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Home My WebLink AboutPermit Building 2005-07-13F Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-00646ISSUED: 0711312005 APPLIED: 05/3112005EXPIRES: l0/1312006VALUE: S 45,000.00 fi SITE ADDRESS: 1333 lST ST ASSESSOR'S PARCEL NO.: 1703263300544 PROJECT DESCRIPTION: Kitchen renovation Springfield TYPE OF WORK: Care Facility TYPE OF USE: Remodel License Expiration Date Owner: Address MARQUIS HEALTHCARE PROP LLC 4560 SE INTERNATIONAL WAY STE MILWAUKIE OR 97222 05t30t2007 12n0t2007 06t27t2007 0311112007 Commercial Phone 541-342-8077 687-9445 54r-485-0922 541-726-0100 54r-688-1444 Contractor Type Architect General Electrical Mechanical Plumbing Contractor ROBERTSON/SHERWOOD/ARCHITECTS CHAMBERS CONSTRUCTION BUILDERS ELECTRIC INC COMFORT FLOW TWIN RIVERS PLUMBING INC tt42s8 4296 460 17695 TION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type; # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # ofStories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: t-2 VA nla REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: DEVELOPMENT INFORMATI( PUBLIC IMPROVEMENTS Notes: Paee I of4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line OF Building/Combination Permit PERMIT NO: COM2005-00646ISSUED: 0711312005APPLIED: 05/31/2005 EXPIRES: 10/1312006VALUE: $ 45,000.00 Description Bid Amount Fee Description Plan Review Comm/Ind/Public -Mechanical Issuance Fee- + l0oh Administrative Fee + 7Yo State Surcharge Building Permit Minimum/Adj ustment Plumbin g Miscellaneous Mechanical Plan Review Fire & Life Safety SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Trap or Waste not Conn to Fixt + l0oh Administrative Fee + 77o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less + l0o Administrative Fee + 87o State Surcharge Backflow Device Fixture Total Amount Paid Type of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 45,000.00 Total Value of Project Amount Paid Date Paid Value $45,000.00 $45,000.00 Date Calculated 05/31/2005 $221.91 $10.00 $43.14 $30.20 $341.40 $31.00 $45.00 $136.56 $10.00 $il.87 $1.13 $1.39 $3.91 $0.89 $14.00 $9.00 s6.30 $27.00 $63.00 $9.80 $7.84 $42.00 $s6.00 5/31/05 7 t7 t05 7 t7l0s 7 t7 /05 7 t7 t05 7 t7 t05 7 t7 tos 717105 7 t7 /05 7 t7 t05 7 t7 t05 7 t7 t05 7 t7 t05 7 /7 t05 7 t7 t05 7t13t05 7tr3t05 7tr3los 7n3105 4/14t06 4n4t06 4n4t06 4tr4t06 Receipt Number 1200s00000000000696 2200s00000000000896 2200s00000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000923 2200500000000000923 2200s00000000000923 2200500000000000923 1200600000000000481 I 200600000000000481 1 200600000000000481 1 200600000000000481 $1,123.34 tr'eps Pe Plan Reviews Paee 2 oI 4 Valuation Descrintion I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2005-00646ISSUED: 0711312005APPLIED: 05/31/2005EXPIRES: 10/1312006VALUE: $ 45,000.00 Fire Department Review 0610112005 06/0s/2005 OK GRG Plan Review: Kitchen remodel. Addition of walk-in refrigerator and freezer. Job #COM2005-00646. Occupation Classifi cation : I-2. Construction Type: V-A. Kitchen proper is to be unaltered at this time. Maintain K extinguisher in kitchen. Maintain sprinkler coverage in refrigerator and freezer. Sprinkler subcontractor shall contact Springfield Deputy Fire Marshals Gilbert Gordon or Joe