MLP2016-00009 IIIi ' „
TIGARD
City of Tigard
August 9,2019
Vitaly Kovalev
6990 SW Canby St
Portland, OR 97223
Re:Permit No. MLP2016-00009
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 1S125DA03700/3800
Project Name: Walnut Terrace Partition
Job No.: N/A
Refund: ® Check#232924 in the amount of$3,060.00.
❑ Credit card "return"receipt in the amount of$ .
❑ Trust account"deposit"receipt in the amount of$ .
Notes: Refund 100% of tree establishment bond as applicant has successfully planted all
required trees.
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
_ IICity of Tigard
�CiARD 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: Vitaly Kovalev DATE: 8/2/2019
6990 SW Canby St
Portland, OR 97223 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 416249 Case#: MLP2016-00009
Date: 3/21/2018 Address/Parcel: 1S125DA03700/3800
Pay Method: Check Project Name: Walnut Terrace Partition
EXPLANATION: Refund 100% of tree establishment bond as applicant has successfully planted all
required trees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Tree Establish Bond 260-0000-22000 $3,060.00
TOTAL REFUND: $3,060.00
APPROVALS: SIGNAS DATE:
If under$5,000 Professional Staff ���f/
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 ADMJNISTRATION USE ONLY
Case Refund Processed: Date: C., y 'L/ By: 4)
1:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
la
s • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T[GAR D
Project Name: Walnut Terrace Partition
Site Address: // � N
Receipt Number: 434701 - 06/04/2021 l !�
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MLP2016-00009 $-3,060.00
Total: $-3,060.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232924 DHOWSE 06/04/2021 $-3,060.00
Payor: Vitaly Kovalev
Total Payments: $-3,060.00
Balance Due: $0.00
Page 1 of 1
sCITY OF TIGARD RECEIPT
� .�I13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Walnut Terrace Partition
Site Address: �fj // ` / `Urn „
Receipt Number: 416249 - 03/21/2018 (/,�I (ry L�
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MLP2016-00009 Inventory Fee-Open Grown Tree- 1st 1 00-0000-431 1 6 $154.00
MLP2016-00009 Inventory Fee-Open Grown Tree-each 100-0000-43116 $224.00
add'I
MLP2016-00009 Tree Establish Bond-1.5" in SUB or 260-0000-22000 $3,060.00
MLP
Total: $3,438.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 3536 SCOPELAN 03/21/2018 $3,438.00
Payor: Vitaly Kovalev
Total Payments: $3,438.00
Balance Due: $0.00
Page 1 of 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
71
It
for Permit Action
TIGARD 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 ❑ Applicant ❑ Contractor ® City Staff
Check(i)one
REFUND OR Name: Vitaly Kovalev
INVOICE TO: (Business or Individual)
Mailing Address: 6990 SW Canby St.
City/State/Zip: Portland, OR 97223
Phone No.: (503) 522-7499
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
El INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: MLP2016-00009
Site Address or Parcel #: 6614-6618 SW Walnut Ter.
Project Name: Walnut Terrace Partition
Subdivision Name: N/A Lot #: N/A
EXPLANATION: Applicant has successfully planted all required trees. Please refund 100% of
the tree establishment'bond.($3,060). Thank you.
7/29/2019
Date:
Signature:
Print Name: Lina Smith
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.
FOR OFFICE USE ONLY
Route to Sys.Amin: Date By Route to Records: Date/, y The/
Refund Processed: Date??//9 By .`•!' Invoice Processed: Date By
Permit Canceled: Date �j/} Parcel Tag Added: Date By
\Bu lding\Forms\RegPernatAction_092 14.doc