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Permit Support Document FOR OFFICE USE ONLY— SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter i c A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: , SOS J47144 s/r S DATE REECEIVED:/ DEPT: BUILDING DIVISION / ECEI `J bD FROM: 'we, SEP 2 12020 CITY OF TIGARD COMPANY: 69/4,A BUILDING DIVISIO}'V PHONE: 50S 91-3 0'1 6 ? r By: EMAIL: /( k,'s ieb �H?�Qr'( • CCU "H RE: ( 26S sIA) cQt.-e. �ots)V $ MS'T2oz d - 0c7r6 (Site Address) (Permit Number) Rau`e� (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): X. ©2 r n p REMARKS: C 475 cl -f zliee,eceivas i5 . i>6G 'WIOJ , I(— �J 11 ii FO OF ICE US ONLY Routed to Permit Te•. ' ian: Date: °) /� jVLA Initials: Ak Fees Due: ❑Yes P A� No Fee Des ti : Amount Due: f7$ Special Instructions: Reprint Permit(per PE): ❑ Yes No ❑Done Applicant Notified: Date: Initials: ]:\Building\Forms\Transmittal Letter-Revisions_073120.doc Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs Please complete the following information: Customer Name: M sr L c3 1 a u -CAI-. Service Address: Street/Suite tt: 12 S" 5'' ) J✓dc� '.woodS f- (City: 2✓ (2) (J State: Zip: q 7 22 3 Phone Number. ( ) 7j ' 1 3. 04?(i q' Email: 1.5 t 0 i S rn C‘, ; 1. CO,. Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed totaL Fixture Unit Current Point Current Proposed • Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = x 1 = • Bidet x 1 = x 1 = Clothes washer x 4 = y x 4 = Dishwasher 1 x 1.5 — t. rj x 1.5 = Hose bib ( x 2.5 = 2.5 x 2.5 = • Hose bib,each 2 x 1 = 2 x I = Kitchen sink 1 x 1.5 = ( • 5 x 1.5 = Laundry sink x 1.5 = x 1.5 = Lavatory 2 x 1 = '2._ 4 x I = 1.f Water closet, 1.6 GPF 3 x 2.5 = 1,S x 2.5 = Bathtub/whirlpool \ x 4 = y x 4 = Shower stall Z x 2 = Lk x 2 = • Bath/shower combo x 4 = 1 x 4 = Current Points: 0_9 Proposed Increase: $ Current Points+Proposed Increase= 3 7 =New Total Points =Required Meter Size 3/y Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=%s" 37.5 and over points=1" 13 76 New Meter Size Needed for New Total Points: 3/4Cost: $ i9 (see page 1) Current Meter Size per Utility Billing: --p- . Cost: $ 91 9 0 6 (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ L 0 1 I (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY Current Meter Size Confirmed with UB i4 /O 42-/Z.02 Signature of epresentative Date/ L•/Bufding/Forms/WaterMetes 070119Add.dOCx Page 2 C1eanWater Services Service Provider Letter Our commitment is clear. Submission Date: Aug 18,2020 Confirmation#: 482 Applicant Name: BLAUER,MARC CWS File#: 20-002195 Contact Email: laslokismcb@gmail.com Review Type: Partner City Plan Review Contact Phone: (503)953-0969 Ground Disturbance: 814 Primary Address: 9265 SW Edgewood ST New Impervious Area: 814 Tigard,OR 97223 Primary Jurisdiction: Tigard Mod.Impervious Area: 0 Affected Tax Lots: 2S1020000400 Development Activity: SFR Addition Project Description: adding 814 sf of living space;;Sfd Addition FOR DISTRICT USE ONLY ® Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200' of the site. This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 19-5, Section 3.02.1, as amended by Resolution and Order 19-22. All required permits and approvals must be obtained and completed under applicable local,State, and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s) found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 19-5, Section 3.02.1, as amended by Resolution and Order 19-22. All required permits and approvals must be obtained and completed under applicable local,state and federal law. ❑ This Service Provider Letter is not valid unless CWS approved site plan(s)are attached. ❑ The proposed activity does not meet the definition of development orthe lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. ❑ NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed By: LDRToolReview Date:August 18, 2020 The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the'Cu alatin River Watershed. Our partners include municipalities,environmental organizations,and developers large and small. Contact Us*25505W Hillsboro Highway*Hillsboro,Oregon 97123 phone:503-681-5100*email:splreview@cleanwaterservices.org*website:www.cleanwaterservices.org/permits-development Clean Water Services -Service Provider Letter Submission