Wicks of any changes to the system. Subcontractor shall submit fire alarm plans to Springfield Fire Marshal's Office for review and approval (2004 Springfield Fire Code 901.2). SDCs added. Fixture credit remains from COM2005-00615. See attached 3 structural comments faxed to Eric Phillips-Meadow. WI. Received response to structural comments. Received final internal approval. Initial Review Planning Review Public Works Review Structural Review Structural Review Structural Review 06/01/2005 06t02t2005 06/03/2005 06/03/2005 06/08/2005 06/08/2005 06/01/2005 06/01/2005 06t0u2005 06t0u200s 06/02t200s 06/08/2005 SKG EMM SB JMP JMP JMP APP APP APP WE IO APP To Request an inspection call the 24 hour recording at 726-3769, All inspection requested before 7:00 a.m. witl be made the same working day, inspections requested after 7:00 a.m. will be made the following rvork day. Foundation: After forms are erected but prior to concrete placement. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Page 3 of4 Reouired Insnections Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-126-3676 Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-00646ISSUED: 0711312005 APPLIED: 05i3112005 EXPIRES: 10/1312006VALUE: $ 45,000.00 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 wiu 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 durin g construction. b B^A-o--q-tq- Owner or Contractors Signature Date Paee 4 of 4 **r,I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Cit- of Springfield Official Receipt D. .lopment Services Department Public Works Department RECEIPT #: 120060000000000048r Date: 0411412006 2222:56PM Job/Journal Number coM2005-00646 coM2005-00646 coM2005-00646 coM2005-00646 Description Fixture Backflow Device + 8% State Surcharge + 10%6 Administrative Fee Amount Due 56.00 42.00 7.84 9.80 Item Total:$l1s.64 Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid CreditCard DAVID P BAKKE j.p 120648 In Person Payment Total: $1 1s.64 -sTiffia- cReceint I Page 1 of I 4114t2006 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-726-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2005-00646ISSUED: 0711312005APPLIED: 05/3112005EXPIRES: 01/1312006VALUE: $ 45,000.00 SITE ADDRESS: 1333 rST ST ASSESSOR'S PARCEL NO.: 1703263300544 PROJECTDESCRIPTION: Kitchen renovation Springfield TYPE OF WORK: Care Facility TYPE OF USE: Remodel License Expiration Date Owner: Address: Contractor Type Architect General Electrical Mechanical Plumbing MARQUIS HEALTHCARE PROP LLC 4560 SE INTERNATIONAL WAY STE MILWAUKIE OR 97222 0st30t2007 12n012007 06t2712007 03nU2007 Commercial Phone 541-342-8077 687-9445 541485-0922 541-726-0100 541-688-1444 Contractor ROBERTSON/SHERWOOD/ARCHITECTS CHAMBERS CONSTRUCTION BUILDERS ELECTRIC INC COMFORT FLOW TWIN RIVERS PLUMBING INC 114258 4296 460 17695 CONTRACTOR INFORMA! # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Vo ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: t-2 VA nla Street Improvements: Storm Sewer Available: Special Instruction: Notes: Sidewalk Type: Downspouts/Drains: REQUIRED PARKING Total: Handicapped: Compact: DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Pase 1 of4 \ \ _l,ult Lrll\u rNI' uruvr,q'! lgN_l 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: COM2005-00646ISSUED: 