The URL can be used to link to this page

Home My WebLink AboutPermit Building 1992-02-05RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 SPrlINGFIELD 5? 4rz JOB NUMBER I 756 225 Fifth Street Springfleld, Oregon 97 477 LOCATION OF PROPOSED WORK:s"#s7/ s. 4zu sr MAP:l8Dzo9 t z-TAX LOT:LtRoD LU cer.ru rrleacor^rsBLOCK:SUBDIVISIONLO'I: Eazz, ZIP: PHONE:e 86 -&z->6, 4T6si. bt4 L4 lttort,-_ + ,(ss lAr*Pr NG laoc OWNER: ADDBESS: ADDITION DEMOLISH OTHER DESCRIBE WORK:I lZa NEW X- REMoDEL k#o< t(-e=ELECTRICAL:{)ltrzzc t-,N) L MECHANICAL:O4)4)k CONTRACTOR'S NAME GENERAL: PLUMBING ADDRESS 5oZz t*Lpt rte. EXPIBES 4qs PHONE 1&6-62>o CONST. CON'TRACTOR # L"e 1L4lq Ll4,w"r.t- &t- QUAD ABEA:3R E _ OFFICE USE _ # OF BLDGS RANGE: OCCY GROUP: # OF STORIES WATER HEATER: FLOOD PLAIN: * OF UNITS: LAND USE: ZONING CODE: '{ OF BDRMScoNSrR. r""=, - i//L"--=- HEAr soun.., GW/ --SECONDARY HEAT SQUARE FOOTAGE: To request an inspection, you must call 726-3769. This ls a 24 hour recording. All inspections requested before 7:00 a.m. wlll be made the same worklng day, lnspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS fi'"-oorarY Eteclric E Rough Mechanical - Prior to cover. tr ^K lVFoundation - After forms are F'Lierected but prior to concrete placement. Eframing - Prior to cover. F(t yi:i:eitins tnsurarion - Prior to E[ DrVwat] ;'Prior to taping. ft *ooo stove - After instatlation. Site lnspection - To be made after excavation, but prior to setting forms. Underslab Plumbing I Electrical / Mechanical - Prior to cover. Footing - After trenches are excavated. Masonry - Steel location, bond beams, grouting. Underground Plumbing - Prlor to filling trench. Underl anical - Prior or decking Floor lnsulation - Prior to decki ng. Sanitary Sewer - Prior to filling trench. Storm Sewer - Prior to filling trench. Water Line - Prior to filling trench. Rough Plumbing -- Prior to cover. x E,X*:l Etectricar - Prior to ** K,E E. Final Plumbing - When allplumbing worl( is complete. Final Electrical - When all electrical work is complete. Final Mechanical - When all mechanical work is complete. Final Building - When atl required inspections have been approved and building is cornpleted. Other MOBILE HOME INSPECTIONS Blocking and Set.Up - When all blocl<ing is complete. Plumbing Connections - When home has been connected to water and sewer. Electrlcal Connecllon - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. Electrical Service - Must be approved to obtain permanent electrical power. Fireplace -- Prior to facing materials and framing lnsp. lnserl - After fireplace approval and installation of unit. Curbcut & Approach - After forms are erected but prior to placement of concrete. Sidewalk & Driveway - After excavation i$ complete, forms and sub-base material in place. Fence - When completed reet Trees -- When all required are planted. V Post and Beam - Prior to floor ,Jdinsutation or decki ng. B, E Frr K K mbi CITY: EU q EN E STATE:9zYo < ,\ tl E Lot Type V ,,,rc,io, - Corner - Panhandle - Cul'de'sac P.L.HSE GAR ACC N S E E .S THE PROPOSED WORK I N THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? _...