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Home My WebLink AboutPermit Building 2001-6-29 .." . I Job# 00.01760.01 I . TRANS#:01-0006018 Page 1 of1JATE:JUN 29 2001 AMT RECD:1 $ 20.00 CHANGE:$ 3.50 CASHIER: 061 SPRINGFIELD ~- CITY OF SPRINGFIELD, OREGON RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 00-01760-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location Of Proposed Site: 806 Old Orchard Ln Spr Assessors Map#: 17032343 Lot: 123 Block: Addition: 3rd Tax Lot #: 09100 Subdivision: River Glen Owner: Homebuilders Construction Co Phone Number: 541-484-6560 Address: 1255 Pearl St Suite 1 00 O",~ity/State/ZiP: Scope Of Work: Single Family Residence '\~~ 'l'\ NeW'. Q\"'~ \~ ~-v.Jo ""~ single family residenc~jpost7t~~ione~ab-on-grade fdn. P . P....'c1.f . ;.i,..... t . ~""-c1 '0""''''1 n 01 p.rmltl fll or. ~n(l no ~!=ii~IJp. ~\)l. ~m -:1- W~ Contractor Type \:c~~t~a~tci~ \ ; '0~~'(,; ~ ,?-<Q'?-~ - Registration # Mechanical Contr Sch60Icratt,.~ .:.'" 0'" ~ O~. 460 ,~~"" ,'" ,v ....~ 2155 Musket~Eugene. OR 97401 . -~~" '?-'" Don~re'wisP,l~bin9 33076 ,...\'\ \ 500 Greenfield Street, Eugene, OR 97404 Eugene. OR 97401 Value: $153,286 Expiration Date 6/27/2001 Phone Plumbing Conlr 6/10/2001 541-688-1931 Plumbing Conlr SCHELSKYS P.O. Box 7945, Eugene. OR 97401 541-744-7135 Office Use Quad Area: 5RNW Land,Use: Single Family Dwelling # Of Buildings: 1 # Of Units: 1 Zo-r'-i~g"Code: LDR Occupancy Group: Dwelling .-(,:'J . \ ~~. . ,,(,,\, Constr. Type: (VN) Wood Frame ..},. Bedrooms:' 3 Heat Source: Forced Air Gas Water Heater: Gas ,'" <~;0'~:Rjl~g<Je..:::~~ '0'\ Gas Sq. Footage: 2100 ,'~';'.\".;"-..-.\.)\ 0\;:-"'. t>.'v ~~_ To request an inspeclion'callJhe ?ft'houJ'recoriJi(l9'\~."!26-3769. All inspections requested before 7:00 a.m. will be made the'samewo'rking:aay:;inspec:tions'requested after 7:00 a.m. will be made the following . ('" ,." v' ,.J ;)'~" _"'. working day. .....;.:,.... .'.v.;J. .:.~~.~\) ....(, '.,.'. 'L"\'~I\~"'\" 1'.'",;\-.......-0\ ,.r:J\'" ..,.:......'b-\'.I~\O\.:\~~.,.,'!r' \'. ~..'.... \ r,._J. \. - v 1'R. . d I . \V.c.t," ',v ->~ ^':-. <,V' ,_,,~ equlre nspectlons . t~,' fl'.Cb'" ~ ~v ~e;J ~...J ~.o O~ -{o~ ~""c, 1(;'o",C .....<o'J1 Buildinll I Verify Ground R'adl;)\:)' ,\\~~ Inst~1I g~ound rod at fooling, and call for inspection in conJ'uction with footing and/or foundation i \)"'" '(;., '1,..... ('\\.. Footing c, ~~-J\f!er trenches are excavated. Foundation ~.;s. -After forms are erected but prior to concrete placement. Slab ... To be made after all inslab building service equipment, conduit piping, and other equipment iter Post and Beam -Prior to floor insulation or decking. Floor Insulation -Prior to decking. Ceiling Insulation ... Prior to cover. Shear Wall Nailing -Before covering sheathing with finish materials. Framing ...Priorto cover. Wall Insulation - Prior to Cover Drywall - Prior to taping. ~ Final Building Rough Electrical Electrical