0711312005APPLIED: 05/3112005 EXPIRES: 01/1312006VALUE: $ 45,000.00 Description Bid Amount Type of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 45,000.00 Total Value of Project Amount Paid Date Paid Value $45,000.00 $45,000.00 Date Calculated 05/31/200s Fee Description Plan Review Comm/Ind/Public -Mechanical Issuance Fee- + l0o/o Administrative Fee + 1Vo State Surcharge Building Permit Minimum/Adjustment Plumbing Miscellaneous Mechanical Plan Review Fire & Life Safety SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Trap or Waste not Conn to Fixt + l0Yo Administrative Fee + 7%o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Total Amount Paid $221.91 $10.00 $43.14 $30.20 $341.40 $31.00 $4s.00 $136.56 $10.00 $11.87 $1.13 $1.39 $3.91 $0.89 $14.00 $9.00 $6.30 $27.00 $63.00 5/31/0s 7t7t05 717105 7t7t0s 7t7t05 7t7t05 7t7t05 7l7l0s 7t7t05 717105 7t7l0s 7t7t05 717105 7l7lus 7t7t05 7n3t05 7n3t05 7tr3t05 7n3t05 Receipt Number 1200500000000000696 2200500000000000896 2200500000000000896 2200s00000000000896 2200500000000000896 2200500000000000896 2200s00000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200s00000000000896 2200s00000000000896 2200500000000000896 2200500000000000923 2200500000000000923 2200s00000000000923 2200s00000000000923 $1,007.70 Epps Pqid Plan Reviews Paee2 of 4 rL Valuation Descrintion I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax S4l-7 26-37 69 Inspection Line Building/Combination Permit Fire Department Review 0610112005 06/0s/2005 OK GRG Maintain K extinguisher in kitchen. Maintain sprinkler coverage in refrigerator and freezer. Sprinkler subcontractor shall contact Springlield Deputy Fire Marshals Gilbert Gordon or Joe Wicks of any changes to the system. Subcontractor shall submit lire alarm plans to Springfield Fire Marshals Oflice for review and approval (2004 Springlield Fire Code 901.2). SDCs added. Fixture credit remains from COM2005-00615. See attached 3 structural comments faxed to Eric Phillips-Meadow. WI. Received response to structural comments. Received final internal approval. Initial Review Planning Review Public Works Review Structural Review Structural Review Structural Review 06/0u200s 06t02t200s 06/03/2005 06/03/200s 06/08/200s 06/08/2005 06t0u2005 0610u2005 06/01/2005 06/01/2005 06t02t200s 06/08/200s SKG EMM SB JMP JMP JMP APP APP APP WE IO APP 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 fotlowing work day. Foundation: After forms are erected but prior to concrete placement. Final Building: After all required inspections have been requested and approved and the buitding is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Paee 3 of4 Reouired fnsnections a L"L- PERMIT NO: COM2005-00646ISSUED: 0711312005APPLIED: 05/3112005EXPIRES: 01/1312006VALUE: $ 45,000.00 PIan Review: Kitchen remodel. Addition of walk-in refrigerator and freezer. Job #COM2005-00646. Occupation Classification: I-2. Construction Type: V-A. Kitchen proper is to be unaltered at this time. 