SGN2007-00219 City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 •
•
TIGA ® `
February 7, 2008 ;tea _: ` *.: spa : -.
G Lynn Takahashi
9845 SW Walnut Pl.
Tigard, OR 97223
Re: Permit No. SGN2007 -00219 & SGN2007 -00220
Dear Ms. Takahashi:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 9845 SW Walnut Pl.
Project Name: Tigard Playschool
Job No.: N/a
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $38.00.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Sign permits created in error. Refund 100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
1: \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
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Raquest for Perri ¢tActionorRefund (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: G Lynn Takahashi DATE: January 18, 2008
9845 SW Walnut P1
Tigard, OR 97223 REQUESTED BY: Shirley Treat
TRANSACTION INFORMATION:
Receipt # : 20075264 Case # : SGN2007- 00219/220
Date: 11/30/2007 Address /Parcel: 9845 SW Walnut Pl/
2S102DB -01600
Pay Method: CreditCard Project Name: Tigard Playschool
EXPLANATION: Permits created in error
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
[Sign] Temp Sign Permit 100- 0000 - 437000 17.00
[[LRPF] LR Planning Surcharge 100 - 0000 - 438050 2.00
[Sign] Temp Sign Permit 100 - 0000 - 437000 17.00
[[LRPF] LR Planning Surcharge 100 - 0000 - 438050 2.00
TOTAL REFUND: $38.00
APPROVALS:
If under $500 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 TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: I .2/4/1 ? By I ,
I:\ Building \Refunds \RefundRequesc.doc 05/23/07
MI I CITY OF TIGARD 2/6I2008
13125 SW Hall Blvd. 4:10:46PM
Tigard, OR 97223 503.639.4171
TIGARD
Refund Receipt #: 27200800000000000387 ./ e -6 " 4_
Date: 02/06/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
• SG N2007-00219 Reversal - [SIGN] Temp Sign Pe 100- 0000 - 437000 (17.00)
SGN2007 -00219 Reversal - [LRPF] LR Planning 100- 0000 - 438050 (2.00)
SGN2007 -00220 Reversal - [SIGN] Temp Sign Pe 100- 0000 - 437000 (17.00)
SGN2007 -00220 Reversal - [LRPF] LR Planning 100- 0000 - 438050 (2.00)
Line Item Total: ($38.00)
Refund:
Method Payer User ID Acct. /Check No. Approval No. Fl ow Received Amount Paid
Credit Reversal GLYNN TAKAHASHI 210392 In Person (38.00)
Refund Total: ($38.00)
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} � ' Tigard, OR 97223 503.639.4171
LTv1.GARD1
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•
Receipt #: 27200700000000005264 (.'.i'•' - /./V.
Date: 11/30/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2007 -002I a [SIGN] Temp Sign Perm 100- 0000 - 437000 17.00
SGN2007 -00218 [LRPF] LR Planning Surcharge 100- 0000 - 438050 2.00
SGN2007 -00219 [SIGN] Temp Sign Perm 100- 0000 - 437000 17.00
SG N2007-00219 [LRPF] LR Planning Surcharge 100- 0000 - 438050 2.00
SGN2007 -00220 [SIGN] Temp Sign Perm 100- 0000 - 437000 17.00
SGN2007 -00220 [LRPF] LR Planning Surcharge 100- 0000 - 438050 2.00
Line Item Total: $57.00
Payments:
Method Pacer User ID Acct. /Check No. Approval No. H ow Received Amount Paid
CreditCard G LYNN TAKAHASHI ST 210392 In Person 57.00
Payment Total: $57.00
cRcccipt.ipt Page 1 of 1
Community Development
TIGARD 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: G Lynn Takahashi
INVOICE TO: (Business or Individual)
Mailing Address: 9845 SW Walnut PI
V 12) I D City/State /Zip: Tigard, OR 97223
477 Phone No.: V 3 • ;x' - k(( O
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 # : SGN2007 -00219
Site Address or Parcel # : 9845 SW Walnut PI
Project Name: Tigard Playschool
Subdivision Name: Lot # :
EXPLANATION: Sign permit created in error - signs no longer permitted to be placed
at current site.