Date: 8/18/2020 Confirmation t: 482 Applicant Name: Marc Blauet Review Type: Partner City Plan Review Contact Email: laslokismcb@gmail.com Ground Disturbance: 814 Sq. Ft. Contact Phone: 503-953-0969 New Impervious Area: 814 Sq. Ft. Primary Address: 9265 SW EDGEWOOD ST Mod. Impervious Area: 0 Sq. Ft. Primary Jurisdiction: Tigard Development Activity: Single-Family Dwelling Addition Affected Tax Lots: 2S102DC00400 INSTRUCTIONS:This pre-screening report is the Service Provider Letter(SPL)as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22. PROVIDE A COPY OF THIS SPL TO THE JURISDICTION RESPONSIBLE FOR LAND USE REVIEW AND PERMIT ISSUANCE.This pre-screening review does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered and this review does NOT eliminate the need to obtain additional CWS permits or reviews if project changes in scope or location.All required permits and approvals must be obtained and completed under applicable local,State and federal law. Pe`�tni ux RgNt��r I ; a'J ,_ '- Re quit d(r� Next S teps • Environmental Site Assessment No Review Water Quality Treatment Review TBD Contact city(primary jurisdiction)responsible for land use review and permit and Stormwater Inspection issuance. Erosion Control Inspection Permit TBD Contact city(primary jurisdiction) responsible for land use review and permit issuance. Erosion Control Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit with Site Plan issuance. Line Tap Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit issuance. Disconnection Permit TBD Contact city(primary jurisdiction) responsible for land use review and permit issuance. Connection Permit TBD Contact city(primary jurisdiction) responsible for land use review and permit issuance. Connection Permit with Plumbing TBD Contact city(primary jurisdiction)responsible for land use review and permit Plan issuance. Easement Review TBD Contact city(primary jurisdiction) responsible for land use review and permit issuance. The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the Tualatin River Watershed.Our partners include municipalities,environmental organizations,and developers large and small. Contact Us,2550 5W Hillsboro Highway`Hillsboro,Oregon 97123 phone:503-681-5100*email:splreview@cleanwaterservices.org'website:www.cleanwaterservices.org/permits-development • CleanWate�\Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number 20-002195 1. Jurisdiction: Tigard 2. Property Information(example: 1 S234AB01400) 3. Owner Information Tax lot ID(s): Name: Marc Blauet Company: Address: 9265 SW Edgewood St OR Site Address: 9265 SW Edgewood St City,State,Zip: Tigard, OR,97223 City, State,Zip: Tigard, OR, 97223 Phone/fax: 503-953-0969 Nearest cross street: Omara Email: Laslokismcb@gmail.com 4. Development Activity(check all that apply) 4. Applicant Information ® Addition to single family residence(rooms, deck,garage) Name: Marc Blauet ❑ Lot line adjustment ❑ Minor land partition Company: ❑ Residential condominium 0 Commercial condominium Address: 9265 SW Edgewood St ❑ Residential subdivision 0 Commercial subdivision City, State,Zip: Tigard, OR, 97223 ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 503-953-0969 Other Email: Laslokismcb@gmail.com 6. Will the project involve any off-site work? ❑Yes 0 No 0 Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document, and to the best of my knowledge and belief,this information is true, complete, and accurate. Print/type name Marc Blauet Print/type title Signature ONLINE SUBMITTAL Date 7/30/2020 FOR DISTRICT USE ONLY O Sensitive areas potentially exist on site or within 200'of the site,THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also be required. O Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5, Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,State and federal law. ® Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,state and federal law. ❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. 