Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2020-00338
Date Issued: 08/09/2023
Tt(3A.R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel 2S103CC15800
Jurisdiction: Tigard
Site address: 12185 SW PLANTATION TER
Subdivision: PLANTATION ESTATES Lot: 3
Project: Toews ADU
Project Description: Converting 910 sq.ft. of finished basement to an ADU. NO FINAL INSPECTION UNTIL WATER
METER IS UPSIZED.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 1 First: 0 sf Basement: 910 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Yes
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 910 sf Value: $10,000.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 1
Other Fixture Units: Water piping/DWV
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 2
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 5
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvcIFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 WI Svc or Fdr: 0
Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 18
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW ADU VB R-3 910
Owner: Contractor:
TOEWS,JORDAN&MEGAN OWNER Required Items and Reports(Conditions)
12183 SW PLANTATION TER
TIGARD,OR 97223
PHONE: PHONE:
FAX:
Total Fees: $6,370.52
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, o if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification er T se rules are set forth in OAR
g69_nn1_nn1n ihrn„nh nna oc ..nn _neon V.,,,mew,.tie,,i .•nn„nr ib r„ a nr rllrnrf n„ccenne t, nl inir by rnllinn SM 9 I 1 arm a 9/44.
Issued By' Permittee Signature:
.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the lob site at the time of each inspection.
IIII
Mechanical Permit Application FOR OFFICE I SE ONI,Y
City of Tigard Received Date/By: Permit N ( Lc. UO.3 v ]3125 SW Hall Blvd.,Tigard,OR 97223 Plan Review d G�
Phone: 503.7I8.2439 Fax: 503.598.1960 Other Permit:
Date/By.
T t C,.y R IU Inspection Line. 503.639.4175 - Date Ready/By: Juns HE See Page 2 for
Internet'. www.tigard-or.gov Notified Method: Supplemental Information
TYPE OF WORK I COMMERCIAL FEE*SCHEDULE - USN:CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
-- Value:$
CATEGORY OF CONSTRUCTION RESIDENPIAI.EQE IPMENT/SYSTEMS FEi«i
® 1-and 2-family dwelling El Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family El Master builder ®Other:aasement renovation for ADO Description Qty. Ea. Total
d00 SITE INFORMATION AND LOCAL ION - Ileatiug/cooting:
Air conditioning 46.75
Job site address:12185 SW Plantation Terrace Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:TIGARD, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Basement renovation for ADU Duct work 23.32
Cross street/directions to job site: Go north from Gaarde and 121 Ave and turn west Hydronic hot water system 23.32
onto Plantation Terrace. Second house on the north side of Plantation Terrace Residential boiler(radiator or hydronic) 23.32
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 1 23.32 23.32
Other: 23.32
Subdivision:Plantation Estates Lot no.:3 Other fuel appliances:
Tax map/parcel no.:2S 103CC 15800 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
CONVERSION OF EXISTING FINISHED BASEMENT SPACE TO 910 SQ,FT IN-LAW SUITE fireplace 23.32
(AD11) NO CHANFFS TO THE FXISTINO FOOTPRINT OR PROFIT F OF THE RFSIDFNCF
ARE PROPOSED AS PART OF THE CONVERSION. Log lighter(gas) 23.32
In conjunction,replace the existing boiler and tank hot water heater with a combination tankless Wood/ ellet stove 33.39
baler anti not water neater. - 7
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
(a PROPERTY OWNER 0 TENANT
Other: 23.32
Environmental exhaust and ventilation:
Name:Jordan and Megan Toews Range hood/other kitchen 33.39
equipment 1 33.39
Address:12183 SW Plantation Terrace Clothes dryer exhaust 1 33.39 33.39
City/State/ZIP:TIGARD, OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) ( 23.32
Phone:(360 )510-931 1 Fax:( ) Attic/crawlspace fans 1 23.32 23.32
621 APPLICANT ❑ CONTACT PERSON Other: 2332
-- - - Fuel piping:
Business name:Homeowner
--__ $14.15 for first four;$4.03 for each additional
Contact name:Jordan Toews Fete. 13n-v`Le-r" 1 14.15
Address:12183 SW Plantation Terrace Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:TIGARD, OR 97223 water heater
Phone:(360)510-9311 Fax::( ) Fireplace 1 4.03
F.-mail: Range I 4.03
ADU TheToews.com
Barbecue 1 4.03
CON I'RACI'OR Clothes dryer(gas) 1 4.03
Other,
Business name Homeowner
MECHANICAL PERMIT FEES".
