Permit ,r CITY OF TIGARD SEWER CONNECTION PERMIT
g COMMUNITY DEVELOPMENT Permit#: SWR2020-00139
Date Issued: 8/14/2020
tGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S103DD00850
Jurisdiction: Tigard
Site address: 13815 SW PACIFIC HWY 10
Project: Domino's Pizza Subdivision: None Lot: None
Project Description: 1.75 EDU increase.
Contractor: Owner: D W SIVERS CO
4730 SW MACADAM AVE#101
PORTLAND, OR 97239
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/13/2020 $10,150.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.75
Total 510,150.00
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 follow the rules adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUNC by calling Q3.232.1987 or 1.800.332.2344. //
Issued By: /f- ,, j�jyr � ,�,_� Permittee Signature: fatie1l: �/���j�'�-�'7CJ«!Call 503.639.4175 by 7:00 a.m.for the next available inspection
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.