Service Low Voltage Underground Plumbing Underfloor Plumbing Underfloor Drain Rough Plumbing Shower Pan Water Line Sanitary Sewer Line Storm Sewer Line Backflow Device Final Plumbing Rough Gas Rough Mechanical Gas Service Final Gas Final Mechanical C u rbcut Sidewalk SW.Curbside SW-Setback CC-Standard . . Page 2 of 4 I Job# 00-01760.01 I Required Inspections I Building I - When all required inspections have been approved and the building is complete. Electrical - Prior to cover. -Must be approved to obtain permanent power. I Plumbin!l - Prior to filling the trench. - 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 cover. -After line is installed and line has been connected to a minimum of one appliance. Pressure te! - When all gas work is complete. - When all mechanical work is complete. I Public Works I ...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 -After forms are erected but prior to placement of concrete Street Improvement: Fully Improved Curb Cut?0 Improvement Agr.?D San Sewer Depth (Ft): 6 4 Storm Sewer Available? 0 Special Req.: Security Required: Bond Begin DateTime: Special Instructions: Other Utilities: Project Supervisor: Sidewalk Type: Additional ROW? Size Of Line (in): DownspoutslDrains: Enchroachment Permit: San Sewer Tee (in): Bond End DateTime: SETBACK SIDEWALK ON Types Of Warning Devices Reqd. o 8 To Curb and Gutter 00/00/0000 00:00 AM CURBSIDE SIDEWALK ON 6 00/00/0000 00:00 AM ... . Zoning: LDR FloodPlain? 0 Wetlands? 0 Journal numbers 1: 2: Comments: I Job# 00-01760-01 I Overlay District: # of Street Trees: 5 . 3: Additional Requirements: Required Attachments: Source Locn: Material: Planner: Liz Miller Urban Growth Boundary?D Glenwood Area? 0 Quantity Of Fill: Supplier: Drainage: Floodway FEMA: Zone X White Construction Types:(VN) Wood Frame Occupancy Groups: Dwelling # Of Buildings: 1 # Of Bedrooms: 3 Handicap Access? 0 rArea (Sq. Feet) Main: 2100 Accessory~84 Fee Residential Plan Check Total Plan Check Building Permit State Surcharge For Building Permit Building Administrative Fee Total Building Temporary: 200 Amps or Less State Surcharge - Electrical Administrative Fee - Electrical Total Electrical 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 Hood and Exhaust One to Four Outlets Minimum Mechanical Permit Administrative Fee - Mechanical Less than 100,000 BTU Page 3 of4 Land Use: Single Family Dwelling Pave Driveway? 0 Flood Plain FEMA: Panel 1134 of 2975 Private Garage/Carp/Stor # Of Stories: 1 Height (feet): 24 Current Units:O Proposed Units:1 Census Code: New SF - attached Total:2484 Paid On Receipt# Plan Check 12/06/2000 3983 Buildinll 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 Electrical 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 Plumbinll 01/09/2001 4206 06/29/2001 6018 01/09/2001 4206 01/09/2001 4206 06/29/2001 6018 06/29/2001 6018 01/09/2001 4206 06/29/2001 6018 Mechanical 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 