HomeMy WebLinkAboutPermit _ -.i.luilding Permit Application
Residential FOR OFFICE USE ONLY
City of Tigard
DECEIVED Received 'ennit No.: r
Date B : �, /,y�, LLf� i)'� _ 91
• II
13125 SW Hall Blvd.,Tigard,OR 9 2 Plan Review
Phone: 503.718.2439 Fax: 503.598.196 DateiB : ZT� MIII Other Permit:
r F: Inspection Line: 503.639.4175 FEB 28 2023 Date Ready/By: qq p„t El See Page 2 for
Internet: www.tigard-or.gov NotifiedlMethod: A 140 i La - H'r Supplemental Information
C{TY01'TIGARD tANU ) C Is1STlul�
TYPE OF 1 IEDING nJv{SIoN REQUIRED DATA:1-AND 2-FAMILY DWELLING
El New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
dAddition/alterationireplacement ❑Other: equipment,materials,labor,overhead,and the profit(L for the
CATEGORY OF CONSTRUCTION work indicated on this application. S07- D
�J
1-and 2-family dwelling El Valuation: $
(�
El Accessory building 0 Multi-family
Number of bedrooms: L�
❑Master builder ❑Other: Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors: I
Job site address: I OIoki,� SvJ e V._ (....4.3 New dwelling area: C�1 square feet
City/State/ZIP: -I-Iei.A.-u) ..„r2_ --I.D1 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: w I Ltosw J d ao a Covered porch area: square feet
Cross street/directions to job site: �-Ly,^1 t Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
_ _ 1r_47) �[ �� Existing building area: square feet
rolintvbj{ PrCeAt(��i��i- 3lefL�fSl,�.(�Sx! she New building area: square feet
d PROPERTY OWNER ( 1 ❑ TENANT Number of stories:
Name:GA- fA^I i ( WIZETJI N VVI L Pani WV-Derr," Type of construction:
Address: I oIOit c.kj ( o IC L.4,1 Occupancy groups:
City/State/ZIP: 116 112 7 0IZ, ci-122..3 Existing:
Phone:(c4) 4 oil-- c' c1 I Fax:( ) New;
['APPLICANT ['CONTACT PERSON BUILDING PERMIT FEES*
(PleasBusiness name: t�{-b� .tom ,7rt` rl7 vieweref(or r depsit):schedule)
� � "l_ GtI"'"l I�� Structural plan review fee(or deposit):
Contact name: 4,44-12.4 coin LAF, . - C 1...1
Address: 1 DQOl FLS plan review fee(if applicable):
o �VJ GA-t.L\-(a IQ
City/State/ZIP. Total fees due upon application:
OIL,�D a q,27�� Amount received:
Phone:( 07j)lilt- 531_77/...- Fax::( ) —
E-mail:CA/Y.l S-1-IA a I r,)�% wiI v , PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
t" /"s[ u Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: (7p(1„.fi c �y�v Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: I I LN _ Total fee due upon application: $201.60
Authorized signature: `(/V--I ,' This permit application expires if a permit is not obtained
v b•✓�� within 180 days after it has been accepted as complete.
Print name:att.([.71 I tr J 4 Date: 2 *Fee methodology set by Tri-County Building IndustryJ Service Board.
I:\Building\Permits\BUP-RESPemutApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received Pemut No.: yq_ Z�
13125 SW Hall Blvd.,Tigard,OR 9EC E IVE D Date/By: ��r� 7 �7
� I Phone: 503.718.2439 Fax: 503.59R.19fi0 Plan Review Other permit No.:
Date/By:
f i,n it n Inspection Line: 503.639.4175 FEB 2 8 2023 Date Ready/By: taro: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK
CITY OF TIQARD FEE* SCHEDULE
❑New construction DIVISION Description
special information use checklist
Description I Qty. I Ea. I Total
., Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
34 I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory ❑Multi-family
Each additional bath/ldtchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
(t) p V Catch basin or area drain 18.76
Job site address: U �;�2
6
City/State/ZIP:-"flbj kif') Q� �i 1�Z FoDroting drain
line,or trench drain 1 ge 2
Ir _ ` Footing drain(no.linear tl.:_) Page 2
Suite/bldg./apt.no.: Project name: L'v I p54 V- --3O7A4 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 11.51
A�01 fl TC . CA,U Clotheswasher 25.02 Dishwasher 25.02
t • , i / prinking fountain 25.02
C • yI C rigonEjectors/sump 25.02
l}}'PROPERTY OWNER ID TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 4:,Or1 f i L ' ti 6v 1 t
Floor drain/floor sink/hub 25.02
Address: l(,) k IO k V 1.C')t, I.A Garbage disposal 25.02
City/State/ZIP: '-rL s n -7 U `I-11 v, Hose bib 25.02
Phone:O__jj}} Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: 'ur7 2�t?-.,J 1"' t tit Medical gas(value:$_) Page 2
Imo" l Primer 12.51
Contact name: /4.4,7/!J��I�\pr�..,, tdY7 : . i S�� Roof drain(commercial) 12.51
Address: I D Do t/ 4'\ ) LGf` 'J 4 DD 1� Sink/basin/lavatory 25.02
City/State/ZIP:V�D/ R� 0 e--)7i2� Solar units(potable water) 62.54
Phone:(C1� ` C ' 42 .27'i Fax::( ) Tub/shower/shower pan I 12.51
E-mail: (1,l f-�t -.) f A TG, <<,,,.L/1 Urinal 25.02" CO CTOR Water closet 1 25.02
Water heater 37.52
Business name:------ . �, � / !' 1IXv Water piping/DWV + 56.29 Gjiij,1'
Address: 1 j�j � L��- FFy)-1)t V �,+-O d..J Other: 25.02
City/State/ZIP: [�D�;--1� ` {l v zl>'1u1) V��t �+�� Subtotal
Phone:( f/7)rC I O1 i (D vLi-9- Fax:( ) Minimum permit fee: $72.50
CCB Lic.: \111\4 . 1 Plumbing Lic.no.: ?tAA1 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: 0_, - TOTAL PERMIT FEE
Print name: -r I CJ-t--(I,I A ( J Date: 2 / 1-6 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Tee methodology set by Tri-County Building Industry Service Board.