Address:12183 SW Plantation Terrace Subtotal 164 92
City/State/ZIP:TIGARD, OR 97223 Minimum permit tee($90 00)
i Plan review(25%of permit fee) 38.73
Phone:(360)510-9311 Fax: ( ) State surcharge(12%of permit fee) 18.59
CCB lie.: TOTAL PERMIT FEE 212.24
This permit application expires if a permit is not obtained within 199
days after it has been accepted as complete.
Authorized signature:P� '' t"-'- " Fee methodology set by Tri-County Building Industry Service Board
Print name:Jordan //v-dews Date:2020 December 10
I:\BuildinglPermits1MEC PermitApp_040113.doe 440-46.7r(11/02/COM/WEB)
P
Mechanical Permit Application - City of Tigard `
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to S500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:1Building\Permits\MEC_PermitApp_040113.doc 2
, tVEC)
Electrical Permit Application �. ' t(Hz i)1.1 1( i 1 ,I u,()
City of Tigard 2 8 Received Fermat: Sj, O"�R)3?S
. 13125 SW Ball Blvd.,Tigard,OR 9 Plan Reviemv
Phone: 503.718.2439 Fax: 503.598.1 per. : Related Pem e:
T t G A R IJ Inspection Line: 503.639.4175 a,TI Or TI .arc Ready DatofR rurv:
H See Page 2 for
Internet: www tigard-or gov I, DING DIVISION Notified/Method Supplemental Information
PL
TYPE O ORE AN REVIEW
❑New construction ®Addition/alteration/replacement Please cbxk all that apply(submit 71 sins of plans%Mame chucked).
❑Demolition ()Riff: Service or La W d=4 amps or more 0 Budding over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at Ism volts or ❑Floamg buddimgs.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to gmmt&or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family 0 Master builder Other. amps for all other installations. Innall buildings.
0prim pump. ❑Inosllarion of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emereencysystem. larger sepamatolyderived
['Addition of new motor load of system.
Job#: Job site address:12183 SW Plantation Terrace 100HP or more. ❑"A" `E""1-a„. I-3"
City/State/ZIP:TIGARD, OR 97223 ❑si`or mine rmaidented units. „a,vehicle parks.
❑Heahheore facilities. ❑
Suite/bldg./apt.#: Protect name:Basement Renovation for ADU ❑Rurtad to itio m ❑Supply gotta 'rat more than
• ❑Service or feeder 600 amps or more. 600*tilts numriwal.
Cross street/directions to job site: Go north from Gaarde and 121 Ave and turn FEE SCHEDULE
west onto Plantation Terrace. Second house on the north side of Plantation Terrace n""'o"m' I oa 1 lace I Ta a1 ) •
New residential single-or multi-family dwelling unit.
Subdivision:Plantation Estates Lot#:3 includes attached garage.
1,000 sq.it.or less 168.54 4
Tax map/parcel#:2S 103CC 15800 Fa arld'1 son sq.a or portion 33.92 1
rem.srRIP'r1ON OF.WORK Limited energy,residential
75.00 2
CONVERSION OF EXISTING FINISHED BASEMENT SPACE TO 1000 SO.FT IN-LAW SUITE (with above sq.a.)
(ADLI) NO CHANAFS TO THE FXISTIWO FOOTPRINT OR PROFIT F OF THE RFSIOFNCF Limited energy,multi-family 75 W
ARE PROPOSED AS PART OF THE CONVERSION_ residential(with above sq.It)
0 PROPERTY OWNER 0.TEIVAAPI Renewable Energy ❑ See Paget
Services or feeders installation,alteration,and/or relocation
Name:Jordan and Megan Toews 200 amps or less 100.70 2
Address:12183 SW Plantation Terrace 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZiP:TIGARD, OR 97223 601 amps toL000amps 301.04 2
Phone:(360)510-9311 Fa.:( j Over l,000 amps orvolts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:ADU@TheToews.com relocation
Owner installation.This installation is being made on property that I own which is not 200 amps of less 59.36 1
intended for sale,lease,r or hange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
_
Owner signature: Date: JZ-3o-2,ozo 401 amps to 599 amps 168.54 2
(t�1 ICAIYI' COk'trrACT FERSC N. Rnaeb eirenits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Homeowner above service or feeder fee, 7.42 2
each branch circuit
Contact name:Jordan Toews A.Fee for bullish circuits wrthrnn
service Address:12183 SW Plantation Terrace ct feeder fee,maim 1 56.18 2
City/State/ZIP:TIGARD, OR 97223 Each addl branch circuit 17 7.42 126.14 2
Miscellaneous(service or feeder not included)
Phone:(360)510-9311 Fax::( ) Each manufactured or modular 67.8I 2
dwelling service and/or feeder
Email:ADU@TheToews.com Reconnect only 67.84 ' 2
CONTRACTOR`. . Pump or irrigation circle 67.84 2
Business name:Homeowner Sign or outline lighting 67.84 2
Signal circuit(s)or limited-enerD See Paget 2
Address:12183 SW Plantation Terrace panel,alteration,or extension.
