Permit Support Document {
III n
{ fr�
r j ;
W
City of Tigard
August 9, 2019
a
TL Remodel& Construction
PO Box 1996
Lake Oswego, OR 97035
Re: Permit No. MST2018-00027
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10235 SW Highland Dr
Project Name: McKee
Job No.: N/A
Refund Method: zs Check#232955 in the amount of$61.60.
❑ Credit card"return" receipt in the amount of$ .
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 as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
<V''451/-74/47 -
Dianna Howse
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
TIGARD 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 for Permit 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: TL Remodel&Construction DATE: 8/2/2019
PO Box 1996
Lake Oswego, OR 97035 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 415189 Case#: MST2018-00027
Date: 1/22/2018 Address/Parcel: 10235 SW Highland Dr
Pay Method: CreditCard Project Name: McKee
EXPLANATION: Per applicant's request as customer canelled job. Refund 80%of permit fees.
REFUND INFORMATION:
ee Description From Receipt .7
Fee Revenue A.ct.ount Nt, Refund
Example: Building Permit Fee Example. 2300000_43104 $Amount
Building Permit 230-0000-43104 $61.60
TOTAL REFUND: $61.60
APPROVALS: SIGNAT E / ATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
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
Case Refund Processed: Date: / , 7/)--/ By: cr'�zi`
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
III' • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
t_I Gh R ID
Project Name: McKee
Site Address: 10235 SW HIGHLAND DR
Receipt Number: 436077 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2018-00027 $-61.60
Total: $-61.60
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232955 DHOWSE 08/27/2021 $-61.60
Payor: TL Remodel &Construction
Total Payments: $-61.60
Balance Due: $61.60
Page 1 of 1
1
IIIu
CITY OF TIGARD RECEIPT
Il • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: McKee
Site Address: 10235 SW HIGHLAND DR
Receipt Number: 415189 - 01/22/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
g MST2018-00027 Building Permit-Additions,Alterations, 230-0000-43104 $77.00
Demolition
Total: $77.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 004561 BTAGGART 01/22/2018 $77.00
Payor: Timothy Labunsky/TL Remodel&Construction
Total Payments: $77.00
Balance Due: $0.00
I
Page 1 of 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT, t 0 I
111 Request for Permit Action ��,
TIGARD 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 ❑ Applicant ❑ Contractor ity Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE ACTION FOR THE ITEM(S) CHECKED (✓):
ANCRI"VOID PERMIT APPLICATION.
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#:
Site Address or Parcel#: /�ol-�S 452,,J A' yh
Project Name: t(r�_
Subdivision Name: " Lot#: '!
EXPLANATION: � -7 lev- idrrlJi i" ,G,
_ e 3 .¢/ 74h / 1,.tJ
1,/f1 1 4`4 1",j�s it_.✓,,.,)t illy ctn/ A.Y,a i I cxnlG/ q/ )l. w- /f,Lf .SC.c f G�f
`I-mac'/ 7c`✓ ,4'9"l El- G-c 6,,/
/ 6 c e� /''6'YLe7 !i /` S j,°,1`7b fir .'
Signature: Date: 6/ t/%7
Print Name:
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.
7D — (.. 6 o .- 7S, yD
Route to Sys Admin: Date ,�.y / By r" . Route to Records: Date .3 7 j-/ By
Refund Processed: Date /?.. / By Invoice Processed: Date By
Permit Canceled: Date g'/.ay By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_120518.doc
Allyson Armstrong Y ' .ST O" t v -' 000,;-7
From: Allyson Armstrong
Sent: Monday, November 26, 2018 9:31 AM
To: 'hello'
Subject: RE: 10235 SW Highland Dr
Chris,
Thank you for your response. I have been informed that there is a form that needs to be filled out in order for us to void
the permit application. Please complete this form http://www.tigard-
or.gov/document center/Building/RegPermitAction.pdf
Then email the completed for to tigardbuildingpermits@tigard-or.gov /1 /
Thank you,
Allyson Armstrong
4.-"/ /N r-r(--
From: hello<chrisk@tlremodel.com>
Sent: Wednesday, November 21, 2018 12:32 PMZ�� 7-
To:Allyson Armstrong<AllysonA@tigard-or.gov>
Subject: RE: 10235 SW Highland Dr /--(
Hello,
We will not be moving forward with this project please void this application.`
Skink you
01.11110
TL Remodel & Construction Inc.
Cell: 503-705-7611
Email: Chrisk@tlremodel.com
From:Allyson Armstrong
Sent:Tuesday, November 20, 2018 12:30 PM
To: chrisk@tlremodel.com
Subject: 10235 SW Highland Dr
Chris,
I am following up on a permit application you submitted back in January for 10235 SW Highland Dr. The project was for
installing a new window in a living room. Can you please advise if you are moving forward with this project in the future
or would you like me to void this permit application? This is my second attempt to contact you. I also left a voice mail
back on 8/2/18.
Thank you,
Allyson Armstrong
1
Building Permit Application \, 0 1 n ef/a-;y ,9 -
Residential r AI I FOR OFFICE USE 0\L1
Cityof Tigard A� Received
+ Date/By: / ) 1 Permit No.: /V e 7 O1 jt�.6yrry'S 7
M 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ! `1J !/'� (� G,�c+i7`
a Phone: 503.718.2439 Fax: 503.598.1960 3 At i. 2 2 2018 Date/By: Other Permit: hi/VW l `7,,,,(le FO
r�
T I G A R D Inspection Line: 503.639.4175 ,.. ,/N p Date Ready/By: Juris: RI See Page eJ2 for ld
Internet: www.tigard-or.gov cc c'? o 9 Ott- ,1 Notified/Method: Supplemental Information
TYPE OF Wiikt REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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
tEl Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
El1-and 2-family dwelling 0 Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10235 sw highland Dr New dwelling area: square feet
City/State/ZIP:Tigard OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:mckee Covered porch area: square feet
Cross street/directions to job site: 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
installation of new window in living room 8/0 x 5/0 Valuation: $ C� Irv,
Existing building area: v square feet
New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name:Carol McKee Type of construction: ,
Address:10235 SW Highland Dr Occupancy groups:
City/State/ZIP:Tigard OR 97224 Existing:
Phone:(503)3602399 Fax:( ) New:
0 APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:TL Remodel&Construction (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Chris Kyle
Address:PO Box 1996 FLS plan review fee(if applicable):
City/State/ZIP:Lake Oswego OR 97035 Total fees due upon application: tr i
Phone:(503)7057611 Fax::( ) Amount received:
E-mail:Chrisk@tlremodel.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:TL Remodel&Construction Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:po box 1996 Solar Installation Specialty Code checklist.
City/State/ZIP:Lake Oswego OR 97035 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)97842783 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.:191214
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Timothy Labunsky Date:01/17/18 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
I
l
I
1
Branden Taggart
From: David Young
Sent: Tuesday, December 19, 2017 9:55 AM
To: #Building Permit Technicians
Subject: 10235 SW Highland
Please add a investigative fee for structural work without permit. A new or larger than original window was installed
without a permit. Let me know if you have any questions.
Thanks,
David.
Sent from my iPad
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
1
1