I:Building\Permits\PLMU-PerahApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1°'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
p and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00Au $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive TLm
W ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: -Commercialirator ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any ot'the above.
Floor Drain/sink: -2"
-3" Isometric or Riser Diagram
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
_ uilding ivision
One & Two-Family Dwelling
TIGARD
Fees Checklist
PERMIT INFORMATION: Application Date - FEE VERSION
Permit#: y yvv f o�3�- asae�S Plan #: Floors:
Valuation: `'' Covered Porch: Basement cce
Bedrooms: ` Deck: lst Floor
WC (toilets) I Deck Cover: 2rd Floor
Lavatories Patio Cover 3.d Floor
Tub/shower Accessory Struct. R-3 Total
Laundry Tray Water Heater Garage
Exhaust Vents Gas Flue Vents Total for Elec.
Backflow Prey. Furnace / Heat Pump / AC # for Electrical
BBQ Gas Fireplace #Fuel Lines
FEES: Description: Fee Ap lie Fee Entered:
DC Prov Revw: Planning
Info Proc/Arch: Lg$2.00 (over 11x17)
Info Proc/Arch: Sm $.50 (up to 11x17) 51
Metro CET: Residential Use
School CET: District:
Tigard CET: Admin
Tigard CET: ODHCS
Tigard CET: AH
Electrical Permit: Permit Fee: Ni
Limited Energy:
12% State Surcharge
Mech. Permit: Permit Fee:
12% State Surcharge
Plumbing Permit: Permit Fee:
12% State Surcharge
Erosion Control: w/Permit-Ping
Notes:
Q 1tV,c - Vr t—v+ -- p \a." e✓
Z> '��.Me �-- G�oc l %pc-c.fL._ ,r �-�-�' (t)\a,-) CD-A--c
3) e ✓ ti•'r
I:\Building\Forms\ResPl`anCheckFec .doc 12/13/22 Page
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Viki lam.. tej- e.reeb-51 GtixiAss lO CG 1 S`\ 1
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(�� r`�� T►-��- ru..A,-D G,v rr Co MMun e6-e9-us. W>0L E. �: i�4'%.14--
FOR OFFICE USE ONLY-SITE ADDRESS: l',)(p(p 5 SW WV. Lh.
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
r i c,A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: t-j' AP-4.nc- DN1-1 DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: 6,01Z-j cg1-11.-1A a NJ MAR 1 6 2023
COMPANY: {-'ip -)P 1r-lc. CITY OFT 'ARD
PHONE: '22 �fy(- j- q,722 BUILDING D VV�S : „ 4-
EMAIL: CAA vi esti Ina Q Vi vi Frei • C.n im
RE: lOtp( t ‘-AN CA:5W-- I..14 . M�T207--1, -DOr-)
(Site Address) (Permit Number)
l N l Woi--1 -c \O i.1
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: De tion:
Additional set(s) of plans. )C Revisions: pr A e-y
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
X Other(explain): W pr-- cr,/1 CS -- S -k/ LC i 122soV t P iZ
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technic' n: Date: Initials: I7� ,�
Fees Due: ❑ Yes No Fee Description: Amount Due:
'\ .). ---r) -6-----
Special
Instructions:
Reprint Permit (per PE): ❑Yes Et<lroV
❑ Done
Applicant Notified: .,/ Date: 4,2,0/13 Initials: P
4\91141
Qes ElNo ❑N/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995) re
J �
Yes 0 No N/A Public Facilities Improvement (PFI) Permit: r-'
equired: ❑ Yes ❑ No
Applied For: ❑ Yes ❑ Ncystop intake
Sensitive Lands: ❑ Yes ip-TIO
0 Main Land Use Case #s: 0 Conditions met
Applicant notified of land us expiration date:
pproved By Planning: Date: 2 z- /2.3
Notes
Revision 1: El Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date: 3A,03
Site Plans #:
Building Plans #: j
Building Permit #: build ng permit # entered on page 1
Workflow Routing: B'Planning leering Coordinator B-BttifdIng
Workflow Sign-off: I:I-Sign-off for Planning (include notes from planning review)
Route Documents: sneering: (1) copy of permit application, (1) site plan, (1) building plan
and orJ inal plan review routing form.
e-Btfifding: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.