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: COM2005-00646ISSUED: 0711312005APPLIED: 05/3112005EXPIRES: 01/1312006VALUE: $ 45,000.00 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 701.005 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 aII times during construction. Owner or Contractors Signature Date Page 4 of 4 -T 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt :velopment Services Department- Public Works Department RECEIPT #: 2200500000000000923 Date: 0711312005 2:18:47PM Job/Journal Number coM2005-00646 coM200s-00646 coM2005-00646 coM2005-00646 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7o/o State Surcharge + l0% Administrative Fee Amount Due 63.00 27.00 6.30 9.00 Item Total:$105.30 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check BUILDERS ELECTRIC llh 92049 By Mail $105.30 Payment Total: $105.30 711312005 Page I of I -t \. 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: COM2005-00646ISSUED: 0710712005APPLIED: 05/3112005EXPIRES: 01107t2006VALUE: $ 45,000.00 SITE ADDRESS: 1333 lST ST ASSESSOR'S PARCEL NO.: 1703263300544 PROJECT DESCRIPTION: Kitchen renovation Springfield TYPE OF WORK: Care Facility TYPE OF USE: Remodel License Expiration Date Owner: Address: Contractor Tvpe Architect General Electrical Mechanical Plumbing MARQUIS HEALTHCARE PROP LLC 4560 SE INTERNATIONAL WAY STE MILWAUKIE OR 97222 0s13012007 12110t2007 06t27t2007 031ru2007 Commercial Phone 541-342-8077 687-9445 541485-0922 541-726-0100 541-688-1444 Contractor ROBERTSON/SHERWOOD/ARCHITECTS CHAMBERS CONSTRUCTION BUILDERS ELECTRIC INC COMFORT FLOW TWIN RIVERS PLUMBING INC 114258 4296 460 17695 TORINFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: n law requires You to low rules by the Oregon UtilitY #of on Center. Those rulbe6tseet forth Height Type You mWater Range lling the Energy Path:l Sprinkled Building:nla Load: t-2 VA lber for the Oregon Utili Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yo ofLot Coverage: REQUIRED PARJ(NG Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: PUBLIC IMPROYEMENTS Notes: Page 1 of4 a T Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fa,x 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2005-00646ISSUED: 0710712005APPLIED: 05/3112005EXPIRES: 0110712006VALUE: $ 45,000.00 Description Bid Amount Tvpe of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $r.00 45,000.00 Total Value of Project Amount Paid Date Paid Date Calculated 05/3U2005 Fee Description PIan Review Comm/Ind/Public -Mechanical Issuance Fee- + l0%o Administrative Fee + 7Yo State Surcharge Building Permit Minimum/Adjustment Plumbing Miscellaneous Mechanical Plan Review Fire & Life Safety SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Trap or Waste not Conn to Fixt Total Amount Paid $221.91 $10.00 $43.14 $30.20 $341.40 $3r.00 $45.00 $136.56 $10.00 $r1.87 $1.13 $1.39 $3.91 $0.89 $14.00 5/31/05 7t7tvs 7t7t05 7t7t05 7t7t05 7t7tgs 7t7t05 717105 717105 7t7t05 7t7t05 7t7tos 7t7tos 717t05 7t7t05 Receipt Number 1200500000000000696 2200500000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200s00000000000896 2200500000000000896 2200s00000000000896 2200s00000000000896 2200500000000000896 2200500000000000896 2200500000000000896 2200s00000000000896 2200500000000000896 2200500000000000896 s902.40 Fees Peid Plan Reviews Pase2 of 4 -4:E h L]L] Valuation Descriotion I Value $45,000.00 $45,000.00 Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Rax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00646ISSUED: 0710712005APPLIED: 05/3112005 EXPIRESz 0110712006VALUE: $ 45,000.00 Fire