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Home My WebLink AboutPermit Building 2004-5-28 , ;'-~:ii,2'"~ l D ',. iii", ',"',,',~',","",',i..., WtL"-. . ."~".. , F .,' . .... ~ . ..... ~-.",..'~,~ .- -~~ Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00420 ISSUED: OS/28/2004 APPLIED: 04/14/2004 EXPIRES: 11/28/2004 VALUE: $ 227,463.78 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Contractor Type General Electrical Mechanical Plumbing SITE ADDRESS: 863 Mint Meadow Way ASSESSO~~-m~iE~Nm'.\i)gotVo')lBFa\86Om you to follow rules adopted by the Oregon Utility PROJECW~~~~1'JB~r. It:fY~)s~OO3to~H1Ef)8;e~h In n,A R Q.fl2-001-001 0 throuah OAR 952-001- Owner: O~Jt'E>H rwIlEbtain copies of the rules by Address: 4a8~il\YWtlh!M~llmAj}\0im{hilg~fiijOneuGENE OR 97401 fl'1r1'\bpr fnr thp. ()reaon Utilitv Notification i ' Center is 1.800~332-2344)\.. r CONTRACTOR INFORMATION' lHE. WORK <<u \ ,{,~. f\LL E.XP\RE. \r N01 Contractor lH\5 PE.Ii~\k~~ E.~llmr~3~~ '"Phone ARBOR SOUTH CONSTRUCTION INMllHOBW9~ O~ \5 f\Bf(\~aij~i6~/ 541-913-0016 ROSE CORPORATION cmJ\M~mD R\OD. 09/30/2004 541-686-0905 COMFORT FLOW N'l ,BJ;JQ)f\'l PE. 06/27/2004 541-726-0100 SPECIALTY PLUMBING CO A 102974 11/21/2005 541-686-4191 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New Residential Phone Number: 541-913-0016 BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 3 # of Stories: 2 Height of Structure 23.00 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Gas Energy Path: Path 1 Sprinkled Building: nla Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: 8,470 1,972 1 R-3 U-l VN 676 I DEVELOPMENT INFORMATION' Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 10.00 5.00 5.00 23.00 0.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 1 Yes 31.20 REQUIRED PARKING Total: 2 Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved No Sidewalk Type: Curbside 5' Curb and Gutter Downspouts/Drains: Notes: Pal!e 1 of 4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction V Wood Frame V Wood Bonus Rm Garai!:e Dwellini!:s Dwellini!:s Garai!:e Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge 2 Baths One or Two Family Addressing Assignment Appliance Vent Boiler/Comp Up To 100,000 btu Building Permit Curbcut Permit Dryer Vent Exhaust Hoods Furnace - up to 100,000 btu Gas Fireplace Gas Outlets 1-4 Gas Outlets 4+ Plan Review - Planning Plan Review Residential Plan ReviewIResidential Hourly PW Mult Disc - 2nd Permit Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC SanitarylStorm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Sidewalk Permit Storm Drainage Impervious Area Temp Power 200 amps or less I Valuation Descriotion I $ Per Sq Ft or multiplier $92.40 $78.54 $24.30 Square Footage or Bid Amount 1,972.00 367.00 676.00 Total Value of Project ~ Amount Paid $576.81 $10.00 $156.17 $109.32 $254.00 $31.00 $6.00 $12.00 $981.65 $75.00 $6.00 $9.00 $12.00 $30.00 $4.00 $3.00 $71.00 $61.26 $90.00 $-30.00 $106.00 $76.00 $499.09 $656.56 $10.00 $214.23 $314.63 $135.71 $52.09 $727.42 $164.89 $75.00 $1,169.14 $50.00 Date Paid 4/14/04 5/28/04 5/28/04 5/28/04 5/28/04 5/28/04 5/28/04 5/28/04 5/28/04 5/28104 5/28/04 5/28/04 5/28/04 5/28/04 5/28/04 5/28104 5/28/04 5/28/04 5/28/04 5/28/04 5/28/04, 5/28104 5/28/04 5/28/04 5/28/04 5/28104 5/28/04 5/28/04 5/28/04 5/28/04 5/28104 5/28/04 5/28/04 5/28/04 Pai!:e 2 of 4 . CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-00420 ISSUED: OS/28/2004 APPLIED: 04/14/2004 EXPIRES: 11/28/2004 VALUE: $ 227,463.78 Value Date Calculated $182,212.80 $28,824.18 $16,426.80 $227,463.78 04/14/2004 04/30/2004 04/14/2004 Receipt Number 1200400000000000478 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 2200400000000000686 . CITY OF SPRINGFIELD I Status Issued Building/Combination Permit PERMIT NO: COM2004-00420 ISSUED: OS/28/2004 