PFI2018-00164 t
• t
City of Tigard
May 27, 2021
Polygon WLH,LLC
703 Broadway St, Suite 510
Vancouver,WA 98660
Re:Permit No. PFI2018-00164
Dear Applicant:
The City of Tigard has processed a refund for the deposit of fees on the above referenced
permit for the following:
Site Address: Parcel# 2S1070001303
Project Name: Polygon at South River Terrace
Job No.: N/AtiSO
Refund: ® Check#I in the amount of$687,741.50.
❑ Credit card"return"receipt in the amount of$
❑ Trust account"deposit"receipt in the amount of$
Notes: Refund of customer deposit for public facilities improvement work completed.
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 form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the RequestforPermitAction 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 Polygon WLH LLC DATE: 5/19/2021
TO:
703 Broadway Street,Suite 510
Vancouver,WA 98660 REQUESTED BY: Dianna Ornelas
BP
TRANSACTION INFORMATION:
Receipt#: 419229&419230 Case#: PFI2018-00164
Date: 8/30/2018 Address/Parcel: 2S1070001303
Pay Method: Check Project Name: Polygon at South River Terrace
EXPLANATION: Release of customer deposit for work completed.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example; 2300000-43104 $Amount
Customer Deposit 100-0000-22000 $687,741.50
TOTAL REFUND: $687,741.50
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 -SL R— May 21,2021
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: B
I:\Building\Refunds\RefundRequest.dm x 09/01/2010
CITY OF TIGARD RECEIPT
13 225 5W Hal Bkvd.Tvgard OR 97223
639
4171
Project Kim: Poiygon at South Rivet Terrace
Site Address:
Receipt Number: 419229 0813012018
CASE NO, FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00164 Customer Deposit IO&OOOO-220DO $500.OW on
Total: $500,000 w
PAYMENT METHOD CHFCKN RUTH MOP AccT lo CASHIER In BLQEJLLQ&U RECEIPT AUT
Check 72352 SCOPELAN D&3(1201 8 5500.00000
Payer. Polygon.WLli,LLC O(soonPormitAcWur4
Total Payments: s5w coo 00
Balance Duo 513.10
CITY OF TIGARD RECEIPT
1:1125 SW Halt 8W,Tigard(M 97223
503 639,4171
Prole Name: Porygon at South River Terrace
Site Addrose:
Receipt Number: 419230 08130/2018
CASE NO� FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00164 Customer Dapos4 100-3=1 22000 $187.741,50
Total! S1®7.741,50
PAYMENT METHOD jrdggg A AUTH CODE ACQT 10 CASHIFR 10 RFCFL*T OATS MQVIPT AUT
Check 72354 SCOPELAN 08!3012018 $716,083-00
Payer: P*gonWLh1,LLC Oregon Permit Account
ToW Psynienw $716.08300
salarres Duet $0.00
[:\Budding\Rcfmds\RefundRequest.dm x 09/01/2010
■ ' 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 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 Polygon WLH LLC DATE: 5/19/2021
TO:
703 Broadway Street, Suite 510
Vancouver,WA 98660 REQUESTED BY: Dianna Omelas
BP
TRANSACTION INFORMATION:
Receipt#: 419229&419230 Case#: PFI2018-00164
Date: 8/30/2018 Address/Parcel: 2SIO70001303
Pay Method: Check Project Name: Polygon at South River Terrace
EXPLANATION: Release of customer deposit for work completed.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Customer Deposit 100-0000-22000 $687,741.50
TOTAL REFUND: $687,741.50
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 SUE— May 21,2021
If over$50,000 Local Contract Review Board
Case Refund Processed: Date: \\ \cl 2\ By: v
I:\Building\Refunds\RefundRequest.dm x 09/01/2010
CITY OF TIGARD RECEIPT
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171 Q
Project Name: Polygon at South River Terrace
Site Address:
Receipt Number: 437649 - 11/19/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00164 $-500,000.00
Total: $-500,000.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 239450 Polygon WLH LL HVANDEWEGE 11/19/2021 $-500,000.00
Payor:
Total Payments: $-500,000.00
Balance Due: $500,000.00
Page 1 of 1
CITY OF TIGARD RECEIPT
■ 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Polygon at South River Terrace
Site Address:
L- Receipt Number: 419229 - 08/30/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00164 Customer Deposit 100-0000-22000 $500,000.00
Total: $500,000.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 72352 SCOPELAN 08/30/2018 $500,000.00
Payor: Polygon WLH, LLC Oregon Permit Account
Total Payments: $500,000.00
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD RECEIPT
i 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Polygon at South River Terrace
Site Address:
Receipt Number: 437650 - 11/19/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00164 $-187,741.50
Total: $-187,741.50
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 239450 HVANDEWEGE 11/19/2021 $-187,741.50
Payor: Polygon WLH LLC
Total Payments: $-187,741.50
Balance Due: $687,741.50
Page 1 of 1
MaCITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
1
Project Name: Polygon at South River Terrace
Site Address:
Receipt Number: 419230 - 08/30/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00164 Customer Deposit 100-0000-22000 $187,741.50
Total: $187,741.50
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 72354 SCOPELAN 08/30/2018 $716,083.00
Payor: Polygon WLH, LLC Oregon Permit Account
Total Payments: $716,083.00
Balance Due: $0.00
Page 1 of 1
Dianna Ornelas
From: Kat Suttles
Sent: Wednesday, November 17, 2021 7:24 AM
To: Dianna Ornelas
Cc: AP
Subject: RE: Refund Request - River Terrace
Good morning,
Payment for both transactions is on chec 239450 dated 05/27/21.
