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PFI2018-00143 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 RequestforPermit 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 Ornelas BP TRANSACTION INFORMATION: Receipt#: 419228 Case #: PFI2018-00143 Date: 8/30/2018 Address/Parcel: 2SIO70001200 Pay Method: Check Project Name: River Terrace Edge EXPLANATION: Release of customer deposit for work completed. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund .Example: Buildin Permit Fee,. -Exam le: 23,00000,43104 $Amount Customer Deposit 100-0000-22000 $344,837.00 TOTAL REFUND: $344,837.00 APPROVALS: SIGNATURES MATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager SSL-- May, 21,2021 If over$50,000 Local Contract Review Board Case Refund Processed: Date: I 1k B y, V I:\Building\Refunds\RefundRequest.dm x 09/01/2010 CITY OF TIGARD RECEIPT ■ 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: River Terrace Edge Site Address: 14992 SW ROY ROGERS RD Receipt Number: 437648 - 11/19/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12018-00143 $-344,837.00 Total: $-344,837.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 239450 HVANDEWEGE 11/19/2021 $-344,837.00 Payor: Polygon WLH LLC Total Payments: $-344,837.00 Balance Due: $344,837.00 Page 1 of 1 CITY OF TIGARD RECEIPT ■ 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 OV v Project Name: River Terrace Edge Site Address: 14992 SW ROY ROGERS RD Receipt Number: 419228 - 08/30/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12018-00143 Customer Deposit 100-0000-22000 $344,837.00 PF12018-00143 Customer Deposit 100-0000-22000 $169,675.00 PF12018-00143 Erosion Control Fee 640-0000-43134 $6,543.77 PF12018-00143 PFI Permit Fee 640-0000-43114 $409,038.52 Total: $930,094.29 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 072351 SCOPELAN 08/30/2018 $998,824.80 Payor: Polygon WLH, LLC Oregon Permit Account Total Payments: $998,824.80 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 w 13115 4111 BHI-A,..tigsrC CTR 47228 " tT:1 5 .F334.R1 A 11 i 1s Project Name: River Terrace Edge Site Address: 14092 SW ROW ROGERS RD Receipt Number: 413228 0813012018 CAISE No, FEE MSCR10T10N REVENUE ACCOUNT N UMBER EM PF12018-00143 CuMotner D"511 100-00W220W 9344.837dl0 PF12018,W143 Gustmwr Dopusil 1000000.32000 SteR.M.00 PF12018-00143 Erasion.control Pae 840.0000.43134 36.54.5" PFt2018�W143 PFI Petttst Fee 6W-0000-43114 S40D,03-52 Tohl: Sw0M29 J'AyM NTS�F �METi+(if5 CNECIf b A T! N�! AIM� CASitWA RECEIPT DATE RECEIPT AMT QfIo,;k 072351 SCOPELAN C7@ta'.3f4':'i}i$ 34108,824:80 Payer: PWygvn VVLFI,.LLC CFrajw PaFmN Accaurd TotalPaymarrta. eatance OW: 8006 I:\Building\Refunds\RefundRequest.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-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: 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). Pertnit#: PF12018-00143 Site Address or Parcel#: #2S1070001200 Project Name: River Terrace Edge Subdivision Name: Lot#: EXPLANATION: The developer put a grading deposit in the amount of$344,837.00 The deposit can be returned in full amount due to the completed part of the job Signature: Date: 4/8/2021 Print Name: Boris Piatski JVer UAJV�.rn shi 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 809/6 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 34 weeks for processing refundrequests. /DD—d�00 —Z2oDQ �/30�/� 3y��17 p-T7 7 /t d,✓r�� fi�M /��2�i�-Od✓y3 r zJ Zo<I oe yiy = -1 �,y R OFFICE USE ONLY Route to Sys Admin: Date B• Route to Records: Date \l 1 q 1 I B Refund Processed: Date S 19 21 B IDO I Invoice Processed: Date B Permit Canceled: B Parce]Ta Added: Date B I:\Building\Forms\RegPermitA ction_720518.doc Y City of Tigard May 27, 2021 Polygon WLH,LLC 703 Broadway St, Suite 510 Vancouver,WA 98660 Re:Permit No. PFI2018-00143 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# 2S1070001200 Project Name: River Terrace Edge � Refund: ® Check#I'3 in the amount of$344, 0`0. ❑ Credit card "return" receipt in the amount of$ ❑ 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, e4&'IkeJez-� 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 Requestfor Permit Action form (if applicable) must be attached to this request forth. 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#: 419228 Case#: PFI2018-00143 Date: 8/30/2018 Address/Parcel: 251070001200 Pay Method: Check Project Name: River Terrace Edge 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 $344,831.00 TOTAL REFUND: $344,837.00 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 15t May,21,2021 If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: I Date: Bc: I:\Building\Refunds\RcfundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 13129 SW HWI BNJ,Tlgard OR 91123 W'Jb3g,lill Project Name: Rwer reffam EcIge Site Arldmos: 14992 SW ROY ROGER S RD Receipt Number: 419228 0813012018 CASE NO, FEE DESCRIPTION j3EVEMME ACCOUNT NW= EAM PFL2018-OM43 custanier Depmll 14e-N"-220W S144 937,W PFU018-00143 custuner DePMA M-GOCW-223W V696no0 PF12018-OD143 Erasion CmIrol Foo 640-MmN43134 $6,54377 M20I&OM43 PFt Panut Few W-CWN�-43114 $40903852 TaW: PAYMf N T M11t9l] 25WER 10 RECEIPT DATE RECEIPT AUT CHECK N AUTM CODE ACCT ID CA Ctwk 07235t SCOPELAN i-j i a 3dXA,624 so Payor: Pc4ygwiWLH,LLC Oregon Permit Ac"e nt Total.Paymeow so"'824 w "anon Du c $000 1:\Budding\Refunds\RefundRequest.doe x 09/01/2010