Correspondence
City of Tigard
Accela Refund Request
-par, This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1-2 weeks for processing.
PAYABLE TO: Bateman Construction Inc. DATE: 9/24/09
4991 SW Nevada Ct.
Portland, OR 97219 REQUESTED BY: Dianna Howse
Attn: Steen Bateman
TRANSACTION INFORMATION:
Receipt 175252 Case 114ST2009-00186
Date: 9/17/09 Address/Parcel: 11675 SW Tiedeman
Pay Method: Check Project Name: Gutierrez
EXPLANATION: Current Planning division denied site plan for construction in flood plain. Refund
100% of plan review fees.
REFUND INFORMATION „
1ee'Description?From Receipt Revenue Account 0.` Refund
44 3 0l) $ Amount
Exam le.. t ILD Permrt )~ee_ J Exam le 451 OOOU
.
Plan Review 2300000-43106 $54.70
TOTAL REFUND: $54.70
APPROVALS:
If under $500 Professional Staff
/ l p
If under $7,500 Division Manager ✓ f ATf a
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINI_STRATION.TSE q;N`LY"
B : 4:.
Refund Request Reviewed: Date:
Case Refund Processed: Date: 02 1, 0,9 :
1:\Building\Refunds\1:efundRequestdoc 04/13/09
owl Community Development
Request for Permit Action CFjVED
su 14 4?."9
TO: CITY OF TIGARD CITY OF TIGAPD
Building Division Services Coordinator D1VIS'0N
13125 SW Hall Blvd., Tigard, OR 97223 BUILDING
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor CK City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED
K CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit H'5T AOO 9 - 0C7 I q&
Site Address or Parcel (p 75 6w l l E7> 9,--IRA.)
Pro)ect Name: Lp (.l T / (L f-
Subdivision Name: Lot
EXPLANATION: E2 I"LJ~iJ/~ r IJ C'o rT7o.-J G5 r_lJ
P L&I ln> 4rJ7 e1-f ,JtJ0T- At 6" 1
Signature: Date: c( ~,Qq
Print Name: `T~
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1-2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date 9 RK o9 B Rte to AdDate 9 ~~,ij By 4077~
Refund Processed: Date B Invoice Processed: Date . B
Permit Canceled: Date B Parcel Tag Added: Date B
Receipt # Date Method Amount $
I:\Building\Forms\RegPermitAction.doc Rev 07/26/07
r~ , r
City of Tigard, Oregon e 13125 W Hall Blvd. ~ Tigard, OR 97223 d:
w.
i~
~,~~?1(~~"1 L hLt i
October 2, 2009-"
Bateman Construction Inc.
4991 SW Nevada Ct.
Portland, OR 97219
Attn: Steen Bateman
Re: Permit No. MST2009-00186
Dear Mr. Bateman:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 11675 SW Tiedeman
Project Name: Gutierrez
Job No.:
Refund: ® Check #101088 in the amount of $54.70.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Current planning denied construction in flood zone. Refund 100% of application
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
fDianna Howse
Building Division Services Supervisor
Enc.
C\Buildin,g\Refunds \Admuustration\LtrRefund -Cancel Permit. doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 e www.tigard-or.gov o TTY Relay: 503.684.2772
City of Tigard, Oregon ° 13125 SW Hall Blvd. o Tigard, OR 97223
qtA
October 2, 2009
Bateman Construction Inc.
4991 SW Nevada Ct.
Portland, OR 97219
Attu: Steen Bateman
Re: Permit No. MST2009 -00186
Dear Mr. Bateman:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 11675 SW Tiedeman
Project Name: Gutierrez
Job No.:
Refund: ® Check #101088 in the amount of $54.70.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Current planning denied construction in flood zone. Refund 100% of application
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
1: \Building\ Refunds \ Administration \ 1. trRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
. . City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or R fund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Bateman Construction Inc. DATE: 9/24/09
4991 SW Nevada Ct.
Portland, OR 97219 REQUESTED BY: Dianna Howse
Attn: Steen Bateman
TRANSACTION INFORMATION:
Receipt #: 175252 Case #: MST2009 -00186
Date: 9/17/09 Address /Parcel: 11675 SW Tiedeman
Pay Method: Check Project Name: Gutierrez
EXPLANATION: Current Planning division denied site plan for construction in flood plain. Refund
100% of plan review fees.
;R EFUND'.INFORMATI'ON:. • . ' • .
Fee; Description From 'Receipt.•.;: - ::::Revenue Account.No.' ; ; Refund:
Example: ,- [BUILD] Pernut. Fee• ' • • • Example: 245- 0000 - 432000 ' • $'Ai glint
Plan Review 2300000 -43106 $54.70
TOTAL REFUND: $54.70
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager ✓ t' /
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
:.•FOR.ACCELA,SYSTEM ADMINISTRATION USE ONLY'. H
Refund Request Reviewed: Date: By:
Case Refund Processed: Date: j� /� jog By:
I: \Building\ Refunds \RefundRequest.doc 04/13/09
Community Development
T I c n ii Request for Permit Action RECEIVE
ED
SEP .L 4 2009
TO: CITY OF TIGARD OF T 1GP D
Building Division Services Coordinator CITY 1N GpNIS1 0 N
13125 SW Hall Blvd., Tigard, OR 97223 BU
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor Er, City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
K CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: MST X100 9 - 001 SCv
Site Address or Parcel #: (1(p 75 j) l Eb £1-1 A /0
Project Name: awn ca. 2. L z.
Subdivision Name: Lot #:
EXPLANATION: PC2 Pill-Nix) 1 JJ C'o, 4- r - nan.) GS r-!J / 'ol
)t.-/t/t%) 4n3 C/i-n)NJor 4£ 64.4 11,r = -
Signature: Cb....._ a� -12)- 1 Date: c( i p41 l -
Print Name: - -7 e_g, E e. Abort-0,K k
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
c) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date 9 M 09 copm Rte to y;i: Admin: Date , B ig,
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPemvtAction.doc Rev 07/26/07