SUB2019-00002 IN
TIGARD
City of Tigard
October 11,2019
Dan Quello
16445 SW 92'Ave
Tigard, OR 97224
Re: Permit No. SUB2019-00002
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 16585 SW 92"d Ave
Project Name: Eagle View Estates
Job No.: N/A
Refund Method: ® Check#233582 in the amount of$250.00.
❑ Credit card "return" receipt in the amount of$
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 withdraw application. Refund 100% of
application fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
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
;II • 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 forPermitAction 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: Dan Quello DATE: 10/4/2019
16445 SW 92°d Ave
Tigard, OR 97224 REQUESTED BY: Dianna Howse
MB
TRANSACTION INFORMATION:
Receipt#: 426044 Case#: SUB2019-00002
Date: 9/25/2019 Address/Parcel: 16585 SW 92nd Ave
Pay Method: Check Project Name: Eagle View Estates
EXPLANATION: Per applicant's request to withdraw application. Refund 100%of application fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Appeal Type 11 to Hearings Officer 100-0000-43116 $250.00
TOTAL REFUND: $250.00
APPROVALS: SIGNAT ES/DATE:
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: 1 By:
I:\Building\Refunds\RefundRequcst.doc x 09/01/2010
CITY OF TIGARD RECEIPT
■ • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TI CAR D
Project Name: Eagle View Estates
Site Address: 16585 SW 92ND AVE /� /V_L
Receipt Number: 436109 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
S U B2019-00002 $-250.00
Total: $-250.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 233582 DHOWSE 08/27/2021 $-250.00
Payor: Dan Quello
Total Payments: $-250.00
Balance Due: $250.00
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T I(.A It,D
Project Name: Eagle View Estates
Site Address: 16585 SW 92ND AVE O/`lG,AferL—
Receipt Number: 426044 - 09/25/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SUB2019-00002 Appeal Type II to Hearings Officer 100-0000-43116 $250.00
Total: $250.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1406 ALINDOR 09/25/2019 $250.00
Payor Dan Quello
Total Payments: $250.00
Balance Due: $0.00
Page 1 of 1
, D
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN 0 4
Request for Permit Action /0/3/9 #
we—
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
'1'0: 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 ,City Staff
Check(✓)one
REFUND OR Name: �� !! '' ,,��
INVOICE TO: (Business or Individual) D pin v' ...Ali .J
Mailing Address: I <O y ? S S W c1 2 rZ GC
City/State/Zip: T(C)UI r7A (7 2 ' 1 2 2-1
Phone No.: -0 3 c,j7p/ - S 4 S- C.
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (i):
0 CANCFI /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 #: S'1J (3201G1 -- 0000Z
Site Address or Parcel#: ! (0 SQ) S 5 W c1 2- n r't'
5 U
Project Name: oj w v i e .S tTi1A-2 s
Subdivision Name: �^ ilk_
#:
EXPLANATION: \i‘f{ lOt.raw n _ 1/V it re Cv ilk_ 12S U
Signature: 0/1/N---- L."----`` — Date: C1l 3 0/ i q
Print Name: V Q �i L c.i Y) ,I 0 Gi.e i l/
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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date c'a7 ?/ I .ti If
Refund Processed: Dateip/3//f By ' Invoice Processed: Date By
Permit Canceled: Date/p/g jam By ,y r Parcel Tag Added: Date By
I:\Building\Forms\ReyPermitAction_ O5f8.doc