City/Slate/ZIP:TIGARD, OR 97223 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 6625/hr
Phone:(360)510-9311 Fax:( ) Investigation(I hr min) 90.00 br
Emai►:ADU@TheToews.com Industrial plant(lhrmin) 78.18dhr
Inspections for which no fee is 9000/Itr
CCB Lic.: Electrical Lie.: Suprv.Lic.: specifically listed('h hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 182.32
Print name: ' Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 21.88
Authorized signature: TOTAL PERMIT FEE: 204.20
l� s This permit app8sation expires if a permit is sat obtained within 180
Print name: .Irk 7 O EW s Dale: jZ_30_2670 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I U3uitdieg\Pmador7.C_PamitApp,E.LR_Fat doe Rev t6+IT/5013 440.46151'ti VO.VCOMINE$
' Plumbing Permit Application
Building Fixtures i oiz orris is I'sF: oNI l
City of Tigard Received
`'r Date/By:
PermitNoMs.r.��,.-m3se
lig ■ 13125 SW Hall Blvd,Tigard,OR 97223 y`
II Phone: 503.718.243t Fax. 303'.598.1960 Plan Review
'� Date/By: Other Pemnt No.:
f;GNP D Inspection Line: 503.639.4175 Date Ready/By: orris: el See Page 2 for
YY Internet: www.tigard-or.Hov Notified/Method: Supplemental Information
I. TN PI OF WORK I .FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description 1 Qty_ I Ea. I Total
®Addition/alteration/replacement , ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-familydwellingice_-__ SFR(2)bath 437.78
❑Commercial/industrial
ElAccessory building El Multi-familySFR(3)bath 500.32
Each additional bath/kitchen 25 02
❑Master builder ❑Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORNIATlON AND LOCATION Site utilities:
Job site address:12185 SW Plantation Terrace Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD, OR 97223
Footing drain(no linear ft-: ) Page 2
Suite/bldg./apt.no.: Project name:Basement Renovation for ADU Manufactured home utilities 50.03
Cross sheet/directions to job site: Go north from Gaarde and 121 Ave and turn west Manholes 18.76
onto Plantation Terrace.Second house on the north side of Plantation Terrace 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:Plantation Estates Lot no.:3 Fixture or item:
Tax map/parcel no.:2S103CC15800 Backflowpreventer 31.27
DESCRIPTION OE WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
CONVERSION OF EXISTING FINISHED BASEMENT SPACE TO 910 SQ.FT IN-LAW SUITE
ADUI NO CHANGES TO THE EXISTING FQOTPRINT OR PROFILE OF THE RESIDENCE Dishwasher 1 25.02 25.02
RE PROPOSED AS PARTOETHE CONVERSION.
Drinking fountain 25.02
In conjunction,replace the existing boiler and tank hot water heater with a combination Ejectors/sum
tankless boiler and hot water heater. P 25.02
[D PROPERTY OWNER ] 0 TENANT Expansion tank 12.51
Name Jordan and Megan Toews Fixtaresewercap 25.02
Floor drain/floor sink/hub 25.02
Address:12183 SW Plantation Terrace
Garbage disposal 1 25.02 25.02
City/State/ZIP:TIGARD, OR 97223 Hose bib 25.02
Phone:(360 )510-9311 Fax:( ) Ice maker 1 12.51 1251
21 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name.Homeowner Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Jordan Toews
Roof drain(commercial) 12.51
Address:12183 SW Plantation Terrace Sink/basin/lavatory 2 25.02 50.04
City/State/ZIP:TIGARD, OR 97223 Solar units(potable water) 62.54
Phone:(360 )510-9311 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:ADU@TheToews.com Urinal 25.02
Water closet 1 25.02 25.02
CONTRACTOR
Water heater 37.52
Business name:Homeowner Water piping/DWV 1 56.29 56.29
Address:12183 SW Plantation Terrace Other 25.02
City/State/ZIP:TIGARD, OR 97223 Subtotal 218.92
Phone:( 360)510-9311 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing Lic.no.:
' Plan review (25%of permit fee) 54.73
State surcharge(12%of permit fee) 26.27
Authorized signature: TOTAL PERMIT FEE 299.92
Print name:Jordan Toews Date:2020 December 10 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tel-Canty Building Industry Service Board.