- l( yes, this application must be signed and apProved bY the Historical Coordinator prior to permit issuance. VALUE G-r7# "y'/s 76s 87 34bN 30 3b3,eo(A) X $/SQ. FT. f(-,20 Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SO. FT. Main Garage Carport / /2," 5zS 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 the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Reviewed v Fleceipt Num ,D Date Paid Rec Plan Check Fee: SYSTEMS DEVELOPMENT C (B) HARGE (SDC) g4 # tszt-E Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE bo?o Roo Z /6b,@(c) FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge N0 . FT. ADDITIONAL CO MENTS Wood Stove/ lnsert/ Fi replace Unit Dryer Vent ooo 3 /,{o /2,oo /.Es -43P2 300 (D) 4aol: \oo Vent Fan Mechanical Permlt lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood No3 By signature, I $tate and agree, that I have carefully examined the completed application and do hereby certify that all lnformation 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 Springf ield, 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 Building Safety Division. 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 natu reY- Date ]5 th set of plans will remain ction of the property, on the site at al MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk 75 t curbcut ?O t Demolition State Surcharge Total Miscellaneous Permits (E)3s1f t zl.2.D-2/3f TOTAL AMOUNT DUE (excluding electrical) (A, B, C, O and E Combined) Z.zo 2e -5 -73D/{TE PAID AMOUNT HECEIVED BECEIVED BY VALIDATION: RECEIPT NUMBER Lot faces Lot sq. ftg. Lot coverage TopographY Total height APPROVED: / ilti '. SPrlIN FIELO RESIDENTIAL PERMIT APPLICATION lnspections: 726'376S Office: 726'3759 LOCATION OF PROPOSED WORK: ASSESSORS MAP: ?2/7t6 ?fr, JOB NUMBER 225 Fifth Street Spri ngf ield, Oregon 97 477 TAX LOT: SUBDIVISION ru LoT: ----- BLOCK - GZzOPHONE: {ozz- ZIP: J IL STATE: ksrz e-o<OWNER ADDRESS: CITY: NEW -- REMODEL ADDITION DEMOLISH OTHEB DESCRIBE WORK: MECHANICAL: -- PHONEEXPIRESADDRESSCONTBACTOR'S NAME ELECTRICAL: CONST. CONTRACTOR # GENERAL: PLUMBING RANGF_: * OF BDRMS: _ OFFICE USE _ LAND USE: ZONING CODE: FLOOD PLAIN WATER HEATER Y OF UNITS: HEAT SOURCE:SECONDARY HEAT: SOUARE FOOTAGE: QUAD AREA: ,T OF BLDGS OCCY GROUP: r OF STORIES: CONSTR. TYPE: -- To request an inspection, you must call 726-3769. This ls a24hour recording. AII inspections requested before 7:o0 a'm' w made the same working day, lnspections requested after 7:00 a.m. will be made the following work day' ill be REOUIRED INSPECT!ONS fl TemporarY Electric II Rough Mechanical - Prior to cover. Final Plurnbing - When all plumbing work is comPlete. Site lrrspection - To be made after excavation, but Prior to setting forms. Rough Electrical - Prior to Final Electrical - When all electrical work is comPlete.cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. t []e n nt When allElectrical Service - M work is complete. approved to obtai nen el tri Footing - After trenches excavated.ing Final Building - When all required inspections have been approved and building is com pleted.mal S Masonry - Steel location beams, grouting. d Other Foundation - After forms are erectccj but Prior to concrete placernent. /Ceiling lnsulation - Prior to covclr. Underground Plumbing - Prior to filling trench.l-l Drywall - Prior to taoing MOBILE HOME INSPE TIONS Underlloor Plumbing / Mechanical - Prior to insulation or decking.Wood Stove - After installation. Posl and Beam - Prior to floor insulation or decking.lnsert - After f irePlace aPProval an<i installation of unit. Blocking and Set'UP - When all blocking is comPlete. Floor lnsulalion - Prior to decki ng.Curbcul & APProach - After forrns are erected but Prior to placement of concrele. Plumbing Connections - When home has been connected to water and sewer. Sanilary Sewer - Prior to filling trench.Etectrical Connection - When blocking, sei'uP, and Plumbing inspections have been aPProved and the home is connecled