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Home My WebLink AboutPermit Electrical 1995-2-23 (2) . . SPRINGFIELD.. ~. The, following project as submitted h"-S the to zonmg, and does not require spc.--ciflc land us approval. ... 225 FIFTH STREET I '''(2 ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477 Zoning <...-1....1 <-- q tXfV"\c:::A INSPEctION REQUEST: 726-376~e '2-c-2"3--<i--;-- Ci ty Job Number ~.I~_ OFFICB: 726-3759 i !'viA AuthoriZE>d Signalure 1./veOltPLETE FEE SCHEDULE BELO\l J 1. LOCATIQN OF_.INSTAL4'ljIO~ . 4-\\ \ F(')~./:t1[\J.G. j . LE~AL DESCRIPTION ~ ~(){ \ ~()~():;Q8, 'f 1 FT ~ o JOB DF.$(::RIPTI,.oN t,t:. ~OI'l\r1 ~ Permits are non-transferable and expire if york is not started vithin 180 days of issuance or if york is suspended .for - 180 days. I 2. CONTRACTOR INSTALLATION ONLY , Electrical Contractor BILLS Address 317...Q...1JEST IlT.H....AVENlJE City ~11"E1llL. Phone_olF_1R<;1 Supervisor License Number 9805 Expiration Date 10/1/95 " " Constr Contr. Number 213S1 Exptration Date 4/?R/Qlr New Residential-Single or Multi-Family per dwelling unit. Service Included: A. Items 1000 sq.ft, or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or _ .Modular Dllelling Service or Feeder I A Cost Sum $ 85.00 2D $ 15.00 ~ $ 1,0,00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 1,0,00 C. Temporary Services or'Feeders Installation, Alteration or Relocation SiC!5~erv~cian (\ v. V Ovners Name \' fl-=t:y.( ~ Address--12-lJ'S }b 2rvi Ci ty ~I)\l H .N1____Phone~ OVNER I~ALLATION The. installation is being made on property I own which is not intended for sale, lease or rent. Ovners Signature: DATE: . r!J -6J "6 -OS RECEIPT I: - \ 1. n 'c-) Y:4 RECEIVED BY: c=::L U",.D... , ..I B. 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 'Over 1000 amps/volts Reconnect Only .200 amps or less ~ 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 see "BIl 40 above New, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm One Circuit Each Addi tiona1 Circuit or with Service or Feeder Permit E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 'lWtIL ~9o . $ 35.00 $ 2,00 not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 t"'\.~ cO '''.75 11o~",~O fl \ '\ .OB NO. eril' OF SPRINGFIELD SYSTH1S DEVELOPI1ENT CHARGE \~ORKSHEET (COMMERCIAL & RESIDENTIAL) . AITACIiMENT B1 Cfsoos<! NAME OR COMPANY: (0 l.'j i~c",,[. s LOCATION' #17/ (-i)r<.S'-'THI/\ DEVELOPMENT TYP!'"' l.-. D. l2.. BUILDING SIZE: . N 8-.) :S.i~ (Z.. I.OT SIZF' SQ. Ft. 1. qf1RM ORA T N6(iE IMPERVIOUS SQ. FT. Z,.3?> fo X $0,209 PER SQ. FT. 0'f8B~) . 2. SANTTARY SFWFR-CTTY '0 ~~ NO. OF PFU'S /6 X $43.26 PER PFU ' . $ "Ie, ,- _ (See Reverse) 3, TRANSPf1RT.A,TTf1I~ NO OF UNITS X TRIP RATE X COST PER TRIP \ X \.0\ X $436.19 X X X $436.19 X $436.19 0- l/'-/o~) $ $ SUBTOTAL (ADD ITEMS 1.2. & 3) $ 1.701 ~ 4. ~ANTTARY SFW!'"R-K~MC NO. OF PFU'S I B x $17.19 PER PFU + $10 MWMC ADMIN. FEE $ 3\ '14::' (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) S (Ll5 z"'Z. \ . IQIAI -MWMC SOC ( S 'Z/t.j;2: ) SUBTOTAL (ADD ITEI"S 1. 2 . 