Permit VOID
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 77/ 6
.711
0
Request for Permit Action
I I c,A iz 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner IN Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Taylor Morrison
Mailing Address: 703 Broadway St,Suite 710
City/State/Zip: Vancouver WA 98660
Phone No.: (360) 946 8674
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
M REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: BUP2019-00115
Site Address or Parcel#: 14450 SW River Terrace BLVD Tigard,OR 97224
Project Name: Polygon at Roshak
Subdivision Name: Polygon at Roshak Ridge Lot#:
EXPLANATION: Major plan changes to the initial plans.
Please void permit#BUP2019-00115 and process refund.
Signature: Qyy pdt-,r 64/f4'414elG� Date: 06/01/2021
Print Name: Omar Alami A.
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests. if,..7. / a. ffD ,A t= //l0 .a 7 . 79.. 5 ..
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FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date ,f' /3 2/ By 1 g
Refund Processed: Date ef/ / By.1) Invoice Processed: Date By
Permit Canceled: Date rT7/a/ By 4'/ Parcel Tag Added: Date By
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71 CITY OF TIGARD RECEIPT
i 8- , 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TI(;AI':[)
Project Name: Polygon at Roshak Ridge Swim Center
Site Address: 14450 SW RIVER TERRACE BLVD
Receipt Number: 423602 - 05/20/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00115 Permit Fee-COM-New Construction 230-0000-43104 $1,397.61
BUP2019-00115 12%State Surcharge-Building 100-0000-24001 $167.71
BUP2019-00115 Plan Review 230-0000-43106 $908.45
BUP2019-00115 DC Provision Review, COM New-Bldg 230-0000-43112 $194.00
BUP2019-00115 Plan Review-Fire Life Safety 230-0000-43108 $559.04
BUP2019-00115 Metro Const. Excise Tax 230-0000-24010 $277.16
BUP2019-00115 Tig-Tual School CET-Non Residential 230-0000-24102 $1,291.55
BUP2019-00115 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $48.00
11x17)
BUP2019-00115 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $52.50
11x17)
Total: $4,896.02
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 200519E3C-1 F6d PUBLICUSERO 05/20/2019 $4,896.02
Payor: Joleen Smith
Total Payments: $4,896.02
Balance Due: $0.00
Page 1 of 1
piiCITY OF TIGARD RECEIPT
i 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Polygon at Roshak Ridge Swim Center
Site Address: 14450 SW RIVER TERRACE BLVD ��
/11-46
Receipt Number: 435825 - 08/13/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00115 $-2,820.97
Total: $-2,820.97
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 240239 DHOWSE 08/13/2021 $-2,820.97
Payor: Taylor Morrison
Total Payments: $-2,820.97
Balance Due: $2,820.97
Page 1 of 1
CITY OF TIGARD RECEIPT
illki 1 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
_I_I t;;A P )
Project Name: Polygon at Roshak Ridge Swim Center
Site Address: 14450 SW RIVER TERRACE BLVD j Ali(
Receipt Number: 423602 - 05/20/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00115 Permit Fee-COM-New Construction 230-0000-43104 d'p `e $1,397.61 E
BUP2019-00115 12%State Surcharge-Building 100-0000-24001 .Pc e $167.71 't
BUP2019-00115 Plan Review 230-0000-43106 $908.45
BUP2019-00115 DC Provision Review, COM New-Bldg 230-0000-43112 $194.00
BUP2019-00115 Plan Review-Fire Life Safety 230-0000-43108 $559.04
BUP2019-00115 Metro Const. Excise Tax 230-0000-24010 ire 90 $277.16 'F"
BUP2019-00115 Tig-Tual School CET-Non Residential 230-0000-24102 /eV 90 $1,291.55 F-
BUP2019-00115 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $48.00
11x17)
BUP2019-00115 Info Process/Archiving-Sm $0.50(up to 230-0000-43135 $52.50
11x17)
Total: $4,896.02
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 200519E3C-1F6z PUBLICUSERO 05/20/2019 $4,896.02
Payor: Joleen Smith
Total Payments: $4,896.02
Balance Due: $0.00
Page 1 of 1
7 -
p
TIGARD
City of Tigard
August 13, 2021
Taylor Morrison
703 Broadway St, Suite 510
Vancouver,WA 98660
Re: Permit No. BUP2019-00115
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14450 SW River Terrace Blvd
Project Name: Polygon at Roshak Ridge- Swim Center
Job No.: N/A
Refund Method: ® Check#240239 in the amount of$2,820.97.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request to cancel permit and resubmitted new plans under
BUP2021-00140. Refund 80% of permit fees and full refund of CET fees paid.
If you have any questions please contact me at 503.718.2430.
Sincerely,
45:eaZ/A"--Z;-''j
Dianna Ornelas
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
■ City of Tigard
l ,G A Ez 1, Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request forPermit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Taylor Morrison DATE: 8/6/2021
703 Broadway St, Suite 710
Vancouver, WA 98660 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 423602 Case#: BUP2019-00115
Date: 5/20/2019 Address/Parcel: 14450 SW River Terrace Blvd
Pay Method: CreditCard Project Name: Polygon at Roshak Ridge Swim
Center
EXPLANATION: Per applicant's request as major plan changes resulted in voiding this permit and
resubmitting new plans under BUP2021-00140. Refund 80%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt 1 Rov.riue Acs out.-a 4h1o. +,..- R.a.1arn(l
F x►ple,,Building Permit Fee' Lx:an11)1e; 23('(h i)(i 43104 I $,Amo1.>tit
Building Permit Fee 230-0000-43104 $1,118.09
12%State Surcharge 100-0000-24001 134.17
Metro Const Excise Tax 230-0000-24010 277.16
Tig-Tual School CET-Non Residential 230-0000-24102 1,291.55
TOTAL REFUND: $2,820.97
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff n
If under$12,500 Division Manager ( cam
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY 1
i,
Case Refund Processed: Date: //rs %L ,/ By: `, JI
I:\Building\Refunds\RefundRequest.doc x 09/01/2010