to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & DrivewaY - Afte r exiavation is comPlete, {orrrts and sub-base materiai in Place. Water Line - Prior to filling trench. Streel Trees - Wlren aii required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and ventinO have been installed.Rough Plumbing - Prior to cover. ( "7d@9 E E E tl r tl tl E tl E l--] Fence - When comPleted. E L_lT Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner -- Panhandle ---- Cul-de-sac Set ks P.L.HSE GAR ACC N S lu l-HE PROPOSED WORK lN THE HISTORICAL DISTFTICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved bY the Historical Coordinator prior to permit issuance. APPROVED:E BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition tltat the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Coclc, regulating the construction and use of buildinqs, and may be suspended or revoked at any time upon violation of any provisions of said ordinatrces. Plan Reviewed By /4#i- J3 Date Paid Fleceipt Number: Recei /D4 S7 Plan Check Fee: -7- (A) 7S z VALUE /? "sz X $/SO. FT. tz.* Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main Garage Carport Systenrs Development Charge is due on all undeveloped propertles within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B)*e97 ADDITIONAL COMMENTS ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge No Wood Stove/ lnsert/Fireplace Unit Dryer Vent MECHANICA!. PERMIT (D) N0 Mechanical Permit lssuance State Surcharge Total Permit Fu rn ace Exhaust Hood Vent Fan By signature, I statc atrd agree, that I have caref ully examined the completed application and do hereby certify that all in{ormation hereon is true and correct, and I f urther 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 Building Safety Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I f urther agree to cnsure that all required inspections are time, that each address is readable qil>0Date nates FG,snu,u,." requested at the mit card is located at the frontfrom the street, th. set of plans v'rill remainof the pro tructionon the MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut -- ft Demolition State Surcharge Total Miscellaneous Permits (E) AB ,o/laz 2?z -tg DATE PAID AMOUNT HECEIVED RECEIVED BY -,- VALIDATION: RECEIPT NUMBER TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) z/2.'3 I ,/rO ,-73 /lAfo7p/53,st . JOB NO. CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE }IORKSHEET (C0MMERCIAL & RESIDENTIAL) NAME OR COMPANY: LOCATION: DEVELOPMENT TYPE:LD?tf roN BUILDING SIZE: /A* "c. 1xc-t-,,pes Arc: \OT SiZ 1. STORM DRAINAGE TMPERVIoUS SQ. FT.4 L x $0.203 PER SQ. FT X $42.08 PER PFU COST PER TRIP $424 .3 1 $424.3 I $424.31 $ $ $15.125 PER PFU + $10 Mt^lMC ADM FEE $ TOTAL-MWMC SDC SUBToTAL (ADD ITEMS 1,2,3 & 4) sQ. Ft. 2. SANITARY SEWER-CITY NO. OF PFU'S (See Reverse) 3. TRANSPORTATION NO OF UNITS X TRIP RATE X x x x_x x_x 4. SANITARY SEt,lER-Mt,lMC NO. OF PFU'S Y (Use PFU Total From Item 2 Above) MI,IMC CREDIT IF APPLICABLE (SEE REVERSE) 5 ADMINISTRATIVE FEES BASE CHARGE (SUBT0TAL ABoVE) X .os K p Burdick SDC Coordinator TOTAL SDC $ ,g er-?d\6.^n',t tr/+ /qt FIXTURE UNIT,CALCUL.AI .-l TABLEI Number of New Fixtures X For remodels, calculSte only the NE additional fixtures) NUMBER OF FIXTURE TYPE NEW FIXTURES Equivalent = Fixture Units illOTE: UNIT EOUIVALENT FIXTURE UNITS Drinking Fountain...-.. Floor Drain.. lnterceptors For G rease/Oil/Sollds/Etc'.." " " " " "" lnterceptors For Sand/Auto Wash/Etc. l-aundry Tub/CIotheswasher. Clothes,walher - 3 Or More.