3 & 4) S i. q E. \ '€. , 5. AOMTNTSTATTV!'" FF!'"S BASE CHARGE (SUBTOTAL ABOVE) X .05 Ci '\"\ DE. ~ ~. ---rR.O~ M L/4LU$,EfC- Date: ::SAt-i, 3i , 19~15" / .. ,- SDc' Coordi nator IQIAI S(1C .3 5, 2.,080';";- B2 ,SDC . .,' , I , . F!XTURE U'NIT CALCU~ TION TABLE: Number of, New .es X Unit Equivalent c Fixture uy6 (NOTE: For rcm~dcls. calculate o.e NEI additional fixturcsl I NUMBER OF UNIT FIXTURE FIXTURE TYPE, NEW FIXTURES EOUIVf,LENT UNITS Bathtub...".,..........,.,."""".".""."".."""".,.",..".",:.. . Drinking Fountain, ,......,.....,..,.. ......,.. ,.., ,..,......'".."", Floor Drain........,'............,..,.,...........,........",."........... Interceptors For Grease/Oil/Solids/Etc................, Interceptors For Sand/Auto Wash/Etc.................. Laundry TubIClolheswasher................................,.. Ciotheswasher -;3 Or More.................,................... Mobile Home Par.k Trap (1 Per Trailer),................. . Receptor For Reffigerator/Water Station/Etc........ Receptor For Commercial Sink/Dishwasher/Etc.. Shower, Single Stall................................................. , Shower, Gang....'... ...............................'................... Sink: Bar, Commercial. Residential Kitchen........................ Urinal, Stall/Wall.'.:..................,....,............................ Wash BasinlLavatory, Single............................,..... Toilet, Public Installation............... ,........................ Toilet, Private...!.............................................. ..... Miscellaneous: ,D,,'II ~R's Sol"',/;" CREDIT CALCU~TION TABLE: calculate credits separates. r- "Z. -z. z.. TOTAL FIXTURE UNiTS 2 1 2 3 6 2 6 6 1 3 2 l/Head 2 2 1 6 4 ..l = If -z. -z. -z. B 18 Based on assessed value. If improvements occurred after annexation date in table, Year Ann~xed Rate per $1.000 Assessed Value 1979 or before $3.46 1980 3.38 1981 3.32 1982 3.21 " 0:: 1983 3,06 1984 2.92 1985 2.73 Credit for, Parcel or land Only If Applicable Improvement (if after annexation datel p,NHt:..x. DP,,\E..', I "IC",D Year Annexed 1985 1986 1987 1988 1989 1990 1991 1993 f3 41a X $ 1'3.0"'70 (Rate X Assessed Value I X $ (Rate X Assessed Value I = = CREDIT TOTAL = $ I' Rate per $1.000 Assessed Value $2.46 2.14 1,77 1.37 0,97 0.61 0.44 0.15 .f 45 2.~ . @ !!!ill~'!!i:!!~!!~ . ~ Job No. !3i5.00efft SYSTEMS DEVELOPMENT CHARGE WORKSHEET PHONE: t\4(), ~~ NAM~ 0~ t~~) ADDRESS: \AJ\ S ~O. ~rt.~ &tot: . STATE: to\'2.-ZIP ~, LqCATION OF I"ROPOSED BUILDING SITE: .~_ . Street Address if Known: 4\,\ \ ~~ 0.-) . .. Platt Name: U 000. ~ Tax Lot Number: .lli/) ') () 'S 'QfL C>0'tO to \ - . 1. DEVELOPMENT TYPE (Check appropriate dwelling(sl. SDC Calculations and dwelling type definitions are on the back.) . A. Sim!le Family - Detached Single Family home NO OF UNITS 1 B. SimIle Family - Attached NO OF UNITS C. Multi-Family Aoartment NO OF UNITS D. Manufactured Home Park NO OF UNITS WPRD SDC Manufactured home not in a park $ :1ri:1fQ X $400 PER UNIT _= . X $370 PER UNIT = '$ X $277 PER UNIT = $ X $280 PER UNIT = $ $~'CO ,15 $. $%{)eV 2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit approval. See SDC Credit Worksheet. 