PDR2016-00016 71
TIGARD
City of Tigard
August 9, 2019
Polygon WLH,LLC
703 Broadway Street, Suite 510
Vancouver,WA 98660
Re: Permit No. PDR2016-00016
Dear Applicant:
The City of Tigard has processed a refund for fees on the above referenced permit(s) as
follows:
Site Address: 15515 SW 150th Ave
Project Name: River Terrace Crossing
Job No.: N/A
Refund: ® Check#232940 in the amount of$2,737.00.
❑ Credit card"return"receipt in the amount of$ .
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$ .
Comments: Planned development modification reduced tree inventory fee. Refund the
difference.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
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
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: Polygon WLH,LLC DATE: 8/2/2019
703 Broadway Street,Suite 510
Vancouver,WA 98660 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 412176 Case#: PDR2016-00016
Date: 8/3/2017 Address/Parcel: 15515 SW 150th Ave
Pay Method: Check Project Name: River Terrace Crossing
EXPLANATION: Planned development modification reduced tree inventory fee. Refund the difference.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee ,Exanple: .2300000-43104 $Amount
Inventory Tree Fee 100-0000-43116 $2,737.00
TOTAL REFUND: $2,737.00
APPROVALS: SIGNATURES/DDAATTE::
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: G/frj/j, By 1,
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223 II 4
503.639.4171
TIGARD
Project Name: River Terrace Crossing
Site Address: 15515 SW 150TH AVE
Receipt Number: 434698 - 06/04/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PDR2016-00016 $-2,737.00
Total: $-2,737.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232940 DHOWSE 06/04/2021 $-2,737.00
Payor: Polygon WLH, LLC
Total Payments: $-2,737.00
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD RECEIPT
a
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARI)
Project Name: River Terrace Crossing
Site Address: 15515 SW 150TH AVE /I I /j of 7y�
Receipt Number: 412176 - 08/03/2017 v�" C� !�
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PDR2016-00016 Inventory Fee-Open Grown Tree-1st 100-0000-43116 $156.00
PDR2016-00016 Inventory Fee-Open Grown Tree-each 100-0000-43116 $14,252.00
adds
PDR2016-00016 Inventory Fee-Stand of Trees-1st 1 00-0000-431 1 6 $202.00
Total: $14,610.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 71646 MBILODEAU 08/03/2017 $14,610.00
Payor: Polygon WLH, LLC
Total Payments: $14,610.00
Balance Due: $11,873.00
Page 1 of 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
T I G A R D 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 El Applicant ❑ Contractor 0 City Staff
Check ✓ one
REFUND OR Name: ,p
INVOICE TO: (Business or Individual) A r C e I ot C-, r-c4 j C n
w .S LC
Mailing Address: Po 1 9 0 n (.-I-0 n-1'e S
City/State/Zip:
Phone No.: 3 k 0 - 69 S 1 7o o
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CELLVOID PERMIT APPLICATION.
REFUN RMIT FEES (attach copy of original receipt and provide explanation below).
CE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: P D Q 2.o 1 (7 ' O O o 1 (o
Site Address or Parcel#: nn G
Project Name: IL 1 Vl°� I e rrU C o S S i J
Subdivision Name: Lot#:
EXPLANATION: ?!c nat c4 ciaN ,!toprn f- ►/V!o cLi(n'C ell/cp n
re.d.,U d toe trey_ 'invC-r F22 S Fro 1 14 , 610 k-o
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Signature: ' " I'8'1/ ( -—,. Date: 4) / 3 / 19
Print Name: Ib1 Q tel I C.U1 (311 O c.(-QC( V
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 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.
IOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date 4,1/' L/ By .1
Refund Processed: Date ,P;4i//9 By -;• . Invoice Processed: Date / By
Permit Canceled: Date ,Q/.Q-- By if- Parcel Tag Added: Date By
I:\Building\Forms\RegPemvtAction_1 518.doc
CITY OF TIGARD RECEIPT
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T1GARD
Project Name: River Terrace Crossing
Site Address: 15515 SW 150TH AVE
Receipt Number: 412176 - 08/03/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PDR2016-00016 Inventory Fee-Open Grown Tree-1st 100-0000-43116 $156.00
PDR2016-00016 Inventory Fee-Open Grown Tree-each 100-0000-43116 $14,252.00
add'
PDR2016-00016 Inventory Fee-Stand of Trees-1st 100-0000-43116 $202.00
Total: $14,610.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 71646 MBILODEAU 08/03/2017 $14,610.00
Payor: Polygon WLH, LLC
Total Payments: $14,610.00
Balance Due: $0.00
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Page 1 of 1