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Permit
Pi-piur-A CITY OF TIGARD BUILDING PERMIT a COMMUNITY DEVELOPMENT Permit#: BUP2009-00170 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2009 Parcel: 2S 103AD05000 Jurisdiction: Tigard Site address: 12840 SW 107TH CT Subdivision: PATHFINDER Lot: 40 Project: Irwin Project Description: Installation of 4' retaining wall and 4' fence. REVISED 11/02/09 wall ht. and fence ht. vary. Fence + wall not to exceed 8' tall. ^ Owner: FEES IRWIN, WILLIAM A IV & Description Date Amount ROSEANN M, 12840 SW 107TH CT Permit Fee - COM 10/28/2009 $76.80 TIGARD, OR 97223 12% State Surcharge - Building 10/28/2009 $9.22 PHONE: Plan Review 10128/2009 $49.92 Contractor: BEN BETTS CONCRETE 23502 SE SHADY VIEW LN EAGLE CREEK, OR 97022 PHONE: 503-757-6057 FAX: Specifics: Type of Use: SF Class of Work: OTR Dwelling Units: 0 Stories: 0 Height: 0 ft Bedrooms: 0 Bathrooms: 0 Value: $4,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Tota 1 $135.94 Required: Required Items and Reports (Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: ~LL - . Permittee Signature: C ~C Call 603.639A176 by 7:00 a.m. for an inspection that business day. This permit card shall be kept In a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • CITY OF TIGARD BUILDING PERMIT t Permit #: BUP2009 -00170 COMMUNITY DEVELOPMENT 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2009 TIGARD Parcel: 2S 103AD05000 Jurisdiction: Tigard Site address: 12840 SW 107TH CT Subdivision: PATHFINDER Lot: 40 Project: Irwin Project Description: Installation of 4' retaining wall and 4' fence. Owner: FEES IRWIN, WILLIAM A IV & Description Date Amount ROSEANN M, 12840 SW 107TH CT Permit Fee - COM 10/28/2009 $76.80 TIGARD, OR 97223 12% State Surcharge - Building 10/28/2009 $9.22 PHONE: Plan Review 10/28/2009 $49.92 Contractor: BEN BETTS CONCRETE 23502 SE SHADY VIEW LN EAGLE CREEK, OR 97022 PHONE: 503 - 757 -6057 FAX: Specifics: Type of Use: SF Class of Work: OTR Dwelling Units: 0 Stories: 0 Height: 0 ft Bedrooms: 0 Bathrooms: 0 Value: $4,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $135.94 Required: Required Items and Reports (Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throug OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: ^ /j `\� /� I ' � Permittee Signature: ./\___D r `tC Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Eb P c cl t -, ®r [ 5 i f .. . FOR OFFICE USE ONLY . . City of Tigard �O eceivea IN /� - . i` � .,atelanB Revie Permit No.: n r ``e " 13125 SW Blvd., Tigard, OR 97223 m , T �' * I • Phone: 503.639.4171 Fax: 503 598.1960 Date/B : t��AL `(I /° Other Permit: T 1 G A R D Inspection Line: 503.639.4175 pate Ready /By: 0 See Page 2 for Internet: www.tigard - or.gov Notified/Method: 9 Supplemental Information .i : .l ... ; t;,5 i34; * ^01RK - .. * i4i*.7 rs+P a F`1> k0 jig ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all al Addition/alteration/replacement ❑ Other materials, labor, overhead, and the p " •' ' °.4 ' ° �4 .. `'St's i/4gi`i2U` ai { equipment, ted this application. . equipmen d an e ofit for the r s?.. ,' . •r. . .. «. .m .: ,u • -. e. ...F... . : .: ; :,, Valuation: $ ❑ 1- and 2- family dwelling ❑ CommerciaUindustrial C 2 /� G'C:O. C�C� Accessory building Number of bedrooms: ❑ ry g ❑ Multi - family ❑ Master builder ❑ Other: Number of bathrooms: �', � y ,� a ' r „6 tipN Total number of floors: Job site address: ,, $�Q i j ( New dwelling area: square feet City/State/ZIP: 7 C�� / - Q C� `-j D - D:S Garage /carport area: square feet Suite/bldg. /apt. no.: J Project name: Covered porch area square feet Cross street/directions to job site: Deck area: square feet 2 C I C I t tc . (1,1,00 .e 4- , L cr, Gr\it r 2- cr\, 1 GT" Other structure area: g7� �„ yy r square feet Subdivision: Lot no.: Permit fees* are based on the value of the work performed. l h t Indicae the value rounded to the nearest dollar) ) of all Tax map /parcel no equipment, materials, labor, overhead, and the profit for the ry i r 3Y(4Js9 oi' 'WO work indicated on this application. LJ e4- Q I / i /�,, ce Valuation: $ !. .v1 - LI - o oc ` ' Existing building area square feet New building area: square feet R P ; Y,f ` : Og Number of stories: Name: Q.C3S.Qarvx . l - tknih. Type of construction: Address: ) - g S to 0-4-4 ex- Occupancy groups: City/ State/ZIP: 1-1 02_ 0 13 Existing: Phone: (Jj) '}-m - 2449 Fax ( ) 1 8 `t l t: i..� x ,.,. ...-KO, t ., 1 Y .. .a YR �N r7. j��, //..yy'�� Y Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon (instruction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone:( ) Fax::( ) E -mail: r k� Business name: " S•ekt.., C * Q L " c $ij ( S Address: ,2'S'-'0a, 5 2_ 3 V l et.J L - s ,.. '. : } . JrJerESt}re eF Y� <a�rle� .. a Structural plan review fee (or deposit): City/State /ZIP: o, ' t op_ ci FLS plan review fee (if applicable): Phone: (SOS) -I-S4-4- - / Fax: ( ) . - CCB lic.: i 1 ! a CJ. 8 , jd Total fees due upon application: Authorized signature: Amount received: This permit application expires if a permit is t obtained within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri- County Building Industry ` Service Board. CD ' a IABuilding \Permits \SIT- PermitApp.doc 12/27/06 440- 4613T(11 /02/COM/WEB) 1 ( 4 1 J , City of Tigard, Oregon ® 13125 SW Hall Blvd. • Tigard, OR 97223 • u TIGARD September 24, 2009 . William Irwin 12840 SW 107t Ct. Tigard, OR 97223 Re: Permit No. BUP2009 -00170 Dear Mr. Irwin: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 12840 SW 107t Ct. • Project Name: Irwin Job No.: N/A Refund: n Check # in the amount of $ . ® Credit card "return" receipt in the amount of $49.92. ❑ Trust account "deposit" receipt in the amount of $ . Notes: Retaining wall not permitted for construction over existing easement. Refund 100% of plan review fees and return two (2) copies of engineering plans received at plan submittal. If you have any questions please contact me at 503.718.2430. Sincerely, w;_4. "(..-(;r ' -- a-t___. Dianna Howse Building Division Services Supervisor Enc. I: \ Building \ Refunds \ Administration \ LtrRefund-CancelPermit.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 1 11 111 _ Community Development TIGARD Request for Permit Action 1ECE�ED TO: CITY OF TIGARD SE P 1 g 2009 Building Division Services Coordinator CITE' OF TIGARp 13125 SW Hall Blvd., Tigard, OR 97223 BUILDING D Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ■ City Staff (check one) REFUND OR Name: \ INVOICE TO: (Business or Individual) L C l L`1-4 M n I �j , 1 _ 1 Mailing Address: ` 1 9\8 g o 4a-w ( 7 . City /State /Zip: 1 ? /I- kb , ca_ 9 7 '�-).. -j Phone No.: 5o3- 3 3,- `d L l q PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ 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 #: .73 L...P 9,00C( -- co 17 0 Site Address or Parcel #: t a` Q 4O 603 1o7 Project Name: 1 (2 1 t) Subdivision Name: Lot #: EXPLANATION: .7,9 , 1 tJ Co l-,3 p. ( . ..,1 . tJ o pi L .Vr.) e_ I -D 9 --re) Er t. Ht. ►JT 1 ss • N_••• )IA 04 \)/1- Tot. -1 €L ) , , utLt., C (I e. t ft L Pi- Fut.rb loo % or Puk i.