3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit) \U\.D ~ ~{\bCl Community S~rvices Diyi\i~ ct 19-'31 qs Date RESIDENTIAL PERMIT APPLICATION ......_...../ Inspections: 726.3769 Office: 726.3759 . :5<2-+-b~ck :s/"" . SP ~..z- q$)5t JOB NUMBER 225 Fifth Street Springfield, Oregon 97477 ;::::0 ~ s t.I rh/ A- I LOCATION OF PROPOSED WORK' ASSESSORS MAP' 'If' - () z. - () tJ-zi 004' tJ ~ !S.- BLOCK: / LOT: OWNER' ADDRESS' CITY' f'o?,u . I / ~ 75' 5 _ ). c'-> ~ '" +'1,/ / . TAX LOT' . . SUBDIVisl<)N: ~()~ //i!JL2fA- 7'-1 7 'if? (') t( PHONE: ' STATE: 'IJvet:i )i..<.../, , I ZIP: '171(77 DESCRIBE WORt<' NEW V REMODEL S.F-D- ADDITION DEMOLISH OTHER CONST. CONTRACTOR " ' 3~~;."'I7 CONTRACTOR'S NAME yDDR SS GENERAl' rJ'J-r/o1.. fA}1;/i /b'?<; PLUMBING: ;..j CI / I a h p M#/lJh4-ll~ /8///$/ MECHANICAl' ELECTRICAl' EXPIRES PHONE tn. \t).~ 14l-~1(1 ~~ - OFFICE USE - QUAD AREA: LAND USe:- \ \ \ \ . FLOOD PLAIN: · OF BLDGS' R~+ }J\. · OF UNITS' , ZONI'NG CODE: Jl)12.- OCCY GROUP: CONSTR. TYPE:.JL~ '. OF BDRMS: :::t; · OF STORIES: \ HEAT SOURCE: W\-t SECONDARY HEAT: 0' WATER HEATER' E-- RANG~' F SQUARE FOOTAGE: II oQ.{ Q To request an Inspection, you must call 726-3769, This Is a 24 hour recording, 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 work day, ~.'[!J Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms, o Underslab Plumbing/Electrical/ Mechanical - Prior to cover. f\TI Footing - After trenches are ~ excavated. ' o Masonry - Steel location, bond ,beams, grouting, rv1 Foundation':"" After forms are L....(:U erected-but- prior to'concrete placement. o Underground Plumbtng - Prior to filling trench, 1\71 Underfloor Plumbing I Mechanical '-f" -,Prior to Insulation or decking, rVl Post and Beam - Prior to floor 4J Insulation or decking. r\11 Floor Insulation - Prior to Lf>-l decking, r'itl Sanitary Sewer - Prior to filling Lf>-l trench, i'v'1 Storm Sewer, - Prior to filling l.+::J trench, 1\7'1 Water Line -' Prior to. filling L.J.J trench, rY1 Rough Plumbing - Prior to ~cove~ ' REQUIRED INSPECTIONS 00 R~ugh Mechanical"': Prior to ' , cover. . . . rVl Rough Electrical _ Prior to ~ cover. n Electrical Service - Must be '-f'..approved to obtain permanent electrical power, o Fireplace - Prior to facing materials and framing Insp, ~ Framing - Prior: to cover. rYl Wail/Ceiling InsJlati.n - Prlo; to ~ cover. ~ Drywall - Prior to taping, o Wood Stovo - Afti.r installatlo,;", D Insert - After fireplace approv~1 and Installation of unit. ~ Curbcut & Approach - After forms are erected but prior to . placemont of concrete. . m Sidewalk & Driveway - After L...f:::J excavation Is' completQ, forms . and sub-base material In plac~. o Fen~e. - When ~omP.leted. rYI Street Trees - When all required ~ trees are planted. ... I\fl Final Plumbing - When all L..fcJ p'lumblng work Is complete. , . RIl Final ElectrIcal - VVohen all If' electrical work Is complete,' rvl Final Mechanical - When all ~ mechanical work Is complete. 