Department Review 0610112005 06/05/2005 OK GRG Initial Review Planning Review Public Works Review Structural Review Structural Review Structural Review 0610u2005 06t02t200s wE 06/03/2005 06/03/200s IO 06/08/2005 06/08/2005 APP Plan Review: Kitchen remodel. Addition of walk-in refrigerator and fr eezer. Job #COM2005-00646. Occupation Classification: I-2. Construction Type: V-A. Kitchen proper is to be unaltered at this time. Maintain K extinguisher in kitchen. Maintain sprinkler coverage in refrigerator and freezer. Sprinkler subcontractor shall contact Springfield Deputy Fire Marshals Gilbert Gordon or Joe Wicks of any changes to the system. Subcontractor shall submit fire alarm plans to Springlield Fire Marshal's OIIice for review and approval (2004 Springlield Fire Code 901.2). SDCs added. Fixture credit remains from COM2005-00615. See attached 3 structural comments faxed to Eric Phillips-Meadow. WI. Received response to structural comments. Received final internal approval. 06t0u2005 06/0u200s 06t0u2005 06/01/2005 06t02t200s 06/08/2005 SKG EMM SB JMP JMP JMP APP APP APP 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. Foundation: After forms are erected but prior to concrete placement. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Rough Plumbing: Prior to coyer and including required testing. Final Plumbing: When all plumbing work is complete. Paee 3 of4 Reorrired Insneefions LT 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: COM2005-00646ISSUED: 0710712005APPLIED: 05/3112005 EXPIRESz 0110712006VALUE: $ 45,000.00 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 701.005 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. AA D9A-")-2^cc Owner or Contractors Signature Date Pase 4 of 4 t}- 225 tr'ifth Street Springfield, Oregon 97 477 541-726-3759 Phone city of Springlield Official Receipt evelopment Services Department Public Works Department RECEIPT #: 2200500000000000896 Date: 0710712005 l2:00:20PM Job/Journal Number coM200s-00646 coM2005-00646 coM2005-00646 coM2005-00646 coM2005-00646 coM2005-00646 coM200s-00646 coM2005-00646 coM2005-00646 coM2005-00646 coM200s-00646 coM2005-00646 Couzoos-ooo+o coM200s-00646 Description Miscellaneous Mechanical -Mechanical Issuance Fee- Building Permit Plan Review Fire & Life Safety SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Transpo Admin Trap or Waste not Conn to Fixt Minimum/Adjustment Plumbing + lYo State Surcharge + l0% Administrative Fee Amount Due 45.00 10.00 341.40 136.56 0.89 3.91 l.l3 I1.87 10.00 1.39 14.00 3l.00 30.20 43.t4 Item Total:$680.49 Pryments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Pald Check CHAMBERS CONSTRUCTION ddK 05 r 869 In Person S680.49 Payment Total: -565dF 717/2005 Page I of I IFMTTD ATTACHMENTA CITYOF'IINGFIELD SYSTEMS DEVEI.OPMENTCHARGEV' -KSHEET JOTIRNAL ORJOB NI'MBER NAMEORCOMPANY:MARQUIS CARE F ILITY I,OCATION 1333 1ST ST MAP & TAX I,oT NUMBER 17 03 26 33 00544 DEVELOPMENT TYPE: NEW DEVEI,OPED AREA (S.F.): E)(STING DEVELOPED AREA (S.F.): TOTAL IMPERVIOUS SURFACE (S.F.): I. STORMDRAINAGE IMPERVIOUS SQ. FT. O K]TCHEN ADDITION FOR CONGREGATE ELDERLY CARE FACILITY ITE: ITE: r-oT srzE (S.F.): 24 x $ 0.310 PER SF SEE COM2OOil)O615 FOR CRED]TS 75 75 2. SANTTARY SEWER-CIry A REIMBURSEMENTCOST: NUMBER OF DFI'I'S B. IMPROVEMENT COST: NUMBEROF DFLrs (SEE REVERSE SIDE) 3. TRANSPORTAT]ON BLDG AREA TGSF X TRIP RATE X COST PERADTXNEWTRIP FACTOR NEW A REIMBURSEMENT COST: 0.024 x 2.02 x $ 18.30 PER TRIP x B. IMPROVEMENT COST: 0.024 * 2.02_ x $ 80.72 PERTRIP x E)flSTING A REIMBURSEMENTCOST: 0.000 x 0 x $18.30PERTRIP x B, IMPROVEMENT COST: 0.000 x 0 $ 80.72 PERTRIP x _!