8/18/2020 Reviewed by Rachael Nys Date Once complete,email to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439 OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro,Oregon 97123 Revised 2/2020 • ._. Main Office • 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • p: 503,681.3600 f:503.681.3603 ^ cleanwaterservices.crg Branden Taggart From: #Building Permit Technicians Sent: Friday, October 9, 2020 7:09 PM To: 'laslokismcb@gmail.com' Subject: FW: 9265 SW Edgewood St - building permit for addition: MST2020-00256 Attachments: 20200807_080530jpg; CWS Service Provider Letter.pdf; Invoice.pdf Hello Mark, I have completed our final review of the Building permit for your addition, and I noticed the Clean Water Services Service Provider Letter was missing a signature from them. The Service Provider Letter we received is attached above. Please contact Clean Water Services to have them sign the document. Additionally, we will need your contractor's CCB license number before we can issue this permit. Once you have obtained the signed document and have provided your contractor's license information,we will be able to issue this permit after the fees are paid. The balance due for the permit is$4,157.10, and I have attached an invoice above for you to reference. The fees can be paid online through our website: https://aca.accela.com/tigard/Default.aspx. From there, click on the Building tab, enter the permit number(MST2020-00256) in the Record Number field, and click Search. Once paid, please notify us at TigardBuildingPermits@tigard-or.gov, and I will place this permit in our open Permit Center conference room for you to pick up after we receive the items described above. Thank you, Branden Taggart • City of Tigard a. , Senior Permit Technician Community Development 7'(r-3ARD 13125 SW Hall Blvd Tigard, OR 97223 (503)718-2449 brandent@tigard-or.gov From: Marc Blauer<laslokismcb@gmail.com> Sent: Friday,August 7, 2020 8:12 AM To: Lina Smith <LinaCS@tigard-or.gov> Cc: Agnes Lindor<agnesl@tigard-or.gov>;#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Subject: Re: 9265 SW Edgewood St - building permit for addition Caution!This message was sent from outside your organization. Hi Line, thanks for getting back to me so quickly. 1. I've attached a copy of the site plan with the silt fence added. It's A-1 in the plans. Let me know if that's what you need. 2.The house is on public sewer. i • 3. Waiting on paperwork back from Clean Water 4. I'll get this water meter worksheet to you shortly. Thanks again for your help. Marc On Thu, Aug 6, 2020, 5:42 PM Lina Smith<LinaCS@tigard-or.gov>wrote: Hi Marc, I'm reviewing your building permit application, and we'll need the following additional items/information: 1. Site plan: Please e-mail us a copy of your site plan, and make sure to show erosion control measures on there. Applicants typically show this is a silt fence on their site plans. 2. Is your property on septic? If so, please show the location of the septic tank on the site plan. 3. You'll need to obtain a service provider letter from Clean Water Services. Please fill out this form online and upload your site plan here: https://www.cleanwaterservices.org/documents-forms/pre-screen-form/ 4. Since you'll be adding bathroom(s), please fill out this water meter worksheet: https://www.tigard- or.gov/document center/UtilitvBilling/Water MeterWorksheet-Additions Remodels ADUs.pdf We'll need items#1 & 2 as soon as possible, so there's no delay in processing your permit. We don't need items#3 &4 right away, but we'll need them before the Building Division can issue your permit. I'm going to be out of the office for the next few business days, so please hit"reply all" if you have any questions,or to send us these items. Thank you, Lina Smith Assistant Planner City of Tigard Community Development 13125 SW Hall Blvd.Tigard, OR 97223 E-mail: LinaCS(a tgard-or.gov 2 Branden Taggart From: #Building Permit Technicians Sent: Friday, October 9, 2020 7:27 PM To: 'laslokismcb@gmail.com' Cc: Dianna Ornelas Subject: RE: MST2020-00256 - Blauer- 9265 SW Edgewood St Attachments: WaterMeters_070119_Add.pdf Hello Marc, I noticed that we have not yet received approval of the correct Water Meter Fixture Unit Worksheet for your addition. Please follow Dianna's instructions below, as approval from our Utility Billing Department is needed prior to permit issuance. Thank you, Branden Taggart ■ City of Tigard Senior Permit Technician Community Development attiOD 13125 SW Hall Blvd Tigard, OR 97223 (503)71B-2449 bra rident@tigard-or;gov From: Dianna Ornelas