` \ q_.I.0 . Signature: \ A Date: q I i g IO 9 Print Name: --- PAt E. 1 1Z, _ q - bPr1-k 4 , \I-N1 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 S s Admin: Date 9 0°/ cialm Rte to Bid: Admin: Date , - - Algraffin B ,,, Refund Processed: Date Qty ., t• By ,;••, Invoice Processed: Date By Permit Canceled: Date 97 q c $ By ./ .fa Parcel Tag Added: Date By Receipt # /75,1,4 )/ Date fh /07 Method C C-- Amount $ I: \Building \Forms \RegPermitAction. c R4 07/26/07 I ti 114 ■ City of Tigard TIG ,� }t I� 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 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: William Irwin DATE: 9/22/09 12840 SW 107 Ct. Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 175224 Case #: BUP2009 -00170 Date: 9/15/09 Address /Parcel: 12840 SW 107th Ct. Pay Method: CreditCard Project Name: Irwin EXPLANATION: Retaining wall not allowed due to easement. Refund 100% of permit fees per Building Official. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: [BUILD] Permit Fee , Example: 245- 0000 - 432000 $ Amount Plan Review 2300000 - 43106 $49. TOTAL REFUND: $49. APPROVALS: If under $500 Professional Staff i ' il) If under $7,500 Division Manager ii „ , i If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board , i _, i t i ' 4 , GELA SYSTEM ADMINISTRATION USE ONLY Refund Request Reviewed: Date: 7 ,..4 A By: r d/ Case Refund Processed: Date: /.2y/e By: ' I: \ Building\ Refunds \RefundRequest.doc 04 /13/09 c L' ' Building Permit Application RECEIVE e o lap 3. SEP 15 2009 FOR O USE O ill Received I gI,/lT _l 76 " i 9 /� Date/By: / Permit No.: City of Tigard Rec 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGARD Plan Review - Phone: 503.639.4171 Fax: 503.598.196 DateB Other Permit: Inspection Line: 503.639.4175 tUILDING DIVISION Date Ready/By: Su See Page 2 for TIGARD 1 emental In Internet: www.tigard or.gov pp Not TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Ni Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION ted on this application. ❑ 1- and 2- family dwelling El Commercial/industrial (tiofl: $ 1 1, bCZO (5Cj ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: U at� i )6` CA New dwelling area: square feet City /State /ZIP: 'r C�,k 9 `- a , a ,' s Garage /carport area: square feet Suite/bldg. /apt. no.: J Project name: Covered porch area square feet Cross street/directions to job site: Deck area: square feet 1 1 Q, er '0 2Pil rr I- r L C ] -p L 1 54' (...-7 Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rotnded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Li. F {� _ 4 _� L' / / _ _ Valuation: $ IG¢�tft � r ��1 Existing building area square feet New building area: square feet gE.PROPERTY OWNER ❑ TENANT Number of stories: Name: S.2arv`' ,nth. Type of construction: Address: 12 $ yo S t o ) ' 1- (T Occupancy groups: City/State /ZIP: '1.1 () Q Q `74-aa3 Existing: Phone: Ws • Z ym _ 3('L Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: CONTRACTOR Business name: {,\ S CotN t-e k Q BUILDING PERMIT FEES* Address: of SSOa, 52, 3 V� e ) 1-/t (Please refer to fee schedule) City/State /ZIP: }n c,, �, �I /� 7/� Structural plan review fee (or deposit): aa VVV Phone: ( 3) 3 _ / Fax: ( ) FLS plan review fee (if applicable): CCB lic.: J $ 1 --4.a Total fees due upon application: Amount received: ii f 7 0~ Authorized signature "----' J This permit application expires if a permit is not obtained / within 180 days after it has been accepted as complete. Print name: i Mo Ivy ,,,.r I ,J Date: 9 Q f * Fee methodology set by Tri -County Building Industry Service Board. I:\Building\Permits \SIT - PermitApp.doc 12 /27/06 440- 4613T(I1 /02 /COM/WEB) I . , -. 