Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2022-00120
TIGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/1/2022
Parcel: 1 S 136DC04600
Jurisdiction: Tigard
Site address: 7255 SW DARTMOUTH ST
Project: Planet Fitness Subdivision: 1995-013 PARTITION PLAT Lot: 3
Project Description: 3.0 EDU increase.
Contractor: Owner: COMMERCIAL NET LEASE REALTY, INC
450 S ORANGE AVE, STE 900
ORLANDO, FL 32801
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/01/2022 $19,875.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 3.0
Total $19,875.00
Required Items and Reports(Conditions)
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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to folio the rules adopted brthe Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain copy o he rules
Issued By: iktaa Signature:
Call 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 job site at the time of each inspection.
INS Tenant Name: PLANET PI'1NESSAccumulative Sewer Tally SWR# 2022-00120
1 e n D Site Address: 7255 SW DARTMOUTH ST PLM# 2022-00338
Parcel#: 1S136DC04600
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 1 1 1 1 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 2 4 6 12 4 8
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 I IP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 6 12 6 12
Sink:
-Lav/Bar-Non-Food Related 2 0 4 8 6 12 2 4
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 2 6 2 6 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 3 18 7 42 4 24
Urinal 6 0 2 12 2 12 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 14 49 30 97 16 48
Current Fixture Value 48 divided by 16= 3.000 Current EDU 1 EDU= $6,625.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 48 divided by 16= 3.000 over (under) $ 19,875.00
Enter EDU Change Here 3.000
*Round EDUs to the nearest 1/100th: a count ending in.005 shall he rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 8/30/2022
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\ScwerTallyShect_6625_070122.xlsx