Value/Quantity Fee Amount 153,286 $360.43 $360.43 153,286 $554.50 $38.82 $16.64 $609.96 1 $40.00 $2.80 $1.20 $44.00 1 $.00 $5.00 $160.00 $11.20 $1.05 $10.00 $4.80 $.45 $192.50 1 1 1 $4.50 $2.00 $.00 $.87 $6.00 1 12/15/00 - Roxie Cuellar stated they didn't need an LDAP because they weren't filling, grading or excavating more than 50 cubic yards. LM . . Page 4 of 4 Fee Job# 00.01760.01 I Paid On Receipt# Mechanical 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 3 1 1 Value/Quantity Vent Fan to One Duct Gas Fireplace Dryer Vent Mechanical Issuance State Surcharge'" Mechanical Total Mechanical New Sidewalk New Curbcut Total Public Works Public Works 01/09/2001 4206 01/09/2001 4206 90 1 Residential - Single Family - Storm Sanitary Sewer Residential Transportation Residential Sanitary MWMC Residential Improvement MWMC MWMC Administrative Fee SDC Administrative Fee Property Annexed 1998 Total System Development System Development 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 01/09/2001 4206 42 3,594 23 1 1 1 1 S.F. Residence... Wi llama lane Total Willamalane SDC Grand Total Willamalane SDC 01/09/2001 4206 1 Plan Check Type Checked By Date Completed Comment Initial Review-Res Wendy Stanley Steve Templin Liz Miller 12/07/2000 12/13/2000 12/18/2000 Engineering-Res Planning-Res Structural...Res Don Moore 01/09/2001 Fee Amount $9.00 $4.50 $3.00 $10.00 $2.03 $41.90 $60.00 $60.00 $120.00 $973.97 $860.20 $810.29 $285.91 $24.33 $10.00 $147.50 $-14.78 $3,097.42 $1.000.00 $1,000.00 $5,466.21 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 ensur~that II re red inspections are requested at the proper time. that each address is reada~n~ th tr that the permit card is located at the front of the property, and the / approved setofp.A;1 r . n7 all times during construction. C6'~~/ Signature ~ - / Dati' ~'..... . . . '. ~ Job: 00-01760-01 Address: 806 Old Orchard Ln Received: 12/6/2000 Unit: BLDG: FLR: Owner: Homebuilders Construction Co FEE DETAILS Fees Value/Quantity Amount Due Amount Paid Building Permit Fees Building Permit 153,286.00 _55~ SubTotal C-557.S0 0.00 Building Administrative Fee Building Administrative Fee 16.64 SubTotal 16.64 0.00 Building Surcharge State Surcharge For Building Permit 38.82 SubTotal 38.82 0.00 Total for Building 609.96 0.00 Mechanical HVAC new or replace Less than 100,000 BTU 1.00 6.00 Vents Hood and Exhaust 1.00 4.50 Vent Fan to One Duct 3.00 9.00 Dryer Vent 1.00 3.00 Gas Piping System One to Four Outlets 1.00 2.00 Gas Fireplace 1.00 4.50 Minimum Mechanical Permit Fee Minimum Mechanical Permit Mechanical Issuance Fee Mechanical Issuance 10.00 SubTotal CV 39.00 0.00 Page 1 of4 , - . . ~ Job: 00-01760-01 Address: 806 Old Orchard Ln Owner: Homebuilders Construction Co Received: 12/6/2000 Unit: SLOG: FEE DETAILS Fees ValuelQuantity Mechanical 8#ii(ln!~!i~!!yg~~~ Mechanical Admin Administrative Fee - Mechanical SubTotal ............................... .