Signature: � , �/ diutat Date: 1/18/08
Shirley Treat
Print Name:
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 - weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Admin: Date 9 C tr By rr
Refund Processed: Date AAVe' f By Invoice Processed: Date By
Permit Canceled: Date e2/ /c r By Parcel Tag Added: Date I y
Receipt # art J- 5 %y Date ///;',./;., 7 Method <' (' Amount $ el, ,
I: \Building \Forms \RegPemutAction -dooc R6 07/26/07
•
1 141 . Community Development
TIGARD Request forPennit 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: El Owner ❑ Applicant El Contractor ® City Staff
(check one)
REFUND OR Name: G Lynn Takahashi
INVOICF. TO: (Business or Individual)
VO Mailing Address: 9845 SW Walnut P1
I ED City /State /Zip: Tigard, OR 97223
°// / Phone No.: Li) 3 - (o3q -gi 10
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 # : SGN2007 -00220
Site Address or Parcel # : 9845 SW Walnut P1
Project Name: Tigard Playschool
Subdivision Name: Lot # :
EXPLANATION: Sign permit created in error - signs no longer permitted to be placed
at current site.
Signature: Date: 1/18/08
Shirley Treat
Print Name:
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 By Rte to Admin: Date V • By '1
Refund Processed: Date:We`j- By.. Invoice Processed: Date By
Permit Canceled: Date By 44y-- Parcel Tag Added: Date By
Receipt # J -S.z7y Date .b /..34yc ? Method r. r Amount $ e G)
I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07
II CITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2007 -00219
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/30/2007
PARCEL: 2S102BD -01600
BUSINESS NAME: TIGARD PLAYSCHOOL ZONE: R -12
SIGN LOCATION: 09845 SW WALNUT PL 100 JURISDICTION: TIG
APPLICANT /AGENT: TIGARD PLAYSCHOOL
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: Y FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 2.5' X 2'
TOTAL SIGN AREA: 5 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: 2 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of one (1) temporary A -frame sign 2.5' X 2'. Sign must be placed on
private property, not in public right -of -way. Valid 5/15/08 - 6/15/08 Sign #2
MATERIALS: WOOD
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 19.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Speaalty Codes and all other applicable
laws. All work will be done in accordance with approved plans. A permanent sign must be placed within 90 days from approval date or sign
permit shall expire. A temporary sign shall expire 30 days from validity date. A balloon sign shall expire 10 days from validity date.
APPROVED BY: .
PERMITTEE SIGNATURE: 79.6
DATE: 11/30/2007
l
ti SIGN PERMIT APPLICATION
City cf Tigard Permit Center 13125 SW Hall Blasi, Tigarr,I OR 9722:1'
Phony 503.639.4171 Fax: 503.598.1960
GENERAL INFORMATION
Name of Development/Project
99 flay S C0 FOR STAFF USE ONLY
Site Address/ Street Permit No.: 5f9k a
Location qN S W (*that Y I .
Expiration Date:
Suite /Bldg. #
City /Stat Zip 7 C.)-(.0 I 9Lia Q k 9--7 22 3 Receipt # : .
Name Approved By. S- TZeg1
Property
Date: 0/ 30/07
Owner Mailing Address Suite Map /n# : a S ( -0/1201)
Zoning: l2l a--
City/State Zip Phone
Tenant or Name Electrical Permit Required? ❑ Yes 2
Business Building Permit Required? ❑ Yes ErNo
Name Rev. 7/1/07
is \curpin \ masters \land use applications \sign pemtit app.doc
Sign
Contractor Mailing Address Suite
(Prior to permit
issuance, a
copy of all Qty /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
licenses are (Note: applications will not be accepted
required if without the required submittal elements)
expired in the Oregon Const. Cont. Board License # Exp. Date
Qty of Tigard's
database) ❑ Completed Application Form
Proposed ❑ Permanent ® Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Sign INI Temporary ❑ Wall ❑ Electronic (3 copies, if a building permit is required)
(Check all that ❑ Other ❑ Billboard ❑ Balloon size requirement: 8 x 11 ", or 11" x 17"
apply q
❑ New sign? ❑ Aker to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: 2 i S i x 2 1 (3 copies, if a building permit is required)
size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.): 5
❑ $40.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft.) ❑ $19.00 Fee (Temporary sign, any type)
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E W NE NW SE SW
Height to top of sign (feet): 2 • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): must include dimensions of wall face and sign
placement.