0 I 1 RECIVED: , CITY OF TIGARD BUILDING DIVISION l os : 1 , ________ 1". a E, es,Gowszsreatz- %be I f . N A . i ____-- 3------------ , 4. . 0 t c \o . .....D c.„< s ' i ? i Y r Q, OrAr- T , i., .s.„.„..5., ..„ , 1 — ,,, ," , -,4 ' • ' - '_..6..... 0 . 61 Vi lea.-,■ LC _ e- c, CITY OF TIGARD - ITE PLAN REVIEW '• _ BUILDING PERMIT NO.: iot.t.P c9Wei 0170 -�" PLANNING DIVISION: µ.Q Required Setb cks: ii, -:‘o Not Approved Side: . �//4 S eet Side: M' Front. Garage: Rear: Jilt._ Visual Clearance: ❑ Ap Rroved ❑ Not Approved Maximum Building Height feet L. F--.. 1/ CWS Serv • Provider Letter Required: ❑ Yes ❑ No Q Received I By : A --ei..AP-403' bete: 9//47 ENGINEERING DEPARTMENT: Actual Slope: _% ❑ Approved ❑ Not Approved Site Plan: ❑ Approved ❑ Not Approved By: Date: Notes: ^ ilis do 5 4 i_,,,,, 1( , ic--i:QL2—,.,., f 2 — S` clot L t y -3 - o,, a ° , mss 0 LO r LJ, I I e....3v, 151-6 4440 T" �0--ts • a CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO: Street Trees: ❑ Approved ❑ Not Approved Protected Trees: ❑ Approved 0 Not Approved By: Date: Notes: 0 r ' Building Permit Application REC EIVE i . - Site Work ' ,. - - FOR OFFICE USE ONLY Received C' C �uT City of Tigard Rec eB i y: I I�OT / Permit No : F C7U 1 • 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGARD Plan Review Other Permit. Phone: 503.639.4171 Fax: 503.598.196 8 R+gF G Date/By. TIGARD Inspection Line: 503.639.4175 (! � DIVISION Date Ready/By: Turf See Pa 2 for 1 Internet: www.tigard- or.gov Notified/Method: Supplementallnformation TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (minded to the nearest dollar) of all Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION ted on this application. ❑ 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ y ' , ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: l o. ` ) Lic ) `:"'c j i U . a c' New dwelling area: square feet City/State /ZIP: f �` ? Q C.t'-)-a )[ Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area square feet Cross street/directions to job site: -�y� Deck area: square feet C ri l 1L, t� l o t ii t L c GrI Lkr L (. .., 1 (�'1 c Other structure area: square feet i REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map/parcel no.: Indicate the value (romded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Li# Valuation: $ i _ r - .0 �d� r!a ;-Lt i Existing building area square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: Q_ DSk1-.)tryC�- c-ti ;tK Type of construction: Address: ) 2 i-ip s 0 / f7 i -' ( Occupancy groups: City/State /ZIP: `"ti- C) O '- L1 Existing: Phone: - 5 y-A .. - ?4,11_, Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board - under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax: : ( ) E -mail: CONTRACTOR Business name: eA (? \ C .l-p * a , BUILDING PERMIT FEES* Address: 350a 3 a, O vj e.:. LA vi re ( to d schedule) ot d City/State /ZIP: e , + �� Cr Structural plan revi fee (or deposit): FLS plan review fee (if applicable): Phone: (` 2) r . _ G, os Fax: ( ) CCB lie.: ] 2)/ R - 7..a 6/4 Total fees due upon application: �.... Amount received: ft/ 7. Fa~ Authorized signature l C��J This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: /_ r !1 ot / - f 4} Date: s Q ? (N t Fee methodology set by Tri -County Building Industry Service Board. 