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Permit
FRPITA ih y rn des" 5;.5; 4igq City of Tigard • October 20, 2011 Randall M & Kathleen N Kakesako 13635 SW 114 Ave. Tigard, OR 97223 Re: Permit No. SWR2011 -00142 Dear Mr. & Mrs. Kakesako: The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 13635 SW 114 Ave. Project Name: Kakesako Job No.: N/A Refund: ® Check #204286 m the amount of $9,135.00. ® Credit card "return" receipt in the amount of $1,400.00. Note: Please allow 2 -5 days for this refund transaction to be credited to your account by the company that issued your card. _ Trust account "deposit" receipt in the amount of $ . Comments: Refund sewer connection and reimbursement fees to be paid through promissory note with the City of Tigard. If you have any questions please contact me at 503.718.2430. Sincerely, .e 7 C - 7 g ri ° Dianna Howse Building Division Services Supervisor Enc. 1 \Building\Refnndsl.n25sSa d„ atlfEdAdeu,4dcT,igikicdJ4iQjo 97223 © 503.639.4171 TTY Relay: 503.684.2772 © www.tigard- or.gov City of Tigard TIG RD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for PemitActzon form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Randall M & Kathleen N Kakesako DATE: 10/18/2011 13635 SW 114 Ave. Tigard, OR 97223 REQUESTED BY: Dianna Howse Debbie Adamski TRANSACTION INFORMATION: Receipt # 184145 Case #: SWR2011 -00142 Date. 10/5/2011 Address /Parcel: 13635 SW 114th Ave. Pay Method Check Project Name: Kakesako EXPLANATION: Clean Water Services sewer connection and inspection fee, the City of Tigard's reimbursement district fees to be paid through promissory note with City of Tigard. - - - - .S;F ,a � "i3t� ^,i:r ':'4;x'7 =„ yp :�` :��: - '�V�;:�'. r?:z',3; °7,.- `�a.:.�y °:: „ -,” ,< .a'- :n .. r,�'r�:. � r ��a' „�•'.:� .. �..,.� ^:.s � .;. -w x - � -, - 45e'4:a "e =0. eeiDesc "r °i 'tionFr` "oiri`;aRece`i `'t'. �: ,. Rene "riue:- AccoiiiitN`o� _ `= : ='= Refiin'd its£ �y,:b rS -xf