-- Mobile Hdme Park TraP (1 Pe r Traiter)................ Receptor For Refri geratorflVater Station/Etc--..- "' Beceptor For Commerclal Sink/Dishwasher/Etc" Shower, Single'Stall.. Shower, Gan9........... Sink, Bar, Commercial Urinal, Stall/YVall.... Wash Basin/Lavatory, Single...-... Water Closet, Public lnstallation.- Water Closet, Private......... Miscellaneous: TOTAL FIXTURE UNITS CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table, calculate credits separates. /Head 2 1 L J 6 2 6 6 1 3 2 1 2 2 1 6 4 Credit for Parcd or tand Only lf Applicable tmprwement (rf after annexation date) x$ (Rate X Assessed Value) $ x $- (Rate X Assessed Value) CREDIT TOTAL RUNOFF COEFFICIENTS FOR STORM DRAINAGE Year Annexed Rate per $1,000 Assessed Value Year Annexed Rate per $1,000 Assessed Value 1979 or before 1980 1981 1982 19&3 1984 1985 $s.21 3.13 3.08 2.96 2.42 2.68 2.51 1986 1987 1988 1989 1990 1991 1992 $ 2.24 1.93 1.57 1.18 0.79 o.44 0.28 tMPERVlous AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT TY OF OREGO'U 225 FIFTE STRBEf, : SPRINGFIELD, OREGON 97477 INSPBCUON REQUBSTI 726-3769 oFPICE: 726-3759 st,ruNGFrELu ELESTT.ICAL PERHIT APPLICATION Job Number 2/7Se 1. LOCATION OP INSTALI,ATIONz IJGAL DESCRIPTION AD JOB DESCRIPTION5,.F,fu, Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2. COT.IIT,ACTOR INSTALT"ATION ONIY ty FEE SCHEDULE BELOS Nev Residential-Single or MuIti-FamiIy per dvelling unit. Service fncluded: Items Cost r0p 4[rr It] ,. A (}-l* tt cokpLetr L000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or Modular Dvelling Service or Feeder /> $ 8s.00 2 $ 1s.00 Sum _ZSZ 30 Electrical Contrac tor TllV,4ml ET*i tddress /Ii> ,YFtCpc bT ciry friZ'gn & Phone 3y'2'Eg4{ Supervisor License Nrimber < a./7,, Expiration Date Bxp iration Date Signature of Superv ctrieian Ovne rs Name C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less $ 40.00 0ver 401 to 600 amps _ $ 80.00 0ver 600 amps or L000 volts see rrB'r above D. Branch Circuits New, Alteration or Extension Per Panel 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_ 0ver 1000 amps/vo1ts Reconnect 0nly One Circui t Each Additional Circuit or with Service or Feeder Permit B $ 40.00 $100. $1 30. $300. $ 40. $ 3s.00 s 2.00 ss0 $60 00 00 00 00 00 00 /, Address Ci ty Phone OIINER INSTALI,ATION The installation is being made onproperty I ovn vhich is not intendedfor sale, lease or rent. Ovners Signature: DATE: Miscellaneous (Service/feeder not included) -Each installation Prrmp or irrigation S 40,00 :lglagytl ine Li_ghting- $ 40.00l,rmr ted Energy/Re" = $ 20,00Limited Energy/conm = $ :O.OO _ ,, .<z-r/z? 7s E 5 RECETVED B Y; fr{"1:sf.li:H" TO?AL Constr Contr. Number 4Z-S<-A SPFI. - - iIELEl % 225 YIYTfl STREET sPRrNGrrELD, oREGON 97477 itrsprctrox nrouest z 726-3769 OFFICB: 726-3759 Eleetrical Contractor Citv Phone Supervisor Licen,se Number Expiration Date EI,BCTRICAL PERHIT APPLICATION City Job Nunber Z 7 3. COHPI,ETE PEE SCffiDtILB BBLOV Nev Residential-Single or Hulti-FamilY Per dvelling unit' Service Included: I tems Cos t $ 8s.00 $ 1s.00 $ 40.00 B Services or Feeders Installation, Alterations or Relocation: 200 amps or less iOi .rb" to 400 amPs -401 amps to 600 amPs - 601 amps to 1000 amPS- Over 1000 amPs/vo1ts - Reconnect 0nlY $ s0.00 $ 60.00 $100.00 $130.00 $300. o0 $ 40.00 $ 2.00 c.TemporarY Services or Feeders in"i"ff"iion, Alteration or Relocation LPQ 1 A I,EGAL DESCRIPTION 2_ DESCR] Sum "U"r" ).S 1000 sq.ft. or less Each additional 500 sq. ft or Portion thereof Each Manuf'd Home or Hodular Dvelling Service or Feeder permits