HomeMy WebLinkAboutPermit Building 2001-05-10Job# 01-00027-01
SPRINGFIELD
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2028 00008th St Spr
AssessorsMap#: 17032613
Lot:3 Block: Addition: First
Page 1 of4
Job Number: 01 -00027-01
Office: 726-3759
Inspection Line: 726-3769
Tax Lot #: 00700
Subdivision: Mimosa Park
ctTY oF SPRfiNGFfiEL4 OREGON
Owner: Colburn Homes lnc
Address: 1178 Echo Hollow Rd
Scope Of Work: Single Family Residence
SFR
Phone Number:
City/State/Zip:
New
541-689-6370
Eugene, OR97402-1328
Value: $112,793
Contractor Type
GeneralContr
ElectricalContr
Landscape
Mechanical Contr
Plumbing Contr
9t30t02
12t1t02
Contractor
Colburn Homes lnc
1178 Echo Hollow Rd, Eugene, OR
97402-1328
Rose Corporation
89976 Day Ln, Eugene, OR 97402-9415
Toms Landscape lnc
1524 Bogart Lane, Eugene, OR 97402
Marshalls Heating
4110 Olympic Street, Springfield, OR
97478
Fridlund Plumbing
X, Eugene, OR 97407
54431
11700
{{OBK
:\SNOI
r0R
Registration #
8783
Expiration Date
5121101
Phone
541-689-6370
541 -686-0905
541-344-2569
541-747-7445
541-746-9433
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
2RNW
1
(VN) Wood Frame
Gas
office use
-
Land Use: Single Family Dwelling
Zoning Code: LDR
Bedrooms: 3
Range: Electric
# Of Buildings: 1
Occupancy Group: Private Garage/Ci
Heat Source: H,
Sq. Footage: 1
To request an inspection call the 24 hour recordi ng at726-3769. All inspections requested before 7:00
a.m. will be made the same worki ng day, inspectio ns requested after 7:00 a.m. will be made the following
working day
Required lnspections
Buildi
f,>
{t= EIDJ)Verify Ground Rod
Footing
Foundation
Post and Beam
-lnstall ground rod at footing, and callfor inspection in conj
-After trenches are excavated.
-After forms are erected but prior to concrete placement.
-Prior to floor insulation or decking.
uction with footing and/or foundation
O\Irt-cel
Floor lnsulation
Ceiling lnsulation
Shear Wall Nailing
Framing
Walllnsulation
Drywall
FinalBuilding
Rough Electrical
Electrical Service
Final Electrical
Underfloor Plumbing
Underfloor Drain
Rough Plumbing
Water Line
Sanitary Sewer Line
Storm Sewer Line
Backflow Device
FinalPlumbing
Underfloor Mechanical
Rough Gas
Rough Mechanical
Gas Service
FinalGas
FinalMechanical
Curbcut
Sidewalk
SW-Curbside
CC-Standard
Street lmprovement: Fully lmproved
Curb Cut?fl lmprovement Agr.?
San Sewer Depth (Ft): 6 - 4
Storm Sewer Available? fl
Special Req.:
Security Required:
Bond Begin DateTime: 00/00/00 00:00 AM
Special lnstructions:
Other Utilities:
Project Supervisor:
Job# 01-00027-01 Page 2 of 4
Required lnspections
Build
- Prior to decking.
-Prior to cover.
-Before covering sheathing with finish materials.
- Prior to cover.
-Prior to Cover
-Prior to taping.
-When all required inspections have been approved and the building is complete
Electricai
I
- Prior to cover.
-Must be approved to obtain permanent power
-When all electrical work is complete.
Plum
- Prior to insulation or decking.
-Prior to cover or placement of concrete.
- Prior to cover.
-Prior to filling trench.
-Prior to filling trench.
- Prior to filling trench.
-After device is installed but before backfilling trench
-When all plumbing work is complete.
Mechanical
-Prior to insulation or decking
-Prior to cover.
-After line is installed and line has been connected to a minimum of one appliance. Pressure ter
-When all gas work is complete.
-When all mechanicalwork is complete.
Public Works
-After forms are ereceted but prior to placement of concrete.
-After forms are erected but prior to placement of concrete
-After forms are erected but prior to placement of concrete
Sidewalk Type:
Additional ROW?
