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j City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
IN •
T I GARD
June 25, 2008
Michal Kaszubowski
14534 SW 82n Ave.
Tigard, OR 97224
Re: Permit No. MST2007 -00132
Dear Mr. Kaszubowski:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 14534 SW 82n Ave.
Project Name: Kaszubowski
Job No.: N/A
Refund: ❑ Check # in the amount of $ .
® Credit card "return" receipt in the amount of $240.00.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Refund overpayment of TIF- Resident fee.
If you have any questions please contact me at 503.718.2430.
Sincerely,
1
Dianna Howse
Building Division Services Coordinator
Enc.
I: \Building\ Refunds\ Administration \LtrRefund - Overpay.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard or.gov • TTY Relay: 503.684.2772
T V
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 Permit Action or Refund form (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: Michal Kaszubowski DATE: 6/12/08
14534 SW 82n Ave
Tigard, OR 97224 - REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 2007 -3953 Case #: MST2007 -00132
Date: 8/28/07 Address /Parcel: 14534 SW 82nd Ave
Pay Method: Credit Card Project Name: Kaszubowski
EXPLANATION: Refund overpayment of TIF -R fees
;,REFiJND�I1vFORMATION 4:a R .. F ` F� t { 4'
^Fee" Descrtpnon From Re'cetpt � , K ' a ' ;,�a ; ttY � F Revenue Account;No' f� `r` ,ti Refund `
?Exampl [BUILD] Permit'Fee' " =
[TIF -R] TIF Resident 210 - 0000 - 448001 $240.00
TOTAL REFUND: $240.00
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager /. " 4' C
If under $22,500 Department Manager
•
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
Case Refund Processed: Date: I ,j.. "f; I By: jr/
I: \Building \Refunds \RefundRequest.doc 05/23/07
CITY OF TIGAR® Gil l /2008
13125 SW Flail Blvd. 12:23:52PM
:- - Tigard, OR 97223 503.639.4171
`T•1GARp ,
Receipt #: 27200700000000003953 6i/ /(., fir / '
Date: 08/28/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MST2007 -00132 [CDCPLN] CDC Pln Rev 100- 0000 - 433060 46.00
MST2007 -00132 [LRPF] LR Planning Surcharge 100 -0000 - 438050 6.00
MST2007 -00132 [BUILD] Bldg Permit 245 -0000 - 432000 1,594.46
MST2007 -00132 [METCET] Metro Const Excise Tx 245- 0000 - 229202 342.88
MST2007 -00132 [PKSDC] SF Park SDC 270- 0000 - 450000 4,812.00
MST2007 -00132 [TIF -R] TIF Resident 210- 0000 - 448001 3,200.00 <--
MST2007 -00132 [TIF -MT] TIF Mass Tr 210 -0000- 448005 240.00
MST2007 -00132 [ERPRMT] Erosion Control 100- 0000 - 207307 88.00
MST2007 -00132 [ERPLN] Erosn PIn Rv CWS 100- 0000 - 207308 28.60
MST2007 -00132 [EROSN] Erosn Phi Rv COT 245- 0000 - 433010 28.60
MST2007 -00132 [WQUAL] Water Quality 520- 0000 - 445002 225.00
MST2007 -00132 [WQUANT] Water Quantity 520- 0000 - 445001 275.00
Line Item Total: $10,886.54
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard MICHAL KASZUBOWSKI - DEB 021333 In Person 10,886.54
KOWSER LLC
Payment Total: $10,886.54
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