The URL can be used to link to this page

ADJ2019-00016 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 1 Request for Permit Action 3119/zo 4&le-- 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SNk'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 1ndividu4 G r2�Cil S-b►l.Q 1 C,8 TWO ATC h 11Cef:S Mailing Address: SGS LtbCll SPS Sc- I OL) City/State/Zip: cSp►1ewj t (QP- q-7 .501 Phone No.: 61l-a> • 490. !K-76P PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).—107`0 ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: /��(`1��P -1 Site Address or Parcel#: 3(00 SyV Da K Project Name: t Dr Irl V l two! Subdivision Name: Lot#: EXPLANATION: ND I JY1(�(/Y V\PMeA / 'GANA A11) % yO6 . Dry ,/067L f6•✓C1 Signature: Date: 112-1 20 Print Name: V )4v'►Y1�1 L.IvJ� 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 • Not more than 801.of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. * y0 / FOR OFFICE Route to Sys Adttun: Date I By Route to Records: Date y B Refund Processed: Date 3 / By AW I Invoice Processed Date B Pennit Canceled: Date 3 2d I B Parcel Tag Added: Date RIT I:\Building\Forms\RegPexmitAcdon_1 518. Agnes Lindor From: Gretchen Stone <Gretchen@CBTwoarchitects.com> Sent: Tuesday,January 21, 2020 1:42 PM To: Agnes Lindor Subject: RE: Steadfast Senior Living Caution!This message was sent from outside your organization. Allow sender I Block sender Hi Agnes, Yes you are correct, the only adjustment required and being requested is for the S-4 screening where the proposal does not provide the full 8 foot width. Thank you, Gretchen Gretchen Stone CBIi VVz ARCHITECTS 500 Liberty Street SE, Suite 100 Salem, OR 97301 (503) 480-8700 p (503) 510-5510 c From: Agnes Lindor [mailto:agnesl@tigard-or.gov] Sent: Tuesday, January 21, 2020 1:36 PM To: Gretchen Stone Subject: Steadfast Senior Living HiGretchen- I just wanted to confirm that I can go ahead and cancel 3 out of the 4 adjustment applications.The only adjustment required is for the S-4 screen. Please confirm that I can cancel the following adjustments: ADJ2019-00015- reduce vehicle parking ADJ2019-00016- reduce bike parking ADJ2019-00017- Reduce density/FAR This is the only adjustment applicable: ADJ2019-00018- adjustment to the S-4 screen Thanks! Agnes Lindor I Associate Planner 1 A . � t City of Tigard April 3, 2020 Steadfast Properties and Development 18100 Von Karman Ave., Suite 500 Irvine, CA 92612 Re: Permit No.ADJ2019-00015, 16, 17 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9360 SW Oak St Project Name: Steadfast Senior Living Job No.: N/A Refund Method: ® Check#235168 in the amount of$1,218.00. ❑ Credit card "return"receipt in the amount of$ 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 as adjustments no longer needed. Refund 100% of application fee. 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 0 www.tigard-or.gov City of Tigard Accela Refund Request This forth is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Requestfor 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 Steadfast Properties and DATE: 3/19/2020 TO: Develoment 18100 Von Karman Ave, Suite 500 Irvine, CA 92612 REQUESTED BY: Dianna Omelas TRANSACTION INFORMATION: Receipt#: 426011oaI Case #: ADJ2019-00015, 16, 17 Date: 9/26/2019 Address/Parcel: 9360 SW Oak St Pay Method: Check Project Name: Steadfast Senior Living EXPLANATION: Per applicant's request as adjustments no longer needed. Refund 100%of application fees per Agnes Lindor. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Development Adjustment 100-0000-43116 $1,218.00 TOTAL REFUND: $1,218.00 APPROVALS: SIGNATURES/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 FCase Refund Processed: I Date: I AT By: I 1:\B61ding\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Steadfast Senior Living Site Address: 9360 SW OAK ST Receipt Number: 436230 - 09/0312021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SDR2019-00005 $-1,218.00 Total: $-1,218.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 235168 DHOWSE 09/03/2021 $-1,218.00 Payor: Steadfast Properties& Development Inc. Total Payments: $-1,218.00 Balance Due: $1,218.00 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 E Project Name: Steadfast Senior Living Site Address: 9360 SW OAK ST n Receipt Number: 426069 - 09/26/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SDR2019-00005 Development Adjustment(includes TMU 100-000043116 $1,586.36 Zone Adjustments) SDR2019-00005 Sensitive Lands Review-Type II 100-0000-43116 $3,646.00 SDR2019-00005 Site Development Review-Type 11- 100-0000-43116 $21,542.64 $1,000,000 and Over Total: $26,775.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 15879 SCOPELAN 09/26t2019 $26,775.00 Payor: Steadfast Properties&Development, Inc. Total Payments: $26,775.00 Balance Due: $0.00 �5f-J, , 3& Page 1of1