CPA2020-00002 CkPiD
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 3�/yr 490
it Ns Request for Permit Action
-1 I,i AA RI) 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 TigardBuildingPer[nits@tigard-or.gov
FROM: E Owner ❑ Applicant ❑ Contractor ® City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) City of Tigard
Carla Staedter
Mailing Address: 13125 SW Hall Blvd.
City/State/Zip: Tigard, OR 97223
Phone No.:
0 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
M CANCEL/VOID PERMIT APPLICATION.
G �i PA REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
`� r /� INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
4 i
1 ,
�� Permit#: CPA2020-00002, CUP2020-00001, SLR2020-00004
ite ' ;%. ess or Parcel #:
Per . Peet
1 , ± � . �‘ Name: Fanno Creek Trail Connections
i ,.,,so p� division Name: Lot #r:
IA 1 ,ytl4 N Per ORS 227.178 The application became void after 180 days on 2/20/21 .
(j• EXPLANATION: pp � y
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( 80% the fees in the CPA2020-00002#ile-earn-go-tuwalds the-tew-caS -
Signature: Meg,,, 13.:2.4...,,,,,.. Date: 2/22/21
Print Name: Monica Bilodeau
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 c via US postal serve,4Q ,g,,,/E\ ..•
3. Please allow 3-4 weeks for processing refund requests,
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FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date 3/L. Z/ By SO
Refund Processed: Date,/ej`y, By t Invoice Processed: Date By
Glyo„eo) Permit Canceled+ Date 3/,/y, By (j Parcel Tag Added: Date By
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IN
CITY OF TIGARD FEE AND PAYMENT HISTORY
■ t. 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
CPA2021-00001 - 13125 SW HALL BLVD, TIGARD, OR 97223
Fanno Creek Trail Connections
Fee Description Revenue Fee Amount Invoiced Paid Date Paid Payment Receipt# Due
Account Number Method
Application Fee 100-0000-43116 $4,845.00 $4,845.00 $3,876.00 3/2/2021 Fund Transfer433170 $969.00
Application Fee 100-0000-43116 $7,669.00 $7,669.00 $6,135.20 3/2/2021 Fund Transfer433170 $1,533.80
Application Fee 100-0000-43116 $3,684.00 $3,684.00 $2,947.20 3/2/2021 Fund Transfer 433170 $736.80
Totals for Fees $16,198.00 $16,198.00 $12,958.40 $3,239.60
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
433170 Fund Transfer 03/02/2021 $12,958.40
Total Payments: $12,958.40
Balance Due: $3,239.60
CITY OF TIGARD RECEIPT
g 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TrGAR.L3
Project Name: Fanno Creek Trail Connections
Site Address: 13125 SW HALL BLVD Ett fA 7-7Z9�s
Receipt Number: 433170 - 03/02/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
CPA2021-00001 Application Fee 1 00-0000-431 1 6 $3,876.00
CPA2021-00001 Application Fee 100-0000-43116 $6,135.20
CPA2021-00001 Application Fee 100-0000-43116 $2,947.20
Total: $12,958.40
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Fund Transfer DROWSE 03/02/2021 $12,958.40
Payor:
Total Payments: $12,958.40
Balance Due: $3,239.60
Page 1 of 1
CITY OF TIGARD RECEIPT
IN J. a
2 • 13125 SW Hall Blvd.,Tigard OR 97223
r- 503.639.4171
TIGARD
Project Name: Fanno Creek Trail Connections
Site Address: 13125 SW HALL BLVD fe-—1u./4/ /Zf/-n/S F 72
Receipt Number: 433169 - 03/02/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
CPA2020-00002 $-12,958.40
Total: $-12,958.40
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Fund Transfer DHOWSE 03/02/2021 $-12,958.40
Payor:
Total Payments: $-12,958.40
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARL)
Project Name: Fanno Creek Trail Connections
Site Address: 13125 SW HALL BLVD 1e,-
Receipt Number: 430802 - 08/25/2020 �V vV
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
CPA2020-00002 Application Fee 100-0000-43116 $3,876.00
CPA2020-00002 Application Fee 100-0000-43116 $969.00
CPA2020-00002 Application Fee 100-0000-43116 $2,947.20
CPA2020-00002 Application Fee 100-0000-43116 $736.80
CPA2020-00002 Application Fee 100-0000-43116 $6,135.20
CPA2020-00002 Application Fee 1 0 0-0 0 00-4 31 1 6 $1,533.80
Total: $16,198.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 6731572 PUBLICUSERO 08/25/2020 $16,198.00
Payor:
Total Payments: $16,198.00
Balance Due: $0.00
Page 1 of 1
s
CITY OF TIGARD RECEIPT
g > 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
"HOARD
Project Name: Fanno Creek Trail Connections
Site Address: 13125 SW HALL BLVD OW /G/'1/eft--
Receipt Number: 430802 - 08/25/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
CPA2020-00002 Application Fee 100-0000-43116 $4,845.00 t-
CPA2020-00002 Application Fee 100-0000-43116 $3,684.00 r
CPA2020-00002 Application Fee 100-0000-43116 $7,669.00 -
Total: $16,198.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 6731572 PUBLICUSERO 08/25/2020 $16,198.00
Payor:
Total Payments: $16,198.00
Balance Due: $0.00
Page 1 of 1