Permit Technician: Date: 31/4,13
Notes:
Engineering Review
L'PFI Permit: A'/4
I 1/,,Slope at building pad: 2°/
nditions met prior to issuance of permit A)
Easements (encroachments) per engineering conditions of approval and plat/A4
[ 'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ErIClo
Assess Water Quantity Fee in-lieu: ❑ Yes d o
LIDA Facility on lot: ❑ Yes Orl o Add Fee: ❑ Yes 0 No
Q Final Plat Recorded /I/A
❑ NOT Approved: Date:
Notes:
Approved By Engineering: 11 pv1T.4 Date: 311/24r23
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
Permit Coordinator Review
Wieonditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
.B'SDC Exemption: 0 Applied for ❑ Received %Does not apply
e1SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes C�✓" N/A
Tigard Trans SDC: ❑ Yes /N/A 0 Deferred
Parks SDC: 0 Yes 7N/A 0 Deferred
LIDA 0 Yes N/A!a'OK to Issue/Approved by Permit Coordinator: Date: 3I g 12043
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Clean Wate� Services
•
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT
Clean Water Services File Number 23RECEIVEQ
1. Jurisdiction: Tigard
2. Property Information(example: 1 S234AB01400) 3. Owner Information MAR 1 6 2023
Tax lot ID(s): Name: Caitlin&Jeremy Wilpone-Jordan
2S103DA05200 Company: a I A CITY OF TIGARD
Address: tossssWCookln BUILDING DIVISION
OR Site Address: 10665 SW Cook Ln City, State,Zip: Tigard,Oregon,97223
City, State,Zip: Tigard,Oregon,97223 Phone/fax: 7J01 -et04' D5�11
Nearest cross street: Email: 6leAr Arlo k qy 1y �) 60,4tl.l % - GOVYI
4. Development Activity(check all that apply) 4. Applicant Information
I1 Addition to single family residence(rooms, deck, garage) Name: Christina Erickson
❑ Lot line adjustment 0 Minor land partition Company: HELP Group Inc
ElResidential condominium 0 Commercial condominium Address: 10006 SW Canyon Rd
❑ Residential subdivision 0 Commercial subdivision City, State,Zip: Portland,Oregon,97225
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: s03-244-8232
Other Email: christina@helppdx.com
6. Will the project involve any off-site work? ['Yes ❑x 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 Christina Erickson Print/type title
Signature ONLINE SUBMITTAL Date 2/28/2023
FOR DISTRICT USE ONLY
0 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.
ISI 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.
Reviewed by c-2� �2 /6 2.9B`i Date 3/1/23
On complete,email to:SPLReviewOcleanwaterservices.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 Office • 2550 SW Hillsboro Highway - Hillsboro, Oregon 97123 • p:503.681.3600 f:503.681.3603 • cleanwaterservices.org
Water Meter Fixture Unit Worksheet for Additions/Remodeligg' 'ED
FEB 2 8 2023
Please complete the following information:
CITY OF TIGARD
Customer Name: 6,1 1-9,,n[ -4 ,i Ie>✓N1.%-( U!l I,P -J012D UILDING DIVISION
Service Address: Street/Suite#: 1plp y. C_,ep /� Vr.L
City: --n— 12.--+- State: ea_ Zip:1127.3
Phone Number: -2 v -°o'j-_ U vj el I Email: ;tAt&AA 1 fi A;t 1 . vv!
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 1 x 4 = q- x 4 =
Dishwasher 1 x 1.5 = 1. x 1.5 =
'Outside Water Spigot t x 2.5 = Z.. v x 2.5 =
Water Spigot,each add'! x 1 = x 1 =
Kitchen sink 1 x 1.5 = 1,G) x 1.5 =
Laundry sink x 1.5 = 1 x 1.5 = 1.- 1.5
Lavatory(bathroom sink) X 1 = 2 ` x 1 1
Water closet,1.6 GPF(toilet) x 2.5 = rj x 2.5 = -_, 0
Bathtub/whirlpool x 4 = x 4 = 2
Shower stall x 2 1 x 2 /y 2
=4.5
Bath/shower combo 1 x 4 = q- x 4 =
Current Points: 2...Q.9 Proposed Increase: ix/x, x4.5
Current Points+ Proposed Increase= 5 =New Total Points =Required Meter Size "5 $I.
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: GJ 6" Cost: $ 1 I , -2. _(see page 1)
Current Meter Size per Utility Billing: Cost: $ t l t 1 " (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 No meter upsizing will be required.
J Bentley 03/06/23
Current Meter Size Confirmed with UB
Signature of UB Representative Date
1:/Building/Forms/WaterMeters_070121 Add.docx Page 2