Size Of Line (in):
Downspouts/Drains:
Enchroachment Permit:
San Sewer Tee (in):
Bond End DateTime:
Curbside - 5'
8
To Curb and Gutter
6
00/00/00 00:00 AM
Types Of Warning Devices Reqd.
Zoning: LDR
FloodPlain? ! Wetlands? [
Planner: Liz Miller
Urban Growth Boundary?[ Glenwood Area?
Quantity Of Fill:
Supplier:
Drainage:
Floodway FEMA: Zone X Light Gray
Job# 01-00027-01
Overlay District:
# of Street Trees: 2
Page 3 of 4
Land Use: Single Family Dwelling
Pave Driveway? V
Journal numbers
1: 2: 3:
Comments:Owner stated he will only be moving 20 cu yards of material
Additional Requirements:
Required Attachments:
Source Locn:
Material:
FIood Plain FEMA: panel1134 of 2975
Construction Types(VN) Wood Frame
Occupancy Groups:Private Garage/Carp/Stor Dwelling
# Of Buildings: 1 # Of Stories: 1 Height (feet): 18
# Of Bedrooms: 3 Current Units:0 proposed Units:1
Handicap Access? [ Census Code: New SF - attached
Area (Sq.
Main:1508 Accessory424 Tota!:1932
Fee Paid On Receipt# Value/Quantity Fee Amount
Plan Check
Residential Plan Check
Total Plan Check
01109t2001 4205 112,793 $300.46
$300.46
Building
Building Permit
State Surcharge For Building Permit
Building Administrative Fee
Total Building
0112312001
01t23t2001
0112312001
4292
4292
4292
112,793 $462.25
$32.36
$13.87
$508.48
Electrical
Wiring Footage 1,000 Sq Ft or Less
Wiring Footage Each Add'l 500 Sq Ft
State Surcharge - Electrical
Administrative Fee - Electrical
Total Electrical
01t2312001
0112312001
01t23t2001
0112312001
4292
4292
4292
4292
1
2
$85.00
$30.00
$8.0s
$3.45
$126.50
Minimum Plumbing Permit Fee
Minimum Plumbing Permit Fee
Two Bathrooms
State Surcharge - Plumbing
State Surcharge - Plumbing
Backflow Prevention Device
Administrative Fee - Plumbing
Administrative Fee - Plumbing
Total Plumbing
Plumbing
0112312001
05110t2001
0112312001
01123t2001
0st10t2001
05110t2001
01t23t2001
05110t2001
4292
5278
4292
4292
5278
5278
4292
5278
$.00
$5.00
$160.00
$11.20
$1.05
$10.00
$4.80
$.45
$192.50
1
1
Mechanical
Hood and Exhaust
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
01t23t2001
01t23t2001
01t23t2001
0112312001
1
1
$4.50
$2.00
$.00
$.87
4292
4292
4292
4292
-01Job#
Page 4 of 4
ValuelQuantiU Fee Amount
Fee
Less than 100,000 BTU
Vent Fan to One Duct
Gas Fireplace
Dryer Vent
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
Paid On
01,23'2001
01/2312001
0112312001
0112312001
01/23/2001
01t2312001
ReceiPt#
4292
4292
4292
4292
4292
4292
1
3
1
1
$6.00
$e.00
$4.50
$3.00
$10.00
$2.03
$41.90
Public Works
New Sidewalk
New Curbcut
Total Public Works
0112312001
0112312001
4292
4292
60
1
$60.00
$60.00
$120.00
System Development
Residential- Single Family - Storm
Sanitary Sewer
Residential Transportation
Residential Sanitary MWMC
Residential lmprovement MWMC
MWMC Administrative Fee
SDC Administrative Fee
Total System Development
01t23t2001
01t23t2001
0112312001
01t23t2001
01t23t2001
01t23t2001
01123t2001
$672.55
$748.00
$810.2e
$285.91
$24.33
$10.00
$127.55
$2,678.63
4292
4292
4292
4292
4292
4292
4292
2,482
20
1
1
1
1
S.F. Residence - Willamalane
TotalWillamalane SDC
Willamalane SDC
0112312001 4292 1 $1,000.00
$1,000.00
Grand Total
PIan Check Type Ghecked By Date Completed Comment
lnitial Review-Res Wendy Stanley 0110912001
Engineering-Res Steve Templin 0111212001
Planning-Res Liz Miller 0111912001
Structural-Res Don Moore 0112212001
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 only contractors and employees who are in compliance with ORS 701.055 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
$4,968.47
S re
will remain on the site at alltimes during construction.