Co py • Wall signs do not require site /plot plans.
Materials: Wp • Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes kr No permit.
Type: ❑ Internal ❑ External • If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overlap a tenant space? of the permit, THE PERMIT WILL BECOME
1:1 Yes 2 No NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
(OVER FOR SIGNATURES)
1
I hereby acknowledge that I have read this application, that the information given is correct, that I am
the owner or authorized agent of the owner, and that plans submitted are in compliance with the City
of Tigard.
DA'l E D this �0 day of NOV Wi , 20
Signature of Owner /Agent
—PretAzik, vio
Contact Person Name Phone No.
CITY OF TIGARD 11/30/2007'
13125 sw 11x11 Blvd. 10:32:1 I AM
Tigard, OR 97223 5113.639.4171
TIGARD
Receipt #: 27200700000000005264
Date: 11/30/2007
Line Items:
Case No 'I'ran Code Description Revenue Account No Amount Paid
SGN2007 -0021 S [SIGN] Temp Sign Perm 100- 0000 - 437000 17.00
SGN2007 -0021 S [LRPF] LR Planning. Surcharge 100- 0000 - 438050 2.00
SGN2007 - 00219 [SIGN] Temp Sign Perin 100 0000 - 437000 17.00
SGN2007 -00219 [LRPF] LIZ Planning Surcharge 100-0000-438050 2.00
SGN2007 -00220 [SIGN] Temp Sign Perm 100- 0000 - 437000 17.00
SG N2007 -00220 [LRPF] LR Planning Surcharge 100 0000 - 438050 2.00
[inc . Ilan 'total: 557.00
Payments:
Met hod Payer User ID Acct./Check No. Approval No. I - Iow Received Amount Paid
CrcclitCard G LYNN TAKAI IASI - II ST 210397 In Person 57.00
Payment "Total: 557.011
ckcceipi.rpi Page 1 o1
City of Tigard, Oregon ® 13125 SW Hall Blvd. ® Tigard, OR 9 7223 f it t T 1. ,. ` ,. , �t�r
y a_
.ti 4
F1' ,A. SIN
February 7, 2008 , '. f6 , =.. a
G Lynn Takahashi
9845 SW Walnut P1.
Tigard, OR 97223
Re: Permit No. SGN2007- 00219 & SGN2007 -00220
Dear Ms. Takahashi:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 9845 SW Walnut P1.
Project Name: Tigard Playschool
Job No.: N/a
Refund: n Check # in the am ount of $ .
M Credit card "return" receipt in the amount of $38.00.
n Trust account "deposit" receipt in the amount of $ .
Notes: Sign permits created in error. Refund 100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
r ...
Dianna Howse
Building Division Services Coordinator
Enc.
