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PRE2021-00012 r C . • TIGARD City of Tigard August 13,2021 Haidar Fakih 10705 SW 71s`Ave Tigard, OR 97223 Re: Permit No. PRE2021-00012 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10745 SW 71"Ave Project Name: LamLuma Bakery Job No.: N/A Refund Method: ® Check#240223 in the amount of$344.00. ❑ Credit card"return" receipt in the amount of$ 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): Proposal was not approvable and city staff cancelled pre-application conference. Refund 100%of application fees paid. If you have any questions please contact me at 503.718.2430. Sincerely, 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 71 . . . 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: Haidar Fakih DATE: 8/6/2021 10705 SW 71stAve Tigard, OR 97223 REQUESTED BY: Dianna Omelas LS TRANSACTION INFORMATION: Receipt#: 433083 Case#: PRE2021-00012 Date: 2/24/2021 Address/Parcel: 10745 SW 71st Ave Pay Method: CreditCard Project Name: LamLuma Bakery EXPLANATION: Per Lina Smith,proposal not approvable;city staff canceled pre-app. Refund 100%of application fees. REFUND INFORMATION:, - Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Application Fee 1 00-0000-431 1 6 $344.00 TOTAL REFUND: $344.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff `/. If under$12,500 Division Manager /(f )'Y2//h-eti4/1-) If under$25,000 Department Manager "`1�� If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY' ' Case Refund Processed: Date: i //3/;=-/ By: --c:( L I:\Building\Refunds\RefundRequest.doc x 09/01/2010 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT R 1 0 Request for Permit Action opli 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 ® City Staff Check(✓)one REFUND OR Name: Haidar Fakih INVOICE TO: (Business or Individual) Mailing Address: 10705 SW 71"Ave City/State/Zip: Tigard, OR 97223 Phone No.: (503) 720-0624 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ® CANCEL/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). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: PRE2020-00012 Site Address or Parcel #: 10745 SW 71"Ave Project Name: LamLuma Bakery Subdivision Name: N/A Lot #: N/A EXPLANATION: Proposal is not approvable, so city staff canceled pre-app. Please refund 100%. Thank you. 3/10/2021 _____ I Date: Signature: > e, Print Name: Lina Smith Refund Policy 1. '1'hc 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 ieview 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 10 Records: Date . /3/2-If By 'c+ / Refund Processed: Date tl(o,/�/ By AV Invoice Processed: Date By Permit Canceled: Date d7 ./� By v Parcel Tag Added: Date By I:\Building\Forms\RegPennitAction_095_314.C{oc 711 CITY OF TIGARD RECEIPT is a • 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: LamLuma Bakery Site Address: 10745 SW 71ST AVE fie oft./ � Receipt Number: 435822 - 08/13/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PRE2021-00012 $-344.00 Total: $-344.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240223 DHOWSE 08/13/2021 $-344.00 Payor: Haidar Fakih Total Payments: $-344.00 Balance Due: $344.00 Page 1 of 1 CITY OF TIGARD RECEIPT • 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: LamLuma Bakery Site Address: 10745 SW 71ST AVE Receipt Number: 433083 - 02/24/2021 (f CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PRE2021-00012 Application Fee 100-0000-43116 $344.00 Total: $344.00 PAYMENT METHOD CHECK# AUTH CODE ACCTID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 7402401 PUBLICUSERO 02/24/2021 $344.00 Payor: Total Payments: $344.00 Balance Due: $0.00 Page 1 of 1