MLP2020-00007 Cr
TIGARD
City of Tigard
November 23,2020
Walt Aman
PO Box 4127
Portland, OR 97208
Re: Permit No. MLP2020-00007
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11655 SW Pacific Hwy
Project Name: Aman Partition
Job No.: N/A
Refund Method: ® Check#237271 in the amount of$3,653.60.
❑ Credit card"return"receipt in the amount of$ .
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Comment(s): Refund 80%of application fees for application withdrawn for a 2-lot
partition. Will resubmit for a 3-lot partition.
If you have any questions please contact me at 503.718.2430.
Sincerely,
1(:(2'3-(//01,---6.4.---)
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 • COMMUNITY DEVELOPMENT DEPARTMENT
'� ■ Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division // /P/ZO 4t)
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 V)one
REFUND OR Name:
INVOICE TO: (Business or individual) Walt Aman
Mailing Address: PO Box 4127
City/State/Zip: Portland OR,97208-4127
Phone No.: 503-789-2157
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).
Permit#: MLP2020-00007
Site Address or Parcel#: 11655 SW Pacific Hwy,Tigard
Project Name: Aman Partition
Subdivision Name: N/A Lot#: N/A
EXPLANATION: Withdrawing the application for a two-lot partition to submit a new application
for a 3-lot partition due to the trip cap that would be applied for a two-lot partition and re-zoning.
%5 ?7 ,X cee
Dianna- Please refund 80% of fees. -Agnes Lindor; 10/13/20 = 3653 . 44 Qd.
Signature: � Date: 10-12-2020
Print Name: Alex Dupey
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund o£
• 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. YG /y P--)
6, c3 •4d
9,0 ' YD
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route I,)Records: Date d /- 2—,/ By /
Refund Processed: Date // /�•/ B Invoice Processed: Date By
Permit Canceled: Date /17/0/x By 6 Parcel Tag Added: Date By
I:\Building\Forms\RegPertnitAction_1 0518. oc
IN
_ ` City of Tigard
i.Ic, 1kz1, 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: Walt Aman DATE: 11/16/2020
PO Box 4127
Portland, OR 97208 REQUESTED BY: Dianna Omelas
Agnes
TRANSACTION INFORMATION:
Receipt#: 430363 Case #: MLP2020-00007
Date: 7/27/2020 Address/Parcel: 11655 SW Pacific Hwy
Pay Method: Check Project Name: Aman Partition
EXPLANATION: Refund 80%of fees for application withdrawn.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Application Fee 100-0000-43116 $3,653.60
TOTAL REFUND: $3,653.60
APPROVALS: SIGNATURES/DATE:
If under $5,000 Professional Staff
If under$12,500 Division Manager 49 Q /1a/J—D
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: //.j By:
I:\Building\Refunds\RcfundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Arran Partition
Site Address: 11655 SW PACIFIC HWY
Receipt Number: 435841 - 08/13/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MLP2020-00007 $-3,653.60
Total: $-3,653.60
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 237271 DHOWSE 08/13/2021 $-3,653.60
Payor: Walt Aman
Total Payments: $-3,653.60
Balance Due: $3,653.60
Page 1 of 1
CITY OF TIGARD RECEIPT
= 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
I[GARD
Project Name: Aman Partition
Site Address: 11655 SW PACIFIC HWY
Receipt Number: 430363 - 07/27/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MLP2020-00007 Application Fee 1 00-0 000-431 1 6 $4,567.00
Total: $4,567.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 3837 ALINDOR 07/27/2020 $4,567.00
Payor: Aman Enterprises, Inc. PO Box 4127 Portland, OR 97208
Total Payments: $4,567.00
Balance Due: $0.00
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