC-Eqq{ OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signahrre 4. suBrorAlaFenovn 16S { vt 3o 7Inspection Request: 726-3769 Shared Dive(T:)/Building Fonns/Electrical Pennit Application I -03.doc (,se Srgnalure Serviees or Feeders Installatiorr City of Springfield 225 Fifth Street, Springfield, OR97477 541-726-3759 Phone 541-726-3676Fa;x May 06,2004 DAVIE LAWRENCE E & AMY J 35690 ZEPHYR WAY PLEASANT HILL OR 97455 Job Number: Location: coM2003-00619 308 S 4TH ST Project:Rebuild SFR after fire damage Dear Permit Holder: The Springfield Building Safety Code Administrative Code provides that in order for a permit to remain valid, the work which has been authorized by the permit must begin within 180 days of the date of issuance, and an inspection must be requested at least every 180 days. According to our records, you obtained a permit for a project at 308 S 4TH ST which is set to expire on 611712004. Our records indicate that you have not requested an inspection within the past five (5) months. This letter is written to notiff you that your permit(s) will be expiring shortly. If you are ready to request an inspection for your project, please phone the inspection line at 541-726-3769. If you do not request an inspection prior to the expiration date, your permit(s) will expire and additional permit fees will be required in order to complete your project. If you have any questions, please feel free to phone me at 541-726-3790. Sincerely, Lisa Hopper Building Safety Supervisor FD-016 TO: FROM SUBJECT: Name of Owner Building Department Springfield Fire Department Structural Damage to Building Ab Dotolc( Date: 4ll5l03 Address or location of building 308 South 4th Type of Building Dwelling (Dwelling, Store, Warehouse, etc.) Estimated value of building $ Estimated loss to building $ Date of fire 4ll5l03 Location of damage to building Throughout (Roof, Wall, Exterior, Interior, etc.) Structural weakness as a result of the fire Floors, walls, roof serious burn damage (Burned rafters, Beams, Joists, etc.) Additional pertinent information Electrical Hazard (Wiring, Outlets, etc.) CC l:\Forms\FD-016 FIRE DAMACE REPORT.doc Signed FIRE DAMAGE REPORT OR ELECTRICAL HAZARD Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2003-00619ISSUED: 0811912003APPLIEDz 0711412003 EXPIRESz 0211912004VALUE: $ 139,923.00 SITE ADDRESS: 308 S4TH ST ASSESSOR'S PARCEL NO.: 1703353400400 PROJECT DESCRIPTION: Rebuild SFR after fire damage Springfield TYPE OF WORK: Fire Damage TYPE OF USE: Repair Owner: DAVIE LAWRENCE E & AMy J Address: 35690 ZEPIIYR WAY PLEASANT HILL OR 97455 Expiration Date 02n6t2005 08/06/2005 03107t2005 Residential Phone s417269905 541-89s-8833 541-988-0868 Contractor Tvpe General Electrical Plumbing Contractor BELFOR USA GROUP TNC BEAR MOUNTAIN ELECTRIC LLC EUGENE EXCAVATION & PLUMBING License 146973 136298 138003 CONTRACTOR INFORMATION 1o # of Buildings: Primary Occupancy Group: Secondary Occupancy Group : Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Paved oh ofLot Coverage: I R-3 VN 3 a(o o\ 2 Yes 30.00 Floor:1,316 990 403 Surface Area: REQUIRED PARJ(NG Total: 2 Handicapped: Compact: 17.00 25.00 30.00 10.00 0.00 AC Mat Yes Storm to ditch on C Street. Notes: Page 1 of3 hNl II L U llJ|-rlL\ \, rr\ I \J-ruvrl!!!!!