-.,...-.,...-.-.-.-.-.-.....-...-.-.-.-...............-.-..... ..,..".-.-.,......."..".."..,'..,...,...,.. ,.,...,.,.,...-...-.....:.-.,.,...:.,.-.:.-.;.:.-.,.:.-.,.,...... ._._..._..._._....w.w........,...."....,.., .....h.....,...,..... ',;."'.,.,.,,.,., .. ,,' ,'.W.W.W.", ;.;.,.,;,,", .,.:...,:." Mechanical Surcharge State Surcharge - Mechanical SubTotal Total for Mechanical Plan Check Building Plan Check Fees Residential Plan Check 153,286.00 SubTotal Total for Plan Check New 1 or 2 Family Dwelling Two Bathrooms Minimum Permn Fee Minimum Plumbing Permit Fee SubTotal 1.00 Plumbing Administrative Fee Administrative Fee - Plumbing SubTotal Plumbing Surcharge State Surcharge - Plumbing SubTotal Total for Plumbing Page 2 of 4 FLR: Amount Due 0.87 0.87 2.03 2.03 41.90 0.00 0.00 (160:0(1 -, 160.00 4.80 4.80 11.20 11.20 176.00 Amount Paid 0.00 0.00 0.00 360.43 360.43 360.43 0.00 0.00 0.00 0.00 ...... . ~ Job: 00-01760-01 Address: 806 Old Orchard Ln Owner: Homebuilders Construction Co . Received: 12/6/2000 Unit: SLOG: FEE DETAILS Fees Public Works Value/Quantity Public Works Pennit New Sidewalk New Curbcut SubTotal Total for Public Works System Development SDC - Stonn Sewer Residential - Single Family - Stonn SDC - Sannary Sewer Sanitary Sewer SDC - Transporation Residential Transportation MWMC Residential Sannary MWMC Residential Improvement MWMC MWMC Administrative Fee MWMC Administrative Fee MWMC Credn Property Annexed 1998 System Development Admin Charges SDC Administrative Fee 90.00 1.00 3.594.00 23.00 1.00 1.00 1.00 1.00 42.22 SubTotal Total for System Development Page 3 of4 FLR: Amount Due Amount Paid 060~ (6D.OO~ 120.00 120.00 ~.=::=> ri602o'-:> ra;0.i9~ 0.00 0.00 ~b '5 ". "2--9 285.91 24.33 10.00 -14.78 ~f47.50 -::, 3,097.42 3,097.42 0.00 0.00 .~ ~ . Job: 00-01760-01 Address: 806 Old Orchard Ln Owner: Homebuilders Construction Co Fees Willamalane SOC . Received: 12/6/2000 Unit: SLOG: FEE DETAILS Value/Quantity Willamalane Park and Recreation SDC S.F. Residence - Willamalane SubTotal Total for Willamalane SOC Grand Total: FLR: Amount Due Amount Paid 1.00 1.000.00 1,000.00 0.00 1,000.00 0.00 5,045.28 360.43 Page 4 of 4 , , ~ ..' -~ .' DUPLIC.C.TE RECEiPT DUPLICATE RECEiPT -~. .--. -------~,--_.__. ------------.-- ._4 ___~____________________________ CITY OF SPRiNGFIELD 225 FiFTH STREET SPRINGFiELO, OR 97477 (541) 726-3753 ===:======;=-======~==================== WELCOME TO DEVELOPMENT SERVICES AND PUDLIC WORKS ------------_. ------------ --- -------..--- --- .._-- - - ------ -- ---------- --- ----- - .---- ! REG...RECElPT:010004206 C:JAN 09 2001 CASHIER 10:059 10:06 am A:JAN 09 2001 ------------------ --------- ._---~-- _. --- ----------------- .---..------..------. ----. 