are non-transferable and expire ii ,ott is not started vithin 180 days ;i i;;;.tce or if vork is susPended for 180 days. 2. CONTRACf,OR INSTALI.ATION ONLY :2 Constr Contr. Number Expiration Date Signature of Supervising Electrician 0vners Name Address 22 city EL/4 Phone p t OVNER INSTALI"ATION e installation is be operty I ovn vhich i or sale,ease or ren DATE: 200 amps or less -r-"f 19'00 zOi "*'p. to 400 amPs - I ::'00ov"r +br to 6oo amps - $ 8o'oo Over 600 amPs or fbOO voTIs see I'B" Branch Circuits Nev, Alteration or Extension Per Panel One Circuit s;"h aaaitional Circuit or vith Service or Feeder Permit - $ 3s.00 z>o ing made on E.Miscel]aneous(Service/feedernotincluded) s not intended $ 40.00 $ 40.00 $ 20.00 $ 36.00 SIETOTAL OP ABOVB 5Z State Surcharge TOTAL oo D ( Th r -Each installation Pump or irrigation Sign/0utline Lighting- Limited EnergY/Res - Limited EnergY/Comm 5 RECEIVED L- t -73 M 7*1 -q 3 4Q SPRINGFIELE, Zonin 225 PTYIE STRBET L ,'.3./KA4 SPRTNGFTELD, 0REGON 97477, rNsPECf,roN BEQUEST -. 726- OPFICE: 726-3759 1.TION OF ,TION ELECTRTCAL PERHIT APPLTCATION Ci ty Job Nunbe, C1 Al )sb 3. COHPLETE FEE SCffiDUI.,E BELOU A. Nev Residential-Sing1e or HuIti-FamiIy per dwelling unit. Service fncluded: I tems Cos t s 8s.00 $ 1s.00 $ 40.00 B Services or Feeders Installation, Alterations or Relocation: L % 1 I IJGAL DESCRIPTIONl?02 r)qt h4O nf\ PTIONL Permits are non-transferable and expire if vork is not started vithin iEO <iaysof lssuance or if 180 days. is suspended for #srt I 23'1 2. CONTTRACTOR INSTALI^ATION ONLY Electrical Contractor Address$asq 3td Or Ci ty I Phone 6+r-orf b Supervisor Licens e Number 5Qq-Jttr Expiration Date /o*)- 7r constr contr. Number 3tF l Vb Cce: Expiration Date lo-l* ?c-l Signature of Supervising ElectricianY s. d*- 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps 0ver 1000 amps/vo1ts Reconnect 0nly Sum c Temporary Services or Feeders Installation, Alteratlon or Relocation s s0.00 s 60.00 s100. 00 $ 130. 00 s300. 00 $ 40.00 s 3s.00 s . 2.00 00 00 00 00 200 amps or less $ 40.00 201 amps to 400 amps - $ 55.00 Over 401 to 600 amps - g 80.00 Over 600 amps or 1000 vorts see ttgrr "f,f,lf- O'*rners N Address cit 7 ca L , f ,l Phone *f rr+-7oS I #{il,0n S rt, D. Branch Circuits Nev, Alteration or Extension Per Panel OVNER One Circui t Each Addi tional Circuit or vith Service or Feeder Permi t The installation is being made on property I ovn which is not intended for sale, Iease or rent. Ovners Signature: DATB:L E. Hiscellaneous (Service/feeder not included) -Each installation' Pump or irrigation Sign/OutIine Light ing- Limited Energy/Res -Limi ted Energy/Comm SUBTOTAL OP ABOVB 5Z State Surcharge TOTAL 6o.ao s 40. $ ao. s 20. S 36. C'TY OF SPF'N'GF'tr{,tr $flFGCf,.' RBCBIVBD 5 _-._ctO4at, . 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Eacir Hanui'd iiome or -Hodular Duelling Service or Feeder l^D.c)'c./, r^o ,a OREGO'U 225 PIFTE STRBEf, SPRINGFIEI,D, ORBGON 97477 INSPECTI0N RBQITBST. 726-3 :t as submitted h af IEGIIBil,GAL r;rqriro scecific land uee PERilIT APPLICATION City Job Wu A", ?,U 7 9O HuIti-Family per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or Modular Dvelling Service or Feeder $ 8s.oo s 1s.00 $ 40.00 Services or Feeders Installation, Alterations or Relocat ion: 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _ 601 amps to 1000 amps_ Over 1000 amps/volts Reconnect 0n1y C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less S 40.00 201 amps to 400 amps _ $ 55.00 Over 401 to 600 amps _ $ 80.00 0ver 600 amps or 1000 volts see rrBil above D. Branch Circuits Nev, Alteration or Extension Per Pane1 Bi :"!n a:. 