APPLIED: 04/14/2004 EXPIRES: 11/28/2004 VALUE: $ 227,463.78 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Vent Fan Willamalane Single Family $12.00 $1,000.00 5/28/04 5/28/04 2200400000000000686 2200400000000000686 Total Amount Paid $7,730.97 I Plan Reviews I Initial Review 04/15/2004 04/15/2004 APP RJB Planninl! Review 04/15/2004 04/2312004 APP TAJ Needs survey because of minimum side setbacks. Public Works Review 04/15/2004 04/19/2004 APP DJW Structural Review 04/15/2004 04/30/2004 POK TCM Refered to Don Moore for further examination concerning wall bracing. Structural Review 04/29/2004 04/29/2004 WE DLM Sent letter requesting additional information and clarification to the architect. 4/29104 dim Structural Review 05/07/2004 05/27/2004 APP DLM Received response from architect today with calrifications and revisions.5/7 12004 dim 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. 1 Sidewalk - Curbside: After forms are erected but prior to placement of concrete. 2 Curbcut - Standard: After forms are erected but prior to placement of concrete. 3 Vfer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing andlor foundation inspection. 4 Footing: After trenches are excavated. 5 Foundation: After forms are erected but prior to concrete placement. 6 Post and Beam: Prior to floor insulation or decking. 7 Floor Insulation: Prior to decking. 8 Shear Wall Nailing: Before covering sheathing with finish materials. 9 Framing Inspection: Prior to cover and after all rough in inspections have been approved. 10 Wall Insulation: Prior to cover. 11 Ceiling Insulation: Prior to cover. 12 Drywall: Prior to taping. 13 Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. 14 Final Building: After all required inspections have been requested and approved and the building is complete. 15 Vnderfloor Plumbing: Prior to insulation or decking. 16 Vnderfloor Drain: Prior to cover or placement of concrete. 17 Rough Plumbing: Prior to cover and including required testing. 18 Shower Pan. Prior to covering and including required testing. 19 Water Line: Prior to filling trench and including required testing. 20 Sanitary Sewer Line: Prior to filling trench and including required testing. 21 Storm Sewer Line: Prior to filling trench. Pal!e 3 of 4 . CITY OF SPRINGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2004-00420 ISSUED: OS/28/2004 APPLIED: 04/14/2004 EXPIRES: 11/28/2004 VALUE: $ 227,463.78 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 22 Final Plumbing: When all plumbing work is complete. 23 Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 24 Underfloor Mechanical. Prior to insulation or decking and including required testing. 25 Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. 26 Rough Mechanical: Prior to Cover 27 Final Gas: When all gas work is complete. 28 Final Mechanical: When all mechanical work is complete. 29 Temporary Electric: Approval required prior to Utility Company energizing pole. 30 Rough Electric: Prior to Cover 31 Electric Service: Approval required prior to utility company energizing service. 32 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 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 agre ensure that all required inspections are requested at the proper time, that each address is readable from the street, t pe mit card is located at the front of the property, and the approved set of plans will remain on the site at all time (lur' ~ons r1!Cti~n. .....~ (''-vI t/ " J Owner or\Conk:8cto~nature 5-2-6 ' 04 Date Page 4 of 4 . t25 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 COM2004-00420 /-' 'y of Springfield Official Receipt __..;velopment Services Department Public Works Department RECEIPT #: 2200400000000000686 Date: OS/28/2004 Description Addressing Assignment Willamalane Single Family Sidewalk Permit Curbcut Permit PWMult Disc - 2nd Permit Storm Drainage Impervious Area Sanitary Sewer - Reimbursement . Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC SanitarylStorm Admin SDC Transpo Admin Plan Review - Planning Furnace - up to 100,000 btu Vent Fan Appliance Vent Exhaust Hoods Dryer Vent Gas Outlets 1-4 Gas Fireplace -Mechanical Issuance Fee- Boiler/Comp Up To 100,000 btu Temp Power 200 amps or less Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 2 Baths .one or Two Family Plan Review Residential Building Permit Gas Outlets 4+ + 7% State Surcharge + 10% Administrative Fee Plan Review/Residential Hourly Payments: Type of Payment Paid By CreditCard DANIEL HILL Item Total: Check Number Authorization Received By Batch Number Number How Received 0039 042490 042490 In Person Payment Total: 5/28/2004 Page 1 of 1 2:14:22PM Amount Due 31.00 1,000.00 75.00 75.00 (30.00) 1,169.14 656.56 499.09 164.89 727.42 314.63 214.23 10.00 135.71 52.09 71.00 12.00 12.00 6.00 9.00 6.00 4.00 30.00 10.00 12.00 50.00 106.00 76.00 254.00 61.26 981.65 3.00 109.32 156.17 90.00 $7,154.16 Amount Paid $7,154.16 $7,154.16 Feb-ll-04 03:51P P.02 II- 225 FIFTH STREET · SPRINGFIELD, OR .7477 . PH,(S4I)n6-37S3 . FA)(, (S4I)126-3<i89 ~~ ELECTRJCALPERMITAPPUCATION I L/ \0\J\ City Job Number C!i!!!2Ii>f ~~~O Date 51 ~'t 0 -, \o.I~ 1. LOcATIONOJ."INSTALLA170N, ....,. 3. COit'lPLETEPEESCHED[JLEBELO~' ~~ /J1;~)T~~) W/f"l LEGAL DESCRIPTiON - I J~/J:g 2~~; 13~IJO JOB DESCRIPTION p~~N: r-;~8gc,;llaw reouires you}O ~ II' . r de.': '''"ioDtec! bv me UI'e9on UlIlll} Pennn~~v~ ~1J":'9:aIrsrerablt aDd ?~~~ ia ~~tlSforth notNQ1iti!ia\imiiD-'f8'Oti\ys lof9s~Uan e 1)1 t1. ~wg>~~ ~O 1- su~~t~rg6l30filay@.01 0 throug u - Om~3P~~bta~n CORies of the,rUles, by 2. ""'caliingme {;~let, f~~e ElectrliwroQ~Jab)h~;~.D ~,\~~*f~~t~OI1 Center \;J -aet:~~i.-l. Address Sqq 7ft:; D:110 Lr1. City <. Eyt:ll'e Phone fof{h-09QS Expiration Date t5Co& _C; 10/0 I / oL( Supervisor License Number I Constr. Contr. Number 5'f Lf 3 I cr /30 jr)t-j I Signature of Supervising Electrician ~uL~_ Owners Name 'DAA.I) H.. M IP. t/ J Address 47 ~ S J/JJd. M~ .J?/AZ4 ~ City -P14C;i Je Phone 913.-1)1)/~ ,,'!#)) . OWNER INST ALLA TlO~ Expiration Date The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 , \ , , A. "Jlilew Residential- Single OT Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof /,./" $106.00 .Jflt,A60 7~OO $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder S50.00 B. Se~vi~s~i Feeders -" fustallation. AUt-rations or Relocation: -.- "'-. . . ~ . 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 401 Ampsf,(Q~tiOOAmps $125.00 ~HI V, . vc. 601 AmPSP:PifflO,9~mP.' $163.00 Over 100)\tJT >slfifl2Vl T SHALL tXPIR_E$/.f7f.M: WQ.R.K ReconnecCcm,~ENC~~ ~NOEH THIS p~f~R)q~' I~ i'vO', .""',, ' ,,~ ,',"".;' ' .,....'., R IS ABANDONED FOR '.' .". , C.T,~p,~S~J~;rjFf'l\IRID. " " '" ' ",' .' InstaUation, AlteratioR or Relocation V S 50.00 $ 69.00 S 100.00 50 tJo 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps qver 600 Amps or 1000 V olts s~e uB" above. D. ':~ranch Circuits' New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with SelVice or Feeder Permit $ 43.00 $ ),00 E. ~~~~~ella~~u.s (Se~vice/reeder not included) -Each InstaUation ' Pump or irrigation $ 50.00 Sign/Outline Lighting S 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee Is $45.00 + Surcharges . .. -. 4. SUBTOTAL OF ABOVE ' --.Z3 Z,1h:J Lft,.. VI- 7. ~A 2.0 ?-7/.