1002 BUILDING PERMIT $554.50 JOB#:00...017GO-Ol 1099 STATE SURCHARGE(7%) 13~.o2 JOB#:00"'01760-01 1098 ADM'Hi FEE (3X) $16.64 JOB#:00...01760-01 1004 ELECTRICALPERMlT $0.00 JOB# :00-01750...01 1099 STm SURCHARGE(I%) $0.00 JOBp:00"'01760"'01 109B ADMIN FEE(3%) $0.00 JDBp:00-01760-01 1003 TEMPORARY ELECT PER $40.00 JOB#:00-01760...01 1099 STATE SURCHARGE(7%) $2.BO JOB#:00-01760-01 109B ADMIN FEE(3%) $1,20 JDB#:00...01760...01 1006 MECHANICAL PERMlr $29.00 JOBp:00-01760"'01 1099 STm SURCHARGE(7%) $2.03 JOBp:00...01760...01 109B ADMIN FEE(3%) $0.87 JOB#:00-01760...01 10B7 MECHANICAL ISSUANCE $10.00 JOB#:00...01760...01 1005 PLUMBING PERMIT $160.00 JDB#:00-01760...01 1099 STATE SURCHARGE(7%) $11.20 JOBp:00...01760-01 109B ADMIN rrE(3~) $4.BO JOB#:00"'01760 Cl 1012 CURB CUT PEKMIT $00.00 JOB#:00...01760-01 1013 SIDEWALK PERMIT $60.00 JOB#:00"'01760...01 1070 SOC/STORM $973.97 JOB#:00"'01760...01 1071 SDC/SANITARY SEWERS $860.20 JOB#:00-01760...01 1072 SDC/TRANSP $B10.29 JOB#:OO"'01760-0i 1055 SDC/RESIDENTlAI. SAN $295.46 JOB#:OO...01760"'Ol 1056 SDC/REGIONAL SEWER $10.00 JOB#:OO...01760-01 1073 SDC/ADMIN $147.50 JOB#:OO"'01760...01 1074 SDC/WII.LAMALANE $1,000.00 JDB#:OO-01760-01 TOTAL DUE $5,OB9.28 RECEIVED FROM: HOMEBUILDERS CONSTRUCTION CHECK: $5,OB9.28 TOTAL TENDERED $5,OB9.28 CHANGE DUE $0.00 ------- -------------- - --- - ----- -----..- -- ---------------------------------------- -- ----- ------------------------ - - -- ------ ---------------------------------------- THANK VOU!!!!!! ---------------------------------------- ---------------------------------------- DUPLICATE RECEIPT DUPLICAT.E RECEIPT ~. . . CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET I JOURNALORJOBNUMBER:-00-01760-01 II NAME OR COMPANY: HOMEBUILDERS CONSTRUCTION COMPANY LOCATION: 806 OLD ORCHARD LANE TAX LOT NUMBER: 17-03.23-43-09100 ANNEXATION YEAR 1998 LANE COUNTY ASSESSED VALUE (LAND) $42,222 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE DWELLING UNITS: 1 BUILDING SIZE: 2484 SF LOT SIZE: 7915 SF 1 ST()\l.M.D.RA IN A(,F I IMPERVIOUS S.F. 1,1 COST PER S.F. J 3594.00 $0.271 I ITEM 1 TOTAL - STORM DRAINAGE SDC 2 SANITARYSFWFR.c:JTY A. REIMBURSEMENT COST: 1 NUMBER OF DFU's 1"1 COST PER DFU I 23 $21.25 B. IMPROVEMENT COST: 1 NUMBER OF DFU's I I COST PER DFU 1 23 I" $16.15 I ITEM 2 TOTAL... CITY SANITARY SEWER SDC ~NSP()RT~ A. REIMBURSEMENT COST: I ADTTRIP RATE I x I NUMBER OF UNITS Ixl COST PER TRIP 1 XINEWTRIP FACTOR I 1 9.57 I $16.12 1 1.00 =1 B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP 1 9.57 1 $68.55 I ITEM 3 TOTAL - T~SPORTATION SDC 1...S..ANTTARYSFWFR _ MWM~ I x I NEW TRIP FACTOR I I 1.00 =1 =1 A. REIMBURSEMENT COST: I NUMBER OF FEU's I" I COST PER FEU I 1 $285.91 B. IMPROVEMENT COST: I NUMBER OF FEU's 1"1 COST PER FEU 1 1 $24.33 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE I ITEM 4 TOTAL - MWMC SANITARY SEWER SDC I SUBTOTAL (ADD ITEMS 1.2.3,&4) 5 ADMIJ'TSTll A TI\IF....EEE:.. SUBTOTAL Ixl ADM. FEE RATE $2.949.92 5% =1 $973.97 I =1 $973.97 ----.lJ =1 $488.75 =1 =1 $371.45 1 $860.20 I' $154.27 $656.02 I $810.29 JJ , =1 $285.91 =1 =1 =1 I I I =1 $305.46 I , =1$2.949.92~ $24.33 ($14.78) $10.00 s:t- ~ 12/13/00 =1 $147.50 I TOTAL SDC CHARGES =1 $3,097.42 J II SDC COORDINATOR DATE . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE " NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO.OFFDITURES DRAINAGE ( # NEW # OLD ) UNIT FIXTURE FIXTURE TYPE x EQUN ALENT = UNITS BATHTUB (2) x 3 6 DRINKING FOUNTAIN () x 1 0 FLOOR DRAIN () x 3 0 INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC. ( ) x 3 0 INTERCEPTORS FOR SAND I AUTO WASH I ETC. ( ) x 6 0 LAUNDRY TUB () x 2 0 CLOTHESWASHER/MOPSINK ( ) x 3 3 CLOTHESW ASHER - 3 OR MORE (EA) ( ) x 6 0 MOBILE HOME PARK TRAP (1 PER TRAILER) ( ) x 12 0 RECEPTOR FOR REFRIG I WATER STATION I ETC. ( ) x 1 0 RECEPTOR FOR COM. SINK I DISHWASHER I ETC. ( ) x 3 0 SHOWER, SINGLE STALL ( ) x 2 2 SHOWER, GANG (NUMBER OF HEADS) ( ) x 2 0 SINK: COMMERClAL/RESIDENTIAL KITCHEN ( ) X 3 3 SINK: COMMERCIAL BAR ( ) x 2 0 SINK: DOMESTIC BAR (. ) x 1 0 WASHBASIN ()x 2 = 0 LAVATORY (3) x 1 3 URINAL, STALL/WALL ( )x 5 0 TOILET, PUBLIC INSTALLATION ( ) x 6 0 TOILET, PRIVATE INSTALLATION (2 ) x 3 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU's' ( ) x 20 0 TOTAL DRAINAGE F1XTURE UNITS =1 23 .EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE, CALCULATE CREDIT SEP ARA TEL Y YEAR ANNEXED 1979 OR BEFORE 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 CREDIT RATE PER $1,000 ASSESSED VALUE $4.74 $4.65 $4.59 $4.46 $4.30 $4.14 $3.93 $3.63 $3.26 $2.85 $2.40 .I YEAR ANNEXED 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 CREDIT RATE PER $1,000 ASSESSED VALUE $1.96 $I.55 $1.36 $I.23 $1.05 $0.90 $0.75 $0.57 $0.35 $0.15 CREDIT FOR LAND (IF APPLICABLE) CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE I 1000 CREDITRATE 42.222 X $0.35 =1 0.000 x $0.35 =1 TOTALMWMCCREDIT =1 $14.78 $0.00 $14.78 ,,- 'I I :1 -. . . r\1\ . I/IJw "r... 'Willamalane . ~,,..,, Park & Recreation District Job. No. .DC) -0 I i:..fO ...D I .... . SYSTEM DEVELOPMENT CHARGE WORKSHEET NAME: +I~~1.rJ'ln0 COvlJl-luc--hon Co.PHONE:50~- ILj 10 ADDRESS: C;SO(; 0 {d 0rclvlA.d STATE: 0 R ZIP: Street Addr~ss: Plat Name: k':/l..eJl lOCATION OF PROPOSED BUilDING SITE: ~(}) Old O\cJlfi~, .Le...- Tax Lot Number: q 100 (~I.~ , .1,. 1. DEVELOPMENT TYPE::; (Check appropriate dwelling(s). SDC calculations and dwelling I ype definitions are on the back.) I'.' A. SlnolA-FRmilv DAtRr.hAQ ~ /SIngle Family home NO. OF UNITS I Manufactured home nol in a park X $1,000 per unit = $ 1000. ~ B. .Sin.QIA-FRrT.likAttRr.hAri NO. OF UNITS X $924 per unit = $ C. Mufti-Familv Aoartment NO. OF UNITS X $692 per unit = $ D. J.;1an!Jf!lclured Homo Pm~ NO. OF UNITS .X $699 per unit '" $ WILLAMALANE SDC $ 2. SDC CREDIT (II applicable) SDC-payer must lurnlsh prool 01 Willarnalane Credit approval. See sac Credit Worksheet. $ 3. TOTAL WlllAMAlANE NET SDC ASSESSED (II SDC reduced lor Credit) $ JOOJ:OW fA) .tJ-JA Development Services Department. City of Springfield (0... / r / ()eJ Date