Sent: Friday, August 28, 2020 9:18 AM To: laslokismcb@gmail.com Cc: UB Online <UBOnlinepay@tigard-or.gov> Subject: MST2020-00256- Blauer-9265 SW Edgewood St Hello Marc, In review of your application packet I noticed that the water meter fixture unit worksheet submitted is not the correct form for adding plumbing fixtures to an existing dwelling. Additional plumbing fixtures may result in the need to upsize the existing water meter. Please complete the attached worksheet for Additions/Remodels/ADUs and return to our Utility Billing Division at UBOnlinepay@tigard-or.gov for review and approval. You will need to list all existing plumbing fixtures and all newly added plumbing fixtures. Utility Billing will email back the worksheet and their recommendations for water meter upsizing which we must have prior to permit issuance. Thank you and please let me know if you have any questions. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits 1 Dianna Ornelas From: Dianna Ornelas Sent: Friday, August 28, 2020 9:18 AM To: laslokismcb@gmail.com Cc: UB Online Subject: MST2020-00256 - Blauer- 9265 SW Edgewood St Attachments: WaterMeters_070119_Add.pdf Hello Marc, In review of your application packet I noticed that the water meter fixture unit worksheet submitted is not the correct form for adding plumbing fixtures to an existing dwelling. Additional plumbing fixtures may result in the need to upsize the existing water meter. Please complete the attached worksheet for Additions/Remodels/ADUs and return to our Utility Billing Division at UBOnlinepay@tigard-or.gov for review and approval. You will need to list all existing plumbing fixtures and all newly added plumbing fixtures. Utility Billing will email back the worksheet and their recommendations for water meter upsizing which we must have prior to permit issuance. Thank you and please let me know if you have any questions. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits 1 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Water Meter Fixture Unit Worksheet For Additions /Remodels /AD Us 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov LOCATION: City of Tigard—City Hall WATER METER SALES: Utility Billing By Appointment Only: 503-718-2460 13125 SW Hall Blvd. Monday —Thursday, 9 a.m. to Noon Tigard, OR 97223 METER: SIZE: FEE: Pricing effective 7/1/2019 5/8" $9,406.00 Fee includes: 3/4" $13,425.00 water system development charge, 1" $24,645.00 water meter, and 1-1/2" $72,969.00 meter installation fee. 2" $118,163.00 DETERMINING METER SIZE FOR RESIDENTIAL CUSTOMERS City of Tigard Water Service Area uses the American Water Works Association Manual and the Oregon Plumbing Specialty Code to determine the size of meter needed to adequately serve buildings. Due to the variety of home sizes built in the Tigard area, we count the fixture units of all homes to determine the appropriate meter size. Use the worksheet on Page 2 to calculate the current number of fixture units compared to the proposed increased number of fixture units, which will determine whether an increased meter size will be required. Submit this signed worksheet with your building or plumbing permit application submittal. DOCUMENTATION Once you are ready to purchase the new meter,please provide the following items to the Utility Billing counter: • Completed water meter fixture unit worksheet for additions, remodels, ADUs, etc. (on back page). • Copy of building or plumbing permit application date-stamped by building division. • Copy of issued building or plumbing permit. Your fixture count will be verified and your request will be processed upon receipt of these documents. No exceptions. INSTALLATION TIME Once the upgraded meter size has been purchased, please contact Public Works for installation. Their number is 503-718-2591. Most meters are installed within 10-14 business days. 1:/Building/Forms/WaterMeters_070119_Add.dOCX Page 1 Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs Please complete the following information: Customer Name: Service Address: Street/Suite#: City: State: Zip: Phone Number: Email: Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total, the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = x 1 = Bidet x 1 = x 1 = Clothes washer x 4 = x 4 = Dishwasher x 1.5 = x 