1\71 Final Building - When all L-f'J required Inspections have been approved and building Is completed. DOther MOBILE HOME INSPECTIONS o Blocking and Set.Up - When all blocking Is complete. D P'lumbtng Connections - When home has been connected to . water and. sewfr. D. Electrical Connection - When blocking, set-up, and plufT,lblng Inspections have been approved and the home Is connected to the s~rvlce panel. o Final - After all required . Inspections are approved and porches, skirting, decks, and . venting have been Installed. I Lot faces tt.l W i Lot sq, ltg, I M.\S. ;1,,0,- Lot coverage n.9 Topography ~ 5 , / Total height ~ ' , . (~)') - i BUILDING RcRMIT t " ITEM I SQ, FT. ja-~lA I I I .' . ~". :'~ ':):",;\1'., '\ i ~.tS THE PROPOSED WORKtN THE _, ' LX'~~r Setbacks, I P.L, , Acel HISTORICAL DISTRICT, OR ON HSE GAR IN I THE HISTORICAL REGISTER? Corner If yes, this application must be signed ,\ S I and approved by the Historical Panhandle :. Iw (C;;' Dt)' I Coordinator prior to permit Issuance, Cul-de-sac, IE 10' I APPROVEP' X $/SQ, FT, = 5to .w \4.10. VALUE ~9,~~ . '-rf)~ I ~aln Gacage Carport Total Value : 1:S. \ rJl . = . 3,bl.- ~~ -~~9.~ Building Permit Fee State Surcharge' I Totai Fee i \'Oos,+- '3.'t (A) . '., SYSTEMS D;EVELOPMENT CHARGE (SDC) I . I\DQ~ u... I (B).~, exl PLUMBING :PERMIT , ITEM! FEE I Fixtures I . I ~ l CoC'J QQ Residential Bath(s) N' , FT. Sanitary Sewer i Water I FT, I Storm Sewer I FT, Mobile Home I .. i Plumbing Permit I State Surcharge - I Total Charge I j,c-'ll c;!:Q. l.!l~ ll.~. ~ e"CQ. +'!:.~ (C) I MECHANICf-L PERMIT Furnace I , Exhaust Hood L{.s.Q. f,.~ Vent Fan N' ~ , , Wood Stovellns'ertlFlreplace Unit . r . I Dryer Vent j \ ! I Mechanical Permit I I I State'Surcharge' Total Permit ! '. ~.~ ls'.~ \.D.~ l. 119- ~~.!lll Issuahce .lS~-4-'!,~ (D) I MISCELLANEOUS PERMITS Mobile Home I State Issuance j State SUrChargel Sidewalk S '"!,I It ..d Curbcut N. \ It ' I Demolition I ~._ 3.._,,_,._~~c~.~~ ~~~ l(,~~ I Total Mlscellanepus Permits (E) .' , . TOTAL AMDUNlj DUE (excluding electrical) (A, B, C, 0, and E Combined) , 11. 'is.. \~,~ ,~ 3.~,bS . Ie" 1,4;0 .Lt ~~.Cf) ::s \03>&\ , 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. Plan Check Fee' Date Paid: Receipt Numbe" ~e~BY: ~~Wed By ~l"3,hs , Dllte Systems Development Charge Is due on all undeveloped properties within the City limits which are being Improved, ADDITIONAL COMMENTS 01ll\t\[)\(\Q . C'.~c1011Y1 QD ~r brYY'l ~O nts \d--\-T: \~,Dl.n ~l'\QQj ~mO ,'. IClft2n r- , ...,... 1','II1II By signature, I stale and agree, that I have carefully examined the completed application and do hereby certlly 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 Building Safety Division, I further certlly 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 tlme~ that each address Is readable 'rom the street, that the permit card Is located at the front of the property, a~ldfJl~proved set of plans will remain on the, site at all0 ring construction, Slgnaturp Datf' /-/7-9S VALIDATION: '~ RECEIPT NUMBER DATE PAIl' f"\ 'j/J.'...l.., , AMOUNT RECcf{: ~s.C>f.~ RECEIVED BY I[)f} ../ ,........ RESIDENTIAL PERMIT APPLICATION " Inspections: 726.3769 Office: 726.3759 LOCATION OF PROP~SE~ WORK: ' 431 Z ASSESSORS MAP' . I~ oZ-OS2J LOT: .' SPRINGFIELD . JOB NUMBER 9J/~ 225 Fifth Street Springfield, Oregon 97477 BLOCK: SUBDIVISION' TAX LOT: C){'-I Do J. Jk..T-~ .rtn)_ ~51l7frA- OWNER: J,- el3t.2 ,'))::1;:7)' ADDRESS: CITY: r~ , ~.;?J DESCRiBE WORI'" NEW ~ REMODEL . ADDITION STATE: '--~ .