From: Dianna Ornelas<Dianna@tigard-or.gov>
Sent:Tuesday, November 16, 20217:31 PM
To: Kat Suttles<katsu@tigard-or.gov>
Cc:AP<ap@tigard-or.gov>
Subject: FW: Refund Request- River Terrace
Importance: High
Hello Kat,
Can you or someone else in Finance please provide the check numbers for the refund amounts shown on the attached
route sheet that were processed in May, 2021? 1 discovered that the amounts have not been backed out of Accela yet
and I need to do that by this Friday.
Thanks so much!
Dianna
From: Dianna Ornelas
Sent:Tuesday, May 25, 20215:17 PM
To: Kat Suttles<katsu@tigard-or.gov>
Cc:AP<ap@tigard-or.gov>;Tina Escalera <tinae@tigard-or.gov>
Subject: RE: Refund Request- River Terrace
Hello Kat,
Thanks to Tina,she discovered that I had an incorrect amount on the check request cover sheet. Please replace with the
attached revised sheet.
Thank you, and thanks, Tina!
Dianna
From: Dianna Ornelas
Sent:Tuesday, May 25, 20214:30 PM
To: Kat Suttles<katsu@tigard-or.gov>
Cc:AP<ap@tigard-or.gov>;Tina Escalera <tinae@tigard-or.gov>
Subject: FW: Refund Request- River Terrace
Hi Kat,
1
When you process the two refund checks for Polygon WLH LLC this week, please email me and copy Tina Escalera when
the checks are ready to be picked up in our mail box. Tina will be mailing these out on Thursday.
Thank you!
Dianna
From: Dianna Ornelas
Sent: Friday, May 21, 202112:45 PM
To: AP<ap@tigard-or.gov>
Subject: Refund Request- River Terrace
Hello Kat,
Please see attached for(2) River Terrace customer deposit refunds both approved/signed by Steve Rymer. Please let me
know as soon as the checks have been cut and routed to me intra-office mail.
Please confirm that you received this email.
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
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."
2
CITY OF TIGARD RECEIPT
13125 8W Has 8wd_TVwd OR 97223
503.839.4171
Project Name: Polygon at South River Term
84to Addresa:
Relmipt Number: 419229 - 08/3012018
CASE NO, FEE DESCRIPTION REMENUE ACCOUNT NUMBER PAM
PFI2016-00164 Customer Deposit 100-ODW22oo0 $900,000.00
Ta41: ""1000.08
ALM4 COOK ACQT ID 9AAW9= REMPT DATE RECEIPT ANT
Check 72352 SCOPELAN o8t30t a $800,000,00
Payer: PotyWWLH,LLC0(*qonPwmlAocourA
Total Paymaps: S9W=00
M Manan Dw: $o 00
CITY OF TIGARD RECEIPT
13125 SW rias ewe..Tigard Ok 9W3
503.839.41 T1
Prgo"Name: Polygon at South River Term
She Address:
Receipt Number: 419230 - 08130!2018
CASE Na FEE DESCRIPTION &M UE agraO NIT HUMUR PAW.
PFI201&00164 CUSWmer Deposit IODW=22000 $187,741.50
Thai: $187,711.50
C&%MUaJtIFTNOD AURUA AUTH COW. ACCT 115 CAMMR 10 USIMMM RECENT ANY
Check 72354 SCOPELAN o813o12018 $716,0$3.00
Payor: Potygon WLH.LLC Oregon Pem*AcocuM
Total Paymanb: $716,083.00
Ballance Due: $0,00
I:ABuildingARefunds\RefundReyuest.doc x 09/01/2010
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
• 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • www.tigard-ongov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@dgard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ;2f City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Polygon WLH LLC
Mailing Address: 703 Broadway Street, Suite 510
City/State/Zip: Vancouver WA 98660
Phone No.: 503-312-6213
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#: PF12018-00164
Site Address or Parcel#: .# 2S1070001303
Project Name: Polygon at South River Terrace
Subdivision Name: Lot#:
EXPLANATION: The developer put a grading deposit in the amount of$687,741.50. The
deposit can be returned in full amount due to the completed part of the job.
Signature: Date: 4/8/2021
Print Name: Boris Piatsld ��`..�i n•,cswrw i
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which has 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.
17y/ s,_
• • OFFICE USE ONLY
Route to S s Admin: I Date By I Route to Records:71 Date\\ Wal Z1 B
Refund Processed: Date 1q 2l I By Invoice Processed: Date B
Permit Canceled: Date 9—" AA61 By Parcel Tag Added: Date B
L\Building\Forms\RegPermitAction_120518.doc