I1BuildingTermns,PLMU-PermnApp.doe 10/01/09 440-4616T(10/02/COIWWEB)
a
. t
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- I" 100. 50 03 0 to 2,000 $121.90
Footingdrain-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$4 52 for
Qty. Fee(ea) Total ( each additional$100.00 or fraction thereof,to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or for $I0,001.00 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 90.00/hr $50.001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge—)12 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
0 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 ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator El Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system.
Dishwasher -Commercial
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink. -2"
3" Isometric or Riser Diagram
0 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: -Lav/Bar non-food related
-Bradley
-ComtServ/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
Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs
Please complete the following information: RECEIVED
Customer Name: Jordan and Megan Toews JUL 2 0 202a
Service Address: Street/Suite#: 12183 SW Plantation Terrace
&,
City: TIGARD State: OR Br+ •> 11QVVISIONl
Phone Number: +1.317.863.9776 Email: ADU@TheToews.com
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 1 x I. = 1 x 1 =
Bidet 0 x 1 = x 1 =
Clothes washer 1 x 4 = 4 1 x 4 — 4
Dishwasher 1 x 1.5 = 1.5 1 x 1.5 = 1.5
Hose bib 1 x 2.5 = 2.5 x 2.5 =
Hose bib,each 3 x 1 = 3 x 1
Kitchen sink 2 x 1.5 = 3 x 1.5 =
Laundry sink 1 x 1.5 1 5 x 1.5 =
Lavatory 6 x 1 = 6 1 x 1 = 1
Water closet, 1.6 GPF 5 x 2.5 = 12.5 1 x 2.5 = 2.5
Bathtub/whirlpool x 4 = x 4 _ ,
et.0
Shower stall 3 x 2 =6 -2 x 2 = -4
Bath/shower combo 2 x 4 = 8 1 x 4 = 4
Current Points: 49 Proposed Increase: 9
Current Points+Proposed Increase= 58 =New Total Points =Required Meter Size 1"
Meter Sizes: 1 to 30 points=518" 30.5 to 37 points=3/ 37.5 and over points= 1"
New Meter Size Needed for New Total Points: 1" Cost: $24,645 i (see page 1)
Current Meter Size per Utility Billing: 5/8" Cost: $ 9,406 (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $15.239
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
****************s**************r***r********s******s*ss*****s****ss***a****r*********
FOR OFFICE USE ONLY
Demzetr Rack 7/20/23
Current Meter Size Confirmed with UB �..._
Signature of UB Representative Date
1:/Building/Forms/WaterMeters 070119_Add.doex Page 2
Property Owner Statement RECEIVED
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed wi (e 8
Construction Contractors Board to sign the following statement before a building perr Jf ®O ]GARD
issued. (ORS 701.325 (2)) BUILDING DIVISION
This statement is required for residential building,electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
FX, I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board, If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement Is true and accurate.
Jo 9-,aau I1,6 O S
Print Name of Permit Applicant
bEe. 30 Zozo
Sig of Permit Applicant Date
Permit#: /7,5T0�)?O an T
Address:
-t' '
,per
Issued by: J-/ - Date: /1/'7/y-j .
This Copy for Permit Offices
I
Plan#
Floors Large g Spy �/ ��
Bed rooms Small IWC / �: _ i J_
t.
LAV
Vent
l S l n ej-}-t % � Q o.3S -
Tub Basement 9 tO
vent 1st Floor r'•O-rk- ,.4 e.A- 1 t`S
Water Heater 2nd Floor
AC 3rd Floor 0 I,, ' w'`1 , 66n 0-Y .
School R-3 Total ( JV �
Garage D ✓ iz-- e-e-- YY'L i . \ i A CJ_ � p S
r I Total -S r
6- ` `' g #forElec "44-4-,
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