~)) / .77l'hU DEMOLISH OTHER PHON~' ZIP: 9'7~7B CONTRACTOR'S NAME GENERAL: _~~c...g ADDRESS 'p'tf),~tl><..23<j ...?;'~lA. CONST, CONJB~~Q.R # =....._, Z~~ *"_ _..__L.' .. EXPIRES .PHONE A:?/~h (' f ;J3-27ZO , .' , PLUMBING: MECHANICAL: ELECTRICAl' 2,'~ c:..., c... . # OF BLDGS: ) ~CCY G~OUP '~-:s QUAD AREA: # OF STORIES: I WATER HEATER' - OFFICE USE - II j I \ CONSTA. TYPE: \/ N HEAT SOURCE:~e=-z:-'T. #:.~ LAND USE: # OF UNITS: RANGE: FLOOD PLAIN: ZONING CODE: # OF BORMS: SECONDARY HEAT: SQUARE FOOTAGE: ----dc..,::>. :To request an inspection, you m'ust Gall 726-3769. This is a 24 hour recording. 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 work day. . 0 Temporary Electric D Site Inspection - To be m3de after excavation, but prior to setting forms. o Underslab Plumbi"ng/Eleclricall Mechanical - Prior to cover. .0 Footing - Arter trenches are excavated. '0 Masonry - Steel location, bond beams, grouting., !KJ Foundation - Arter forms are erecled but prior to concrete placement. o Underground Plumbing - Prior to filling trench. o Underfloor Plumbing/Mechanical _ Prior 10 insulation or decking. [Z] Post and Beam - Prior to floor insulation or decking. ~ Floor Insulation - Prior to decking. o Sanitary Sewer - Prior to filling trench. o Storm Sewer - Prior to filling trenc:h. o Water Line - piior-to Oiling trench. , '. .'), o ~ou9h Plumbing - ~~ior to ~OV(;(. . REQUIRED INSPECTIONS o Rough Mechanical - Prior to cover. I\7l Rough Electrical - P:-ior to L4--J cover. o Electrical Service - Must be approved to obtain permanent electrical power. o Fireplace - PrIor to facing materials and framing Insp. ~ Framing - Prior to cover. rVl Wall/Ceiling Insulation - Prior to ~ cover. I ;XI Drywall - Prlor ~O..~~Ping. o Wood Stove - After Installation. _ 0 Insert - After fireplace approval ~ . and installation of unit. [J Clubcut & .4.pproac:h - After , forms ,:tre erected but prior to pI :-':clIlent of concrell;'. D Sidowalk & Driveway - After .- e;lc3valion is complete, (o"ms 3;)..1 sllb.base maTerizl in piace. o Fl':":cC - \/Jhcn completeCl. o Slro~t Trees - When ail (r;:quired trr:c:~> are planted. o Final Plumbing - When all plumbing work is complet.e. lZl Final Electrical - When all electricat work is complete. o Final Mechanical - When all mechanical work is complete. r7I Final Building - When all ~ required Inspections have been approved and building is completed. OOlher MOBILE HOME INSPECTIONS CJ Blocking and Set.Up - When all blocking is complete. o Plumbing Connections - Wilen home has been connected to water and sewer. o Electrical Connection - When blocking, set-up, and plumbing Inspecttons have been approved and the home is connecled to the service panel. o Final - After ~1I required ins~ections are api=>roved and porches, skirting, decks, and venting have been installed. . . -, '. Lot faces -?