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PRE2021-00004 IqH TIGARD City of Tigard February 25, 2021 AC&Co Architecture 363 State Street Salem, OR 97301 Re: Permit No. PRE2021-00004 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11945 SW Pacific Hwy Project Name: Tigard Plaza Expansion Job No.: N/A Refund Method: ® Check#238391 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): Per applicant's request to cancel pre-app as job was cancelled. Refund 100%of application fees. 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 III e City of Tigard FIGARn 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: AC Sc Co Architecture DATE: 2/23/2021 363 State Street Salem, OR 97301 REQUESTED BY: Dianna Omelas GB TRANSACTION INFORMATION: Receipt#: 432725 Case #: PRE2021-00004 Date: 2/1/2021 Address/Parcel: 11945 SW Pacfici Hwy Pay Method: Check Project Name: Tigard Plaza Expansion EXPLANATION: Per applicant's request as job was cancelled. Refund 100%of application fees per Gary Pagenstecher.. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Application Fee 100-0000-43116 $344.00 TOTAL REFUND: $344.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager �i1t�,?�� ,2J If under$25,000 Department Manager J If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: c r By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Tigard Plaza Expansion Site Address: 11945 SW PACIFIC HWY Q�� A41. Receipt Number: 436250 - 09/03/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PRE2021-00004 5-344.00 Total: $-344.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 238391 DHOWSE 09/03/2021 $-344.00 Payor: AC&Co.Architecture Total Payments: $-344.00 Balance Due: $344.00 Page 1 of 1 v CITY OF TIGARD RECEIPT 1 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Tigard Plaza Expansion Site Address: 11945 SW PACIFIC HWY 04/ &/A/q-c. Receipt Number: 432725 - 02/01/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PRE2021-00004 Application Fee 100-0000-43116 $344.00 --- Total: $344.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 7314494 PUBLICUSERO 02/01/2021 $344.00 Payor: Total Payments: $344.00 Balance Due: $0.00 Page 1 of 1 RECEIVED City of Tigard • COM.MUNITY DEVELOPMENT DEPARTMENT FEB Y ; = Request for Permit Action s 1TYOFTIGARD 1-11 T 1 c;Ala) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.goDINC'DIVISION 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: D Owner I Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR NName: . + C,C� �C� INVOICE TO: 3usincss or Individual) Mailing Address: City/State/Zip: -� rn 0 )z 11, "PO O / Phone No.: � ' / c/ )/ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 6: CANCEL/VOID PERMIT APPLICATION. ,l REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). 0 INVOICE FOR FF.FS DUE attach case fee schedule and .i es explanation b ow provide P ) Permit#: ! r ZV Z / V U 2 y�/f I Site Address or Parcel #: 1 ! C L( `te `�7 a C i d� Project Name: f L Gt IZ D I 2.11- pA \s l(-�1/\ Subdivision Name: Lot#: EXPLANATION: V V) `i) ,' ji /017 47r� ' E /1i• r Signature: Date: J Print Name: Refund Policy I. 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 fur issued permits prior to any inspection requests. 2. :\ll 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 f . Z/ B 4f Refund Processed: Datc 2/13 L/ By O Invoice Processed: Date By Permit Canceled: Date 2/2 /2, By 'D Parcel Tag Added: Date By I:\Building\Forms\ltexll'ennit\ction_l 2051It.doc Dianna Ornelas From: o Planner on Duty Sent: Thursday, February 18, 2021 5:41 PM To: #Building Permit Technicians Cc: Planner on Duty Subject: RE: PRE2021-0004 Tigard Plaza Expansion Refund Request Sensitivity: Confidential Hi Dianna, I checked in with Gary as he was assigned this pre app- he says he's okay with returning a 100%refund to the customer. Hope this helps, have a good weekend! Nikki Nikki Tuason Assistant Planner City of Tigard Community Development 13125 SW Hall Blvd. Tigard, OR 97223 n i k k it@tigard-o r.gov From:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Sent:Thursday, February 18, 2021 2:19 PM To: Planner on Duty<tigardplanneronduty@tigard-or.gov> Subject: FW: PRE2021-0004 Tigard Plaza Expansion Refund Request Sensitivity:Confidential Hello Planning Team, Can someone please look at the attached request and based on the amount of work processed on this permit, please let me know how much the refund should be? Thanks! Dianna From: Marie Jacobsen <mjacobsenPaccoac.com> Sent:Thursday, February 18, 2021 1:47 PM To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Subject: RE: PRE2021-0004Tigard Plaza Expansion Refund Request Sensitivity: Confidential Warning!This message was sent from outside your organization and we are unable to verify the sender. Oh gosh, sorry about that. I was so caught up in finding the invoice that I forgot to finish filling it out! Marie Jacobsen t ' Office Manager AC + Co Architecture I Community 363 State Street Salem. OR 97301 P: 503.581.4114 www.accoac.cone From:#Building Permit Technicians <TigardBuildingPermits@tigard-or.gov> Sent:Thursday, February 18, 2021 1:20 PM To: Marie Jacobsen <miacobsen@accoac.com> Subject: RE: PRE2021-0004Tigard Plaza Expansion Refund Request Sensitivity: Confidential Hello Marie, Thank you for your refund request. Please complete the permit information (#, address, etc.) and re-send documents. Thank you. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits From: Marie Jacobsen <miacobsen@accoac.com> Sent:Thursday, February 18, 2021 12:09 PM To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Subject: PRE2021-0004 Tigard Plaza Expansion Refund Request Sensitivity: Confidential Please see the attached Request for Permit Action Application—the Owner of the Tigard Plaza cancelled the permit after we had paid the submission fees. Please see attached refund request form. Thank You. Marie Saco&sen Office Manager AC + Co Architecture I Community 363 State Street Salem, OR 97301 P 503.581.4114 www.accoac.com 2 • Ca Co ARCHITECTURE COMMUNITY 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." 3