|1l l F' Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2003-00619ISSIJED: 08/19/2003 APPLIEDz 07114/2003 EXPIRESz 0211912004VALUE: $ 139,923.00 Description Bid Amount Bid Amount Type of Construction Use Bid Amount Use Bid Amount $ Per Sq Ft or multiplier $r.00 $1.00 Square Footage or Bid Amount 70,000.00 69,923.00 7n4t03 8/19/03 8n9t03 8n9t03 8/19/03 8/19/03 8n9t03 8/19/03 8n9t03 8/19/03 8/19/03 8fi9103 8n9t03 8/19/03 8/19/03 Value $7o,ooo.oo $69,923.00 $139,923.00 Date Calculated 08/14t2003 08n4t2003 Total Value of Project Date PaidFee Description Plan Review Residential -Mechanical Issuance Fee- + l0Yo Administrative Fee + 7Yo State Surcharge Building Permit Dryer Vent Exhaust Hoods Fixture Furnace - up to 100,000 btu Plan Review - Planning PIan Review Residential Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Total Amount Paid Amount Paid $304.30 $10.00 $86.67 $60.67 $695.6s $6.00 $9.00 $126.00 $12.00 $s9.00 $r47.87 $51.63 $67.92 $5.98 $18.00 $1,660.69 Receipt Number r200200000000001750 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 220020000000000r408 220020000000000r408 2200200000000001408 2200200000000001408 2200200000000001408 2200200000000001408 220020000000000r408 Fpps Peid Plan Reviews Initial Review Planning Review Public Works Review 07fist2003 07nst2003 07n5t2003 07t3012003 APP APP LLH TAJ 07n5t2003 07n7t2003 WE VRJ 2 street trees are required unless they are already in. Contacted Belfor at 7 26-9905, receptionist transfer me to voice mail2:45 711712003. Site plan it not clear, left message to clarify plumbing fixture units and impervious surface. Paee 2 of3 h Valuation Descrintion I Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00619ISSUED: 0811912003APPLIED: 0711412003 EXPIRESz 0211912004VALUE: $ 139,923.00 Public Works Review 07n8t2003 07fi8t2003 APP VRJ Spoke with Brian Joyce of Belfor 711812003,3:25pm. No change in impervious surface. Plumbing fixtures the same except added 1 lav. sink and 1 shower, City Plumbing Inspector will verify at time of plumbing inspection. Plans did not show storm drainage, assuming applicant will take roof drainage to ditch on C Street. Structural Review 0711s12003 08/11/2003 APP DLM To Request an inspection call the24 hour recording at 726-3769. All inspection 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. I Post and Beam: Prior to floor insulation or decking. 2 Floor Insulation: Prior to decking. 3 Shear Wall Nailing: Before covering sheathing with finish materials. 4 Framing Inspection: Prior to cover and after all rough in inspections have been approved. 5 Wall Insulation: Prior to cover. 6 Ceiling Insulation: Prior to cover. 7 Drywall: Prior to taping. 8 Final Buitding: After all required inspections have been requested and approved and the building is complete. 9 Underfloor Plumbing: Prior to insulation or decking. l0 Rough Plumbing: Prior to cover and including required testing. 11 Final Plumbing: When all plumbing work is complete. 12 Underfloor Mechanical. Prior to insulation or decking and including required testing. 13 Rough Mechanical: Prior to Cover 14 Final Mechanical: When all mechanical work is complete. eauired Insnections 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 will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that onty contractors and employees who are in compliance with ORS 701.005 will 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 will remain on the site at all times during construction. f- tq -aj Owner or Contractors Page 3 of3 Date 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department #: 220020000000000 1408 Date:08/19/2003 l0:07:32AM coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 coM2003-00619 Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Plan Review - Planning Fixture Fumace - up to 100,000 btu Vent Fan Exhaust Hoods Dryer Vent -Mechanical Issuance Fee- Building