- Lot Type Setbacks IS rHE PROPOSED WORK IN THE Lot sq, fig, Interior I P,L, HSE GAR ACC I' HISTORICAL DISTRICT, OR ON IN I THE HISTORICAL REGISTER? Lot coverage Corner n If yc~, (his applicat)on must be signed Is tti~ ~7' I and, approved by the Historical Topography Panhandle Iw /t:J / I Coordinator prior to permit issuance. Total height Cul.de.sac IE E"Kj ~y . I APPROVED: BUILDING PERMIT BUILDING VALUE, PLAN CHECK ITEM SQ, FT. X $/SQ, FT, VALUE AND BUILDING PERMIT . Main Garage Carport , &lA) 2. ~- 2... !4/~2. r- p.::>.5'o "-)./ ,<,- S3 ~ I /6. ~3 SYSTEMS DEVELOPMENT CHARGE (SDC) If!:, (B) II 14 ~ Total Value Building Permit Fee Slate Surcharge. Total Fee (A) PLUMBING PERMIT ITEM FEE Fixtures Residential Bath(s) N' Sanitary Sewer FT. Water FT, Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood StovellnsertlFireplace Unit Dryer Vent FX'rE//D O~/ Mechanical Permit /..."~ -z::> /0,- .~ 2~ Issuance State Surcharge -Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk fI Curbcut ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B. C, D, and E Combined) ~-5'r This permit is granted on the expres's condition that the said' . 'construction shall, in.all respects, conform to lf1e 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 provisi~ns of said ordinances. Plan Check Fee: 7/. iiJ3 Dale Paid: '-2~'7 9 J Receipt Number:__9jf~7 Received By: _~ p;an~~/ <1f1'- Y-'" :? Date Systems Development Charge is due' on all undeveloped properties within the City limits which ~re being improved. ADDITIONAL COMMENTS By signature, I state and agree, that I have carefully examined the complete:d application and do hereby certify that all jnformation hereon is true and 'correct, and I further certify that any and all work pcrforn"led 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 o.f the Building Safety Division. I further certify that only cornractors and employees who aro in compr~iance with GRS 701.055 will be used on this project. I further agree to ensure that all required inspectio.ns are reques~ed 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 nle approved set of plans will remain on the site at all times during construction. Signature _{7'h~ .-#- ~ . -'" Date _&_ c.- L c; '15 ~ ' VALIDATION: RECEIPT NUMBER 7:$// lJATE PAin #:. c~.q. "3 AMOUNT RECEIVED _L6,C:. 571 RECEIVED BY ~L-..,.;.7 ~ , .../.; .... . .08 NO. q'?fOOO ../.' . CITY OF SPRINGqELO SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR COMPANY: Ie.FZR-Y i :Te.AN /-fUFrJVt AN lOCATION: L/~'2 r:O~SY-rHJA /~OZ,052-1- 01'100 DEVELOPMENT TYPE: L-l?/Z. - ADt:?lT/ON. BUILDING SIZE: /I.,t. 7.-1 tLt;.ss-f",(~r.tAvt:;lLOT SizE SQ. Ft. 1. STORM DRAINAGE IMPERVIOUS SQ. FT, 2/0 X $0.203 PER SQ. FT. ~L(-? ~) ............ .-/ 2. SANITARY SEWER-CITY NO. OF PFU'S X $42.08 PER PFU c-) (See Reverse) 3. TRANSPORTATION. NO OF UNITS X TRIP RATE X COST PER TRIP X X $424.31 ~- ) ~ X X $424.31 $ X X $424.31 $ 4. SANITARY SEWER-MWMC NO. OF PFU'S x $15.125 PER PFU + $10 MWMC ADM FEE $ - (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ }OTAL-MWMC SDC ~ '-- .../ SUBTOTAL (ADD ITEMS 1,2,3 & 4)$ 4- 2- '" ... 5. ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) X .05 ~'~~L~ 711t.f11~ , -\j Kip Burdick. " SDC Coordinator f 7_~~ '-- .../ ,1,/7~ TOTAL SDC $ i7 ,