Date
o
C'TY OF SPR,,VGFIELD, OREGO'U
SPRI]rrGFIELD
BACKFLOII PREVEMION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIBLD OR 97477
JOB LOCATION:)o
OFFICE:
INSPECTTON IINE:
726-3759
726-3769
8 E+h
AssEssoRs MAP *, I 1C>3 Z 6t3
OI.INER:
h
TAX LOT *: O 6 7OC)
#' qdrT637o
STATE:ZTPz
BACKFL0I.I PERMTT Is $15.00 + 1.05 (STATE SURCHARGE) + $.45 (ADurN. FEE) =$16.50
CONTRACAOR:k
ADDRESS:
CITY:cll ,tr')
ADDRESS:PH0NE *, .4'14-2"s (,q
CITY:STATE: N d(zIP:41 Llo I
coNsTRuCTroN coNTRAcroRS REGISTRATToN *: i I 700 EXPTRES:ba
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION(726_3769). I ALSO STATE THAT ALL INFORI,IATION ON THIS PERMIT/APPLTCATION IS
CORRECT.
FOR OFFICE USB
DATE OF APPLICATION: O5 I O O
RECEIPT S:
JoB *: o / ^Ooo z7 - o I
ISSUED BY:6>TOTAL AMOI.INT COLLECTED:
I>
=*l-{ (5 irj
:E> :E)
|-rl m C'fE? ". :F*f:r3.'.' x> c)H-<H
Itr? F r.}c3 c)I.J O
Cf, i"J LXl. (3 l.,l(f C] -'IrJ*trO
{r+
L,I
Ln(}
m
;:rf
(3FH
)
INGFIELO
225 FIFTU STREET
SPRINGFIELD, OREGON 97
INSPECTION REQI'EST
OFPICE: 726-3759
Adhorized Signature
IJGAL DESCRTPTIONt+o a( /a oo+
JOB DESCRIPTION3tr R-
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
Ci ty Phone
Supervi.sor Li cense Number /529_5
Expiration Date o
Constr Contr. Number 1/
Expiration Date.a
: tz$-S
Signature of luaervising Electrician,2),*4,
CAL PERHIT APPLICATION
Job Nurnber O
3. COHPT,]ETE FEE SCEEDIILE BELOV
A. New Residential-Single or
Hulti-Family per dvelling unit.
Service Included:Items Cost Sum
1000 sq.ft. or less I $ 85.00 ?5.
Each additional 500
sq. ft or portion thereof iJ- $ 15.00 ? O
Each Hanuf'd Home- or
Hodular DweIIing
Sertice or Feeder .$ 40.00
B.Services or Feeders
Installat ion, Alterations
or Relocation:
200 amps or less s s0.00
s 60.00
s100.00
$130. 00
$300.00s 40.00
201 amps to 400 amps _401 amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect Only
C.
rJ
Temporary Services or Feeders
Installation, Alteration or Relocat
200 amps'"or less $ 40.00
201 amps to 400 amps
-
$ 55.00
over 4b1 to 6oo amPs
-
$ 8o'oo
0ver 600 amps or tbOO-iETIs see rrB.
Branch Circuits
ion
a666
D
ovners uame Cc[}{ome,=
New, Alteration or Extension Per Panel
s;"htAdJition"rCircuit or vith Service
or Feeder Permit
-
$ 2.00
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation _
Sign/Ou tline Lighting_
t,imi ted Energy/Res
-Limi ted Energy/Comm
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
rn
Address il79 L..l^o 4 OtI RJ"l
ci 4 e Phone 6 -6
OVNER INSTALLATION
The installation is being made on
property I ovn vhiih is not intended
for sale, Iease or rent.
