ADJ2019-00017 V 0 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.dggrd-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: ^ r
INVOICE TO: (Busu,ess or Individual) ��re(C,Ie S-K)Y)p 1 CB JW Q A-i/1.. Ic�
Mailing Address: � LtOC1� rJ � S� C CLC D
City/State/Zip: 6pxj Vy I QP-
Phone
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PhoneNo.: 5-D3 • 4-90, 2�-7y2
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).-1 00%
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: ADJWbl;,` ODD(^j
Site Address or Parcel#: q,)(DO &V Oa K
Project Name: &feM-&tsf Sen or L l y t iog
Subdivision Name: Lot#:
EXPLANATION: ND IJ /// 7'zci✓�1
Signature: Date: f 2I
Print Name: fptiy?Cf L.(vtc{civ/
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 800/6 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.
YO G
IOR OFFICE USE ONLY
Route to Sys Admin: Date B Route to Records: Date -
Refund Processed: Date 311 g So B ; /P/Invoice Processed: Date / / B
Permit Canceled: Date_ql/ B rcel Tag Added: I Date B
1:\Building\Fomes\RegPemiitAction_205] .doc
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
CBIT OARCHITECTS
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
Hi Gretchen-
[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
i
s
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 Omelas
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 form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for PermitAetion 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 Ornelas
TRANSACTION INFORMATION:
Receipt#: 42601fAJ 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 DA
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: By:
I:\Building\Refunds\RefundRequesL.dm a 09/01/2010
CITY OF TIGARD RECEIPT
13125 SW Hail 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
Project Name: Steadfast Senior Living
Site Address: 9360 SW OAK ST
Ori 6�, fVq-�
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 100-000043116 $3,646.00
SDR2019-00005 Site Development Review-Type II- 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 09/26/2019 $26,775.00
Payor: Steadfast Properties&Development, Inc.
Total Payments: $26,775.00
Balance Due: $0.00
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A/
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