__ NTF 4. SANITARY SEWER- MWMC NEW: A. REIMBI.'RSEMENT COST: NLIMBER OF FELJnS B. IMPROVEMENTCOST: NUMBER OF FELIs 0.024 x 0.024 x E)flSTING: A REIMBI'RSEMENTCOST: NUMBER OF FEU's 0.000 B. IMPROVEMENT COST: NUMBER OF FEI-l"s 0.000 MWMC CREDM IF APPLICABLE (SEE REVERSE) x $ 24.04 PERDFU x $ 18.28 PER DFU TOTAL LOCAL SAN.SEWER SDC: NTF $0.89 NTF $3.91 NTF $ TOTAL TRANSPORTATION REIMBI'RSEMENT SDC TOTAL TRANSPORTATION IMPROVEMENT SDC TRANSPORTATION SDC: $46.88 PERFEU $1 .13 M94.46 PERFEU $11.87 $O.OO PERFEU $ $O.OO PER FEU $ INDUSTRIAL STRENGTH INCREASE TOTAL MWMC REIMBURSEMENT FEE TOTAL MWMC IMPROVEMENT FEE MWMC ADMIMSTRATIVE FEE TOTALMWMC SDC:$22.99 TOTAL STORM DRAJNAGE SDC: $27.79sr.lBToTAL (ADD rTEMS l, 2, 3, & 4) 27.79 x 0 $ (3,174.06) $4.80 22.99 x x x 5. ADMIMSTRATTVEFEES: BASE CFIARGE (SI]BTOTAL ABO\E)$ Stev ew W . Eiea vdr A BA r ves 6t8D005 TOTAL TRANSPORTATION ADMINISTRATION FEE TOTAL SEWER ADMINISTRATION FEE 5o/o :$1.39 b $ -$1,803.28 70.781 0.89 4. $ 1.13 $ 11.87 $ 10,00 1.39 29.18 m@ffimMbl,tulHB&urs CARE KrrcHEN, 1333 lsDcrTEs TOTAL SDC CEARGES $ 1 JULY 2OO4 I t183 118{ DRAINAGE FD(TT'RE TINIT (DFI' CALCULATION TABLE NUMBER OFNEW ED(TURES x UNITEQUWALENT: DRAINAGE FXTURE LIN]TS (NOTE: FOR REMODELS, CALCI.JLATE ONLY TIIE NET ADDMONAL FD{TTJRES) II,I.ARQUIS CARX FACILITT'DRAINAGE FD(TURE UMTS FDOURES NEW OLD UNIT FXTI-IREryPE BATHTIIB DRINKING FOL'NTAIN FI,OORDRAIN INTERCEPTORS FOR GREASE/OIUSOLIDS/ETC. INTERCEPTORS FOR SAND/AUTO WASTVETC. LALINDRY TLTB CIOT}IES WASHERA,IOP SINK cr_oTr{Es WASHER - 3 oR MORE (EA) MOBILE HOME PARK TRAP (1 PER TRAILER) RECEPTOR FOR REFRIGERATOR/WATER STAT]ONIETC. RECEPTOR FOR COMMERCIAL SINK/ DISHWASHER/ETC. SHOWER, SINGLE STALL sHowER, GANG (NUMBER OF HEADS) SINK: COMMERCIAL, RESIDENTI.AL KITCHEN SINK COMMERCI-ALBAR SINIC WASH BASIN/DOI,IBLE I.-A.VATORY SINK: SINGLE LAVATORY/RESIDENTIAL BAR URINAL, STALI.ItrALL TOILET, PUBLIC INSTALLATION TOILET, PRTVATE INSTAIIANON MSCELI,ANEOUS: NUMBER OF EDU'S* -15 -6 -42 -75 0 TOTAL DRAINAGE FXTIIRE I.]NITS:-75 -3I 0 0 0 J 0 0 0 0 0 0 0 3 I 3 J 6 2 J 6 t2 I 3 2 2 3 2 2 I 5 6 3 2 6 0 5 4 9 8 -8 -9 0 1 9 2 2 0 +EDU CEouivalent Dwellins UDit) is a dischrse equivalent toa sinsle familv dwellins (20 DFLD set at 167 eallons per dav CREDIT CALCULATION TABLE: BASED ON ASSESSED VALUE IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE IN TABLE, CALCULATE CREDITS SEPARATELY YEAR ANNEXED CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE IMPROVEMENT (IF AFTER ANNEXATION DATE) RATE PER $1,OOO ASSESSED VALUE $1.25' 91.09 $0,92 $o.72 $0.48 $0.28 .09 .05 x x $0.00 RATE PER $I,OOO ASSESSED VALUE YEAR ANNE)(ED 1979 1980 1981 1982 I 983 r984 I 985 1986 1987 r988 r 989 1990 1991 or before $5.29 $5.19 $s.12 $4.98 $4.80 $4.63 $4,40 $4.07 $3:67 $3.22 $2.73 $2.25 $1.80 1992 1993 1994 1995 1996 1997 I 998 r999 2000 2001 2002 2003 2004 $0.00 $0.00 COM200t006rt5, MARQUIS CARE KJTCHEN, 1333 1ST sT.xls CREDIT TOTAL 1 JULY 2OO4