Correspondence
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((~'1y p y Tigard, pgV.gry of Oregon ~ 13125 SWHall Blvd. ~ Tigard, OR 97223
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January 8, 2010
Steve Adams
15806 SW Upper Boones Ferry Rd.
Lake Oswego, OR 97035
Re: Permit No. SWR2009-00116
Dear Mr. Adams:
The City of Tigard has processed a refund for fees on the above referenced permit(s) for the
following:
Site Address: 15875 SW 72nd Ave.
Project Name: Calypte
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $720.00.
❑ Trust account "deposit" receipt in the amount of $
Notes: Existing sewer credits applied to sewer permit fees. Refund 100% of fees paid.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
1:\Bwlding\Refunds\Administration\LtrRefund-Re fundOnly.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 e www.tigard-or.gov ® TTY Relay: 503.684.2772
Community Development
Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
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)
t M r✓u ~-Gl5
Mailing Address: $Q(p Lt PPP &)6S
City/State/Zip: -•(~U1L Q`d CO e-01,0
Q(Z 97035
Phone No.: 'J-03 - 3on,0 0 ~C)
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED
® CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit ct)W K APP c! OCR 4
Site Address or Parcel 15$ 75 ) 7 ati'
Project Name: CA LY PTf,
Subdivision Name: & Lot
EXPLANATION: 1 L A 1~ L~. C a. n rTs ~/~J'~o?ly ~L I Q~tQ • DO l ~v 7.
Signature: Date:
Print Name: ~j~l /A M5k(
Refund Policv
1. The Director or Building Official may authorize the refund of
a) any fee wh ch 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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 perrruts 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
to S s rldmin: ate/A// 7 Rte to Bldg Admin: Date d B
Refund Processed: Date By d~ voice Processed: Date B
Permit Canceled: Date Lf/ B Parcel Tag Added: Date B
Receipt # Date Method Amount $
1:\Building\Forms\RegPermitAc6on.doc Rev 07/26/07
City of Tigard
s
Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for.Pemiit 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: Steve Adams DATE: 1/8/2010
15806 SW Upper Boones Ferry Rd.
Lake Oswego, OR 97035 REQUESTED BY: Dianna Howse
DEB
TRANSACTION INFORMATION:
Receipt 175740 Case SWR2009-00116
Date: 10/22/09 Address/Parcel: 15875 SW 72nd Ave.
Pay Method: CreditCard Project Name: Calypte
EXPLANATION: Per applicant's request as existing sewer credits were applied towards fees for added
plumbing fixtures.
REFUND 4ND0RMA ;'ION:
Fee DescriptionsFrom~Receipt Revenue Acco unt No. Refund
Exarn_l~ ` [BUILD] Perfnli f t exam 215-uuuu,-43'uuu $Amount
Sewer connection fee 5000000-25500 $720.00
TOTAL REFUND: $720.00
APPROVALS: `
If under $5006, Professional Staff
If under $7,500 Division Manager
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR ACCEI:A SYSTEM ADMINI$ TION :,7:PSE ONLY,
Refund Request Reviewed: Date: / f, /c7 By: I
Case Refund Processed: Date: /G! B : -
I:\Building\Refunds\Refund Request. doc 04/13/09