Permit Plan Review Residential + 7o/o State Surcharge + llYo Administrative Fee 67.92 51.63 5.98 59.00 126.00 12.00 18.00 9.00 6.00 10.00 695.65 147.87 60.67 86,67 Item Total:$1,356.39 Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check BELFOR djb $ 1,356.39 11is6.3e In Person Payment Total: CITY OF SPRINGFIELD SYSTEMS DEVELOPMEN T yVORKSHEET JOURNAL OR JOB NUMBER: Com2003-00619 NAME OR COMPANY Lawrence Davie LOCATION 308 S 4th Street TAX LOTNUMBER:17033534 tl 400 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING LINITS 0 BUILDING SIZE 0 LOT SIZE (SF):0 a E] t-loO &HFa or!& 1070 l09l 1092 I 093 1094 I 054 1055 1054 I 056 1079 1078 I. STORM DRAINAGE DIRECTRTINOFF TO CITY STORM SYSTEMI IMPERVIoLis s-F. xI o.oo COST PER S.F $0.290 CHARGE $0.00 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CIry STANDARDS IMPERVIOUS S.F 0.00 x COST PER S.F s0.290 x DISCOLINT RATE 50% DISCOLTNT $0.00 ITEM 1 TOTAL - STORM DRAINAGE SDC $0.00 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: NUMBER OF DFU'S 3 x COSTPER DFU s22.64 B. IMPROVEMENT COST: NUMBER OF DFU'S 3 x COST PER DFU $17.21 : I $s1.63 ITEM 2 TOTAL. CITY SANITARY SEWER SDC $l 19.55 3. TRANSPORTATION A. REIMBURSEMENT COST: ADT TRIP RATE 9.57 x NUMBER OF LTNITS 0 x COST PER TRIP st7.23 x : I $o.oo B. IMPROVEMENT COST: ADT TRIP RATE 9.57 NUMBER OF UNITS 0 x COST PER TRIP s76.01 x : I so'oo ITEM 3 TOTAL. TRANSPORTATION SDC $0.00 TRIP 1.00 F 1.00 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU's 0 x = I $0.00 B.IMPROVEMENT x = I $0.00 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL. MWMC SANITARY SEWER SD( : : I $o.oo $0.00 COST PER FEU s332.86 NUMBER OF FEU's 0 COST PER FEU s34.83 SUBTOTAL (ADD ITEMS 1,2,3, & 4)$r 19.s5 5. ADMINISTRATIVE FEE: SUBTOTAL $l19.55 x ADM. FEE RATE 5% CHARGE $5.98 TOTAL SANITARY ADMTNISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE I 5.e8 Virginia Jurasevich 712y2003 PREPARED BY DATE TOTAL SDC CHARGES $125.53 x DRAINAGE FIXTURE UNIT CALCULATION TABLEDI',U NUMBER OFNEW FXTURES X TINIT EQUIVAIENT: DRAINAGE FXTURE UNITS DRAINAGE FIXTURE UNITS NO. OF FIXTURES NEWFIXTURE ryPE OLD (NOTE: FORREMODELS,CALCULATE ONLY TT{E NET ADDITIONAI FIXTURES) LINIT EQUIVALENT 0003BATHTUB 0 1 00DRINKING FOLINTAIN 0 0 3 0FLOORDRAIN 0003INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 6 000INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 2 00LAUNDRY TUB 0003CLOTHESWASHER / MOP SINK 0006CLoTHESWASHER - 3 OR MORE (EA) 0 12 00MOBILE HOME PARK TRAP (I PER TRAILER) 0001RECEPTOR FOR REFRIG / WATER STATION / ETC. 3 000RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 2 2SHOWER, SINGLE STALL 0002SHOWER, GANG (NUMBER OF HEADS) 3 000SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 2 0SINK: COMMERCIAL BAR 0 0002SINK: WASH BASIN/DOLIBLE LAVATORY 1 110SINK: SINGLE LAVATORY/RESIDENTIAL BAR 0 0 5 0URINAL, STALL / WALL 6 000TOILET, PUBLIC INSTALLATION 0 0 3 0TOILET, PRIVATE INSTALLATION 3 toa set at 167 0 unit MISCELLANEOUS DFU TYPE NUMBER OF EDU'S TOTAL DRAINAGE FIXTURE UNITS *EDU rsa MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 0 0 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE/ 1OOO CREDITRATE 50.00 x $4.92 : I so.oo CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1OOO CREDIT RATE $0.00 x $4.92 TOTAL MWMC CREDIT BEFORE 1979 $4.92 1979 s4.92 1980 $4.83 198 1 s4.77 1982 s4.64 1983 $4.47 1984 $4.30 r985 $4.09 1986 $3.78 1987 $3.41 1988 $2.98 1989 $2.52 1990 $2.06 1991 s1.64 1992 $r.45 1993 sl.3l 1994 s1.13 1995 s0.97 1996 s0.82 1997 $0.63 1998 $0.41 1999 $0.22 2000 $0.04 20 =t 0 l-$0-0-6-