1: \Building\Permits \SIT - PermitApp.doc 12/27/06 440- 4613T(11 /02 /COM/WEB) • a- rA C5?jj City of Tigard, Oregon © 13125 SW Hall Blvd. U Tigard, OR 97223 11 . � Y. September 24, 2009 ' _ . __ _ . William Irwin 12840 SW 107 Ct. Tigard, -OR 97223 Re: Permit No. BUP2009 -00170 • Dear Mr. Irwin: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 12840 SW 107 Ct. Project Name: Irwin Job No.: N/A Refund: ❑ Check # in the amount of $ Credit card "return" receipt in the amount of $49.92. ❑ Trust account "deposit" receipt in the amount of $ Notes: Retaining wall not permitted for construction over existing easement. Refund 100% of plan review fees and return two (2) copies of engineering plans received at plan submittal. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. I: \Building\ Refunds\ Administration \LtrRefund - CancelPermit.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 1, CITY OF TIGARD RECEIPT E a . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD 2 ` Receipt Number: 175331 - 09/24/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID BUP2009 -00170 $-49.92 Total: $49.92 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 04562C DHOWSE 09/24/2009 $ -49.92 Payor: William Irwin Total Payments: $49.92 • Balance Due: $49.92 Page 1 of 1 11111 CITY OF TIGARD RECEIPT S . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 1 EGARE) 0/ fL i / (-- Re ceipt Number: 175224 - 09/15/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID BUP2009 -00170 Plan Review 2300000 -43106 $49.92 Total: $49.92 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 04562C DADAMSKI 09/15/2009 $49.92 Payor: William Irwin Total Payments: $49.92 Balance Due: $0.00 Page 1 of 1 I City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: William Irwin DATE: 9/22/09 12840 SW 107 Ct. Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 175224 Case #: BUP2009 -00170 Date: 9/15/09 Address /Parcel: 12840 SW 107th Ct. Pay Method: CreditCard Project Name: Irwin EXPLANATION: Retaining wall not allowed due to easement. Refund 100% of permit fees per Building Official. ` REFUND. INFORMATION: ' Fee Description From Receipt... :: ; : Revenue Account :No: .'. • Refund Example: [BUILD] Permit Fee , Example:•. 245- 0000 - 432000 - :$ Plan Review 2300000 -43106 $49.92 • TOTAL REFUND: $49.92 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager n 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 ¢�( Refund Request Reviewed: Date: 4?,� + R /C' ` By: Case Refund Processed: Date:;/.? yi,y ;.-r By: _ l:\ Building \Refunds \Re fundRequest.duc 04/13/09 ° Community Development Request for Permit Action " TIGARD TO: CITY OF TIGARD SLP ° 2009 Building Division Services Coordinator m ' � ! � � � 13125 SW Hall Blvd., Tigard, OR 97223 JFf f�ING DtVISJ N Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor g City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) LLD Mailing Address: 19€ go 'au ( 7 �J� C T City/State /Zip: I(ao a2 9'7 )..a Phone No.: �O3-� 3"7 a $t.1/ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V): ❑ CANCEL PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). El REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: 73 u.P aco q - f'D i ? 0 Site Address or Parcel #: t ` o` Q 0 a /o7 Project Name: 91.5L- 1 Subdivision Name: Lot #: EXPLANATION: -rig , 1 1 ,E C LAD Pt Ll - IJ t) T A LI,(.t) S p must - r? ��r5t -l€ rJT 1 SSV.tiS . NS_ 11A 0 ti.1.4i1/4) "F,ut otr(t ct Pr L PEl ixp t> l00% o - 3\ €t.0 Fes. Signature: (KT \p4_ 4 ¢, Date: g I 1 g ID 9 Print Name: P Q _ g1)1}d4 ) \I-N\ 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 Q m Oct C ; Rte to Bid • Admin: Date 94232E1 B Refund Processed: Date y dy r , e: B ';r'— Invoice Processed: Date B • Permit Canceled: Date y /;-'V j By ,c(444- Parcel Tag Added: Date ' By Receipt # . Date Jam' /rshl :'. Method (_ -- Amount $ I: \Building \ Forms \RegPermitAction.d`C R607 /26/07 ,