769 Jlr '' !trv,ltq p'nlect l..r ilng.i il0t sa'rrtN(;FrELl, .ne Ci.rcui t ./ Each Additional Circuit or vith Service or Feeder Permi I Z SI.,BTOTAL OF ABOVE 5Z State Surcharge TOTAL OFFICE: 726-375 1. LOCATION OT 9 Zoning. D,., i.0_:,1'L-P. CoHPLETB FEB SCBEDULE BBLog ll'gneturoMsingle or IJGAL DESCRIPTION JOB DESCRTPTIONl)i fu,, (' , Zb PAl <,F,.€ed. Permits are non-transferable and expire lf vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. COIiITRACTOR INSTALT,ATION ONLY B Electrical Contrac tar 7nr44a) t&-f, Address ,/{Z ,VAtaxs 467 Ci ty Eu4.phone 3y'2 -gb4si Supervisor License Number ? Ol: r Expiration Date 'o constr contr. Number 4ZS-gO Sum Exp iration Date Signature of Ovners Name s s0.00 s 60.00 $100. 00 $130.00 $300.00 $ 40.00 00 00 00 00 /-, J ..Z,or<- ,' 6rae , Address Ci ty Phone $ 3s.oo 5g- $ 2.oo _# 3- 4r1qS OVNER INSTALI^ATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. Ovners Signature: DArE: f ol I RECEIPT *: E. Miscellaneous (Service/feeder not included) -Each installation Prrmp or irrigation $ Sign/outline Lighting- $ Limi ted Energy/Res S Limited Energy/Comm $ 39,n 40. 40. 20. 36. 5 ---f-v-RECEIVED B lar. \-r- JOB NO.lzr 15 t- CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (C0t'lt'IERCIAL & RESIDENTIAL) NAME OR COMPANY LOCATION:8t t s. 4cU gr ls ozo9tz - 41oo DEVELOPMENT TYPE: BUILDING SIZE: L3? - Ktew 9f"- sQ. Ft I STORM DRAINAGE IMPERVIOUS SQ. FT. 2. SANITARY SEWER-CITY NO. OF PFU'S (See Reverse) OT SIZ 'Lt oo x $0.192 PER SQ. FT tg X $39.78 PER PFU 3. TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP o-o 5 x $40r.05 x $401.05 x $401.05 X $ $ SUBT0TAL (ADD ITEMS i,2, & 3)$ l|Zze: ADMINISTRATiVE FEES BASE CHARGE (SUBT0TAL ABoVE) X .0s TOTAL - C ITY sDC S 1511 5. SANITARY SEt^lER-MWMC NO. OF PFU'S ts $13.62 PER PFU + $10 MhlMC ADMIN. FEE s 255Y (Use PFU Total From Item 2 Above) Mt,lMC CREDIT IF APPLICABLE (SEE REVERSE) l-J-TOTAL-Ml^lMC SDC Kip Burdick SDC Coord'inator I x {, X 4 +3 \9 2 -2.o)- 22402 TorAL spc s lozz*2 u /l rit Equivalent = Fixture Units (NOTE: FXTURE UNIT CALCUIA' .?I TABLE: Number or New Fixtures ) l.rr"r""aas,catcutatJi"r'in"lgadditionalrixtures) IE$T,['[', UNIT EQUIVALENT z-.zt -$b\ FIKTURE UNITS r3 1? FIXTURE TYPE Bathtub----.-. Drinking Fountain""" Shower, Single Stall-."""""' Shower, Gang...--...... Sink, Bar, Commercial Floor Drain. i ;;;il For G rease/oiu.?,orllsf : Interceptors For Sand/Auto Wasn/trtu""""""""" Lunary Tub/Clotheswasher"""""' Clotheiwasher - 3 Or More"""""""""'"""' f.ll'"Oif" Horne Park Trap (1 Per Traiter)" "'':""""" neceptot For Ref rigeratorAVater Station/ Etc" " " " n"""pr", For Commercial Sink/Dishwasher/Etc" 2 1 2 3 6 2 6 6 1 3 2 1 /Head 2 2 1 6 4 I U rinal, StallflVall.... Wash Basin/Lavatory, Single""""" Water Closet, Public lnstallation" Water Closet, Private.."""' Miscellaneous: CREDIT calculate credits ?- a- 7.7x $l,o (Rate X Assessed Value)x$ TOTAL FIKTURE UNITS CALCUT-AT.oN TABLE: Based on assessed varue. rf improvements occurred after annexation date in table' Credit for Parcel or Land Only lf Appticable lmprovement (if after annexation date) 2 (Rate X Assessed Value) CREDIT TOTAL RUNOFF COEFFICTENTS FOR STORM DRAINAGE Year Annexed Rate Per $1,000 Assessed ValueYear Annexed Rate Per $1,000 Assessed Value 1985 1986 1987 1988 1989 1990 1991 $2.16 1.90 1.60 0.25 0.87 0.50 0.16 1979 or before 1980 1981 1982 1983 1984 $2.83 2.76 2.71 2.60 2.46 2.33 IMPERVIOUSAREA:TOTALLoTSIZEXRUNOFFCOEFFICIENT + 2 L I b I6 I