Osners Signature:
DATE:
s
s
$
$
Its.e
5rr--
-2:?.<
40.00
40.00
20.00
36.00
5
,- ,4Itz6fRBCEIVEDUI:
1. LOCATION OF INSTALI.^ATION
eoa ? 8+^ S+r€t
Z
T- G:
€r
Job# 01-00027-01
SPRINGFIELD
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 2028 00008th St Spr
AssessorsMap#: 17032613
Lot: 3 Block: Addition: First
Page 1 of4
Job Number: 01-00027-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot #: 00700
Subdivision: Mimosa Park
ctTY oF SPR1NGFfiELq OREGOIV
Owner: Colburn Homes lnc
Address: 1178 Echo Hollow Rd
Scope Of Work: Single Family Residence
SFR
Phone Number:
City/State/Zip:
New
541 -689-6370
Eugene, OR97402-1328
Value: $112,793
Contractor Type
GeneralContr
ElectricalContr
MechanicalContr
Contractor
Colburn Homes lnc
1178 Echo Hollow Rd, Eugene, OR
97402-1328
Rose Corporation
89976 Day Ln, Eugene, OR 97402-9415
Marshalls Heating
4110 Olympic Street, Springfield, OR
97478
Registration #
8783
Expiration Date
5121t01
Phone
541-689-6370
541-686-0905
541-747-7445
54431 9/30/00
/r
THISP
AUTH(
IT SHALL EXPIRE IF THE WORK
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
2RNW
1
(VN) Wood Frame
Gas
Office Use
Land Use: Single Family
Zoning Code: LDR
Bedrooms: 3
Range: Electric
# Of Buildings: 1
Occupancy Group: Private Garage/Ci
Heat Source: Heat Pump
Sq. Footage: 1508
To request an inspection callthe 24hour recording a1726-3769. 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
working day.
Required
Verify Ground Rod
Footing
Foundation
Post and Beam
Floor Insulation
Ceiling lnsulation
Shear Wall Nailing
Framing
Walllnsulation
Drywall
-lnstall ground rod at footing, and callfor in
-After trenches are excavated.
concrete place-After forms are erected but prior to
-Prior to floor insulation or decking.
-Prior to decking.
-Prior to cover.
-Before covering sheathing with finish materials.
-Prior to cover.
-Prior to Cover
- Prior to taping.
in conjuction with footing and/or foundation i
ment.
ERTHISPERM IT
ONEDFOH
Dwelling
t4).
Final Buitding
Rough Electrical
Electrical Service
Final Electrica!
Underfloor Plumbing
Underfloor Drain
Rough Plumbing
Water Line
Sanitary Sewer Line
Storm Sewer Line
FinalPlumbing
Underfloor Mechanical
Rough Gas
Rough Mechanical
Gas Service
FinalGas
FinalMechanical
SW-Curbside
GC-Standard
Job# 01-00027-01 Page 2 of 4
Required lnspections
-When,ll,"q,i,"#provedandthebuildingiscomplete
Electrical
I
-Prior to cover.
-Must be approved to obtain permanent power.
-When all electricalwork is complete.
Plumbing I
- Prior to insulation or decking.
- Prior to cover or placement of concrete.
-Prior to cover.
- Prior to filling trench.
- Prior to filling trench.
-Prior to filling trench.
-When all plumbing work is complete.
Mechanical
-Prior to insulation or decking
- Prior to cover.
-After line is installed and line has been connected to a minimum of one appliance. Pressure ter
-When allgas work is complete.
-When all mechanicalwork is complete.
Public Works
I
-After forms are erected but prior to placement of concrete
-After forms are erected but prior to placement of concrete
Sidewalk Type:
Additional ROW?
Size Of Line (in):
Downspouts/Drains:
Enchroachment Permit:
San Sewer Tee (in):
Bond End DateTime:
Curbside - 5'
I
To Curb and Gutter
6
00/00/00 00:00 AM
Types Of Warning Devices Reqd.
Street lmprovement: Fully lmproved
Curb Cut?f lmprovement Agr.?[
San Sewer Depth (Ft): 6 - 4
Storm Sewer Avaitable? f
Special Req.:
Security Required:
Bond Begin DateTime: 00/00/00 00:00 AM
Special lnstructions:
Other Utilities:
Project Supervisor:
Job# 01-00027-01
Zoning: LDR Overlay District:
FloodPlain? [ Wetlands? [ # of Street Trees: 2
Journal numbers
1: 2; 3:
Comments:Owner stated he will only be moving 20 cu yards of material
Planner: Liz Miller Additional Requirements:
Urban GroMh Boundary?[ Glenwood Area? [ Required Attachments:
Quantity Of Fill: Source Locn:
Supplier: Material:
Drainage:
Floodway FEMA: Zone X Light Gray Flood Ptain FEMA:
Page 3 of 4
Land Use: Single Family Dwelling
Pave Driveway? Z
panel 1 134 ot 2975
Construction Types(VN) Wood Frame
Occupancy Groups:Private Garage/Carp/Stor Dwelling
# Of Buildings: 1 # Of Stories: 1 Height (feet): 18
# Of Bedrooms: 3 Current Units:O Proposed Units:1
Handicap Access? [ Gensus Code: New SF - attached
Area (Sq.