I: \Building\ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard- or.gov ® TTY Relay: 503.684.2772
•
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Pe mit A ction orROsnd f win (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: G Lynn Takahashi DATE: January 18, 2008
9845 SW Walnut Pl
Tigard, OR 97223 REQUESTED BY: Shirley Treat
TRANSACTION INFORMATION:
Receipt # : 20075264 Case # : SGN2007- 00219/220
Date: 11/30/2007 Address /Parcel: 9845 SW Walnut Pl/
2S102DB -01600
Pay Method: CreditCard Project Name: Tigard Playschool
EXPLANATION: Permits created in error
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount
[Sign] Temp Sign Permit 100- 0000 - 437000 17.00
[[LRPF] LR Planning Surcharge 100 - 0000 - 438050 2.00
[Sign] Temp Sign Permit 100- 0000 - 437000 17.00
[[LRPF] LR Planning Surcharge 100 - 0000 - 438050 2.00
TOTAL REFUND: $38.00
APPROVALS:
If under $500 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 TIDEMARK SYSTEM ADMINISTRATION USE ONLY_
D
d
d P
f
R
Case Refund Date:
,,�.! ski', % (. � '� By
I: \Building \Refunds \RefundRequest.doc 05/23/07
"' CITY OF T[GARD 2 /6 /20ca
�' ° ` ° ,
e z 131 ; S \ \' Hall 131vc1. 4:10:46PM .
: Tigard, OR 97223 -03.639.4I7i
€ 1 IGARI3i •
Refund Receipt #: 27200800000000000387 ./: r =_y , ` ,,' '= •` ---
Date: 02/06/2008 •
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2007 -00219 Reversal - [SIGN] Temp Sign Pe 100- 0000 - 437000 (17.00)
SGN2007 -00219 Reversal - [LRPF] LR Planning 100- 0000 - 438050 (2.00)
SGN2007 -00220 Reversal - [SIGN] Temp Sign Pe 100- 0000 - 437000 (17.00)
SGN2007 -00220 Reversal - [LRPF] LR Planning 100- 0000 - 438050 (2.00)
Line Item Total: ($38.00)
Refund:
'lethocl Payer User ID Acct. /Check No. Approval No. Flory Received Amount Paid
Credit Reversal GLYNN TAKAHASHI 210392 In Person (38.00)
Refund Total: ($38.00)
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i/18/2008
AI �: a : 13125 S\\ Hall Blvd.
1 1 :39.4 1 AM
%,:;..2.: _ 5 i
y rd, OR 97223 503.439.4171
'n>3aai1
Receipt #: 27200700000000005264 _'=:%''c= - /"7. - _
Date: 11/30/2007
Line Items:
Case No Trail Code Description Revenue Account No A moun t Paid
SGN2007 -00218 [SIGN] Temp Sign Perm 100- 0000 - 437000 17.00
SGN2007 -00218 [LRPF] LR Planning Surcharge I00- 0000 - 438050 2.00
SGN2007 -00219 [SIGN] Temp Sign Perm 100- 0000 - 437000 17.00
SGN2007 -00219 [LRPF] LR Planning Surcharge 100- 0000 - 438050 2.00
SGN2007- 00220 [SIGN] Temp Sign Perm 100- 0000 - 437000 17.00
SGN2007 -00220 [LRPF] LR Planning Surcharge 100- 0000 - 438050 2.00
Line Item Total: $57.00
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCarcl G LYNN TAKAHASHI ST 210392 In Person 37.00
Payment Total: $57.00
cl:cccilil l Page 1 01. I
IIII
Commun Development
TIGARD 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: G Lynn Takahashi
INVOICF. TO: (Business or Individual)
Mailing Address: 9845 SW Walnut PI
V 0 1 I) City /State /Zip: Tigard, OR 97223
iv/ , Phone No.: -5Z) f4 - kl 1 O
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 # : SGN2007 -00219
Site Address or Parcel # : 9845 SW Walnut PI
Project Name: Tigard Playschool
Subdivision Name: Lot # :
EXPLANATION: Sign permit created in error - signs no longer permitted to be placed
at current site.
Signature: L Date: 1/18/08
Shirley Trea
Print Name:
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 pernuts.
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 By Rte to Admin: Date 6! ' OS — By if „ '4.7
Refund Processed: Date . G O .' B ,q r Invoice Processed: Date B
Permit Canceled: Date a G Off'' B A Parcel Ta: Added: Date
Receipt # I 7-372 7 Date / d/ % 7 Method Cr Amount $ Jf-,
I:\ Building \Forams \RegPermitAction.. oc Rev 07 /26/07