-~+ 7% State Surcharge 10% Administrative Fee TOTAL Shared Dlivc(T:)iBuildinll Fonns/E!..:clJical Permit AppJicution 1-03.doc ;",. ~ ~Il-Y OF S~r<lNGFIELD SYSTEMS DEVELOPMEAoRKSHEET JOURNAL OR JOB NUMBER: COM2004-00420 NAME OR COMPANY: DANIEL HILL LOCATION: 863 MINT MEADOW , TAX LOT NUMBER: I7032343t113600 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 1 BUILDING SIZE (SF: o LOT SIZE (SF): 8461 r/J ~ ~ o u ~ ~ E-< r/J >-< d gz 1. STORM DRAINAGE ,DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S,F. x COST PER S.F. CHARGE , 4031.50 $0.290 I = I $1,169.14 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. x I COST PER S.F. I x I DISCOUNT RATE I DISCOUNT I 0.00 I $0.290 I 50% = I $0.00 ITEM 1 TOTAL - STORM DRAINAGE SDC '$1,169.14 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's x COST PER DFU I 29 $22.64 B. IMPROVEMENT COST: I NUMBER OF DFU's x I 29 $1,169.14 1070 $656.56 1091 COST PER DFU $17.21 $499.09 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC =, 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE x NUMBER OF UNITS x COST PER TRIP I 9.57 1 $17.23 $1,155.65 x INEW TRIP FACTOR I 1.00 $164.89 1093 B. IMPROVEMENT COST: I ADT TRIP RATE x I NUMBER OF UNITS x I COST PER TRIP I 9.57 I 1 I $76.01 ITEM 3 TOTAL - TRANSPORTA nON SDC ' == , $892.31 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I 1 I I $314.63 x I NEW TRIP FACTOR I 1.00 $727.42 1094 = $314.63 1054 B. IMPROVEMENT COST: INUMBER OF FEU's I x 'COST PER FEU I 1 I $214.23 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SD< = I SUBTOTAL (ADD ITEMS 1,2,3, & 4) ,= , 5. ADMINISTRATIVE FEE: SUBTOTAL x ADM. FEE RATE . $3,755.96 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Denny Wright 4/19/2004 $214.23 1055 $0.00 1054 $10.00 ]056 $538.86 I - $3,755.96 I CHARGE $187.80 135,71 1079 $52.09 1078 TOTAL SDC CHARGES =1 $3,943.76 PREPARED BY DATE . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATHTUB 2 0 3 = 6 I DRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = 0 I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 ILAUNDRY TUB . 0 0 2 ,- 0 I CLOTIIESW ASHER / MOP SINK 2 0 3 = 6 ICLOTIIESWASHER - 3 OR MORE (EA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER / ETe. 0 0 3 = 0 SHOWER, SINGLE STALL 1 0 2 ' - 2 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3' 3, I SINK: COMMERCIAL BAR 0 0 2 = 0 I SINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 SINK: SINGLE LAVATORY /RESIDENTIAL BAR 1 0 1 = 1 URINAL, STALL / WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRIVATE INSTALLATION 3 0 3 = 9 MISCELLANEOUS DFU TYPE ~ER OF EDU'S . . .~-. ~ 'i' 20 0 = ;,.:. TOTAL DRAINAGE FIXTURE UNITS, 29 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,OOO ASSESSED VALUE $5,04 $504 $4,95 $4,88 $4,75 $4.58 $4.41 $4.20 $3,88 $3.50 $3,07 $2,60 $2,14 $1.71 $1.52 $1.38 $1.19 $1.03 $0,87 $068 $0.46 $0.27 $0,09 $0,04 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR o o 1998 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x $0.46 =, $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $0.46 = , o TOTAL MWMC CREDIT = $0.00 . p~ WilIamalane ,t, l Park & Recreation District Job. No.Coll\l9.OY-l-Co<\:l.O ". SYSTEM DEVELOPMENT CHARGE WORKSHEET NAME: ~~~'~Ga.\ \\-~\\ , ' ~ ADDRESS: l{1CqS \f ~\\~~~~\~'\b,~' ~ tOCA TIQN OF PROPOSED BUILDING SITE: Street Address: ,<a(~~ t\ ~~r\ t\~~o...o PHONE: ~\~-cnt" ' STATE: 0\. ZIP:<;'lA{(j~ Plat Name: \ lO~"S.L.\~ Tax Lot Number: t~Gc.o, '1~DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC calculations and dwelling t ype definitions are, on the back.) , A. .smale-Familv Detached, ,yp Single Family home , 'NO. OF UNITS \ Manufactured home not in a park Ul:b ,X $1,000 per unit = $ \DuO ..- "8. ,Binole-Familvl\ttached, NO. OF UNITS X $924 per unit $ C. Multi:"Familv Apartment NO. OF UNITS 'X~.$692 per unit = $ D. ~anlJfacfured Home Parts. NO. OF UNITS WILLAMALANE SDC X $699 per unit = $ $ \DOO ~(fJ ~ $- \aJJ ,cIJ D 11.~/D1 Date $ 2. SDC CREDIT (if applicable) SOG-payer must furnish proof of , Willamalane Credit approval. See SDC Credit Worksheet. , , 3. TOTAL WILLAMALANE NET SDC ASSESSED (If SOCreducedfor Credit) \1N\JI... fat) Devitb"'6ment Se c s Department City of Springfield '