Main:1508 Accessory424 Total:1932
Fee Paid On Receipt# Value/Quantity Fee Amount
Plan Check
Residential Plan Check
Total PIan Check
01109t2001 4205 112,793 $300.46
$300.46
Building Permit
State Surcharge For Building Permit
Building Administrative Fee
Total Building
Building
0112312001
01t23t2001
01t23t2001
4292
4292
4292
112,793 $462.25
$32.36
$13.87
$508.48
Electrical
Wiring Footage 1,000 Sq Ft or Less
Wiring Footage Each Add'l 500 Sq Ft
State Surcharge - Electrical
Administrative Fee - Electrical
Total Electrical
0112312001
01123t2001
0112312001
01123t2001
4292
4292
4292
4292
1
2
$85.00
$30.00
$8.05
$3.45
$126.50
Plumbing
Minimum Plumbing Permit Fee
Two Bathrooms
State Surcharge - Plumbing
Administrative Fee - Plumbing
Total Plumbing
0112312001
0112312001
01123t2001
01123t2001
4292
4292
4292
4292
1
$.00
$160.00
$11.20
$4.80
$176.00
Mechanical
Hood and Exhaust
One to Four Outlets
Minimum Mechanical Permit
Administrative Fee - Mechanical
Less than 100,000 BTU
Vent Fan to One Duct
Gas Fireplace
Dryer Vent
01123t2001
0112312001
01t23t2001
01123t2001
0112312001
01t23t2001
01t23t2001
01123t2001
4292
4292
4292
4292
4292
4292
4292
4292
1
1
$4.50
$2.00
$.00
$.87
$6.00
$9.00
$4.50
$3.00
1
3
1
1
Job# 01-00027-01 Page 4 of 4
Fee Paid On Receipt# Value/Quantity Fee Amount
Mechanical
Mechanical lssuance
State Surcharge - Mechanical
Total Mechanical
01t23t2001
01t23t2001
4292
4292
$10.00
$2.03
$41.90
Public Works
New Sidewalk
New Curbcut
Total Public Works
01t2312001
01t23t2001
4292
4292
60
1
$60.00
$60.00
$120.00
Residential - Single Family - Storm
Sanitary Sewer
Residential Transportation
Residential Sanitary MWMC
Residential lmprovement MWMC
MWMC Administrative Fee
SDC Administrative Fee
Total System Development
System Development
01123t2001
01t2312001
0112312001
0112312001
01t23t2001
0112312001
01t23t2001
4292
4292
4292
4292
4292
4292
4292
2,482
20
1
1
1
1
$672.55
$748.00
$810.29
$285.91
$24.33
$10.00
$127.55
$2,678.63
S.F. Residence - Willamalane
TotalWillamalane SDC
Willamalane SDC
01t2312001 4292 1 $1,000.00
$1,000.00
Grand Total
Plan Check Type Ghecked By Date Completed Comment
lnitial Review-Res Wendy Stanley 0110912001
Engineering-Res Steve Templin 0111212001
Planning-Res Liz Miller 0111912001
Structural-Res Don Moore 0112212001
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 only contractors and employees who are in compliance with ORS 701.055 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.