1.5 = Hose bib x 2.5 = x 2.5 = Hose bib, each x 1 = x 1 = Kitchen sink x 1.5 = x 1.5 = Laundry sink x 1.5 = x 1.5 = Lavatory x 1 = x 1 = Water closet, 1.6 GPF x 2.5 = x 2.5 = Bathtub/whirlpool x 4 = x 4 = Shower stall x 2 = x 2 = Bath/shower combo x 4 = x 4 = Current Points: Proposed Increase: Current Points+Proposed Increase= =New Total Points =Required Meter Size Meter Sizes: 1 to 30 points= 5/8" 30.5 to 37 points=3/4" 37.5 and over points= 1" New Meter Size Needed for New Total Points: Cost: $ (see page 1) Current Meter Size per Utility Billing: Cost: $ (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY Current Meter Size Confirmed with UB Signature of UB Representative Date I:/Building/Forms/WaterMeters_070119 Add.dOCX Page 2 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Water Meter Fixture Unit Worksheet TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov LOCATION: City of Tigard—City Hall WATER METER SALES: Utility Billing By Appointment Only: 503-718-2460 13125 SW Hall Blvd. Monday—Thursday, 9 a.m. to Noon Tigard, OR 97223 (No more than five meter sales per appointment) METER: SIZE: FEE: Effective 7/1/2019 5/8" $9,406.00 Fee includes: RE A,a `' 3/4" $13,425.00 water system development chars G 0 5 MO 1" $24,645.00 water meter, and 1-1/2" $72 969.00 meter installation fee. C'" 2" $118,163.00 Note: An additional charge will apply for water meters where an"existing water main"requires a new service line to be installed by the City to the property address and is paid by the property owner as follows: • Up to 1"=$3,815.00 • Over 1"=Cost+ 10% DETERMINING METER SIZE FOR RESIDENTIAL CUSTOMERS City of Tigard Water Service Area uses the Uniform Plumbing Code to determine the size of meter needed to adequately serve new buildings. In most cases, new residential buildings require a 3/4"meter, however, due to the size of homes built in the Tigard area, we now count the fixture units of all homes prior to selling a meter. Buildings with 37 or less fixture points can use a 3/4"meter. For those over 37, a 1"meter must be purchased. Use the worksheet on Page 2 to calculate the number of fixture units. DOCUMENTATION Please provide the following items to the Utility Billing counter to purchase your meter: • Completed water meter fixture unit worksheet(on back page). • Copy of building or plumbing permit application date-stamped by building division. • Copy of issued building or plumbing permit. Your fixture count will be verified and your request will be processed upon receipt of these documents. No exceptions. INSTALLATION TIME Most meters are installed within 10-14 business days. If your meter is not located within an existing subdivision we may need additional time in order to verify the location of other underground utilities. Please keep these time frames in mind when purchasing your water meter. I:/Building/Forms/WaterMeters_070119.dOCx Page 1 Water Meter Fixture Unit Worksheet Please complete the following information: Contractor Name: IA-as(C ) `--\ - 1)m—C p Ui v`.L r Billing Address: Street/Suite#: 6) 2 6 S w l=4 se \ ) C) o a S-{ City: 7 r 0---a r 01 State: 012 Zip: q7 2 Z '3 Phone Number: co' - °I S 3 - O CI 6 9 New Meter Address: rj-0,\Ak-e_ (t 4 --a VjeJ-e_ Subdivision Name: Lot#: 'ZS I oZ PCCO4x, Building Permit#: Please fill in the number of each fixture as detailed on the plans. Multiply the quantity by the point value to arrive at the point total. Add all point totals together for total fixture unit points. Fixture Unit Quantity Point Value Point Total Bar sink x 1 = Bidet x 1 = Clothes washer 1 x 4 = II Dishwasher t x 1.5 = (, 5` Hose bib 1 x 2.5 = Z f 5— Hose bib, each additional Z. x 1 = 'f.,- Kitchen sink 1, x 1.5 = I, S-- Laundry sink x 1.5 = Lavatory " x 1 = --2:%-dfr 0 Water closet, 1.6 GPF 3 x 2.5 = 7 S Bathtub/whirlpool I x 21 = Shower stall ''(,' , x 2 Bath/shower combo 1 x 4 = 14 Irrigation(#of heads in largest zone) x 1 = Total Fixture Unit Points: 31 Fixture Unit Points: Up to 30= 5/8" Over 37= 1" Up to 37= 3/4" 3�ti - 5/5 > Meter Size: 3/ L( Meter Cost: $ 9 of 9 FOR OFFICE USE ONLY Fixture Units Points verified with Building(Master) Permit or Plumbing ❑Yes ❑ No ❑ Other: Meter#: Sale Date: Receipt#: Meter Cost: Employee Name: 1:/Building/Forms/WaterMeters_070119.dOCX Page 2