,/%,-, I L4*--/
Signature Date
$4,951.97
otz3at
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET
NAME OR COMPANY:
LOCATION:
TAXLOTNUMBER:
ANNEXATION YEAR
DEVELOPMENT TYPE:
DWELLINGUNITS:
LANE COLTNTY ASSESSED VALUE (LAND)
SINGLE FAMILY RESIDENCE
COLBURNHOMES INC
2028 8TH STREET
I 7-03-26- I 3-00700
SFI BUILDING SIZE:SF LOT SIZE:
JOURNAL ORJOB NUMBER: 0l-0027-01
IMPERVIOUS S.F COST PER S.F
248t.7 5 s0.271 $672.s5
I. STORMDRAINAGE
x
$672.55ITEM l TOTAL. STORMDRAINAGE SDC
NUMBEROFDFU'S COST PER DFU
20 $ 16. l5
NUMBEROFDFU's
20
COSTPERDFU
$2r.2s $42s.00
B. MPRO\'EMENT COST:
x
x
2. SAMTARY SEWER- CITY
A. REIMBURSEMENT COST:
48.00ITEM 2 TOTAL - CITY SANITARY SEWER SDC
NEW TRIP FACTORADT TRIP RATE NUMBER OF LINITS COST PER TRIP
1.00 .029.57 I $68.ss
ADT TRIP RATE
9.57
NUMBEROF UNITS
I
COST PERTzuP
$ 16. l2
NEW TRIP FACTOR
1.00 $1s4.27
B.IMPROVEMENT COST:
x xx
x x x
3. TRANSPORTATION
A. REIMBURSEMENTCOST:
$810.29ITEM 3 TOTAL - TRANSPORTATION SDC
10.00
NUMBEROF FEU's
I
COST PER FEU
$285.91 $28s.91
NUMBEROF FEU's
I
COST PER FEU
$24.33 $24.33
$0.00
B. IMPROVEMENT COST:
x
x
4. SANITARY SEWER- MWMC
A. REIMBURSEMENT COST:
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMIMSTRATTVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC
l.08SUBTOTAL (ADD ITEMS 1,2,3,&4)
ADM. FEE RATESUBTOTAL
t27.555%1.08
5. ADMINISTRATME FEE:
x
$2,678.63Ut2l0t$lr,uoIur+l;,b
SDC COORDINATOR
TOTAL SDC CHARGES
DATE
IJI U
NUMBER OF NEW FIXTURES X IJNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OFFXTURES DRAINAGE
FIXTURE
UNITSFXTURE TYPE (#NEW - #OLD )x UMT
EOUTVALENT
BATHTUB (
(
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J J
DRINKING FOUNTAIN 1 0
FLOORDRAIN J 0
INTERCEPTORS FOR GREASE / ON- / SOLIDS IETC.J 0
INTERCEPTORS FOR SAND / AUTO WASH / ETC.6 0
LAUNDRYTUB 2 0
CLOTMSWASHER/MOP SINK I J
CLoTTTESWASHER - 3 OR MORE (EA)6 0
MOBILE HOME PARK TRAP (I PER TRAILER)t2 0
RECEPTOR FOR llEFRrG / WATER STATION/ ETC.
RECEPTOR FOR COM. SINK / DISHWASHER / ETC.
I 0
3 0
SHOWE& SINGLE STALL I 2 2
sHowE& GANG (NT.JMBER OF mADS)2 0
SINK: COMMERCIAL/RESIDENTIAL KITCMN I J
SINK: COMMERCIALBAR 2 0
SINK: DOMESTIC BAR I 0
WASHBASIN 2 0
LAVATORY J I 3
IJRINAL, STALL / WALL 5 0
TOILET PUBLIC INSTALLATION 6 0
TOILET PRTVATE INSTALLATION 2 J 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU's*
(_ )x 2o
TOTAL DRAINAGE FIXTURE T]NITS
0
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
DRAINAGE FIXTURE UNIT CALCULATION TABLE
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALT]E
.00
$0.00
IF IMPROVEMENTS OCCURRED AT'TERANNEXATION DATE, CALCULATE CREDIT SEPARATELY
CREDIT FOR LAND (IF APPLICABLE)
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
$0.00
YEAR
ANNE)(ED
CREDIT RATE PER $1,OOO
ASSESSED VALUE
YEAR
ANNEXED
CREDIT RATE PER $I,OOO
ASSESSED VALUE
I979 OR BEFORE $4.74 r 990 $1.96
I 980 $4.65 t99t $l.ss
198 I $4.59 1992 $r.36
t982 s4.46 l 993 s1.23
r 983 s4.30 1994 $1.05
I 984 $4. l4 I 995 $0.90
I 985 $3.93 1996 $0.7s
I 986 $3.63 1997 $0.s7
t987 $3.26 I 998 $0.3s
I 988 $2.8s t999 $0.rs
I 989 $2.40
TOTAL IVTWMC CREDIT :
x
0.000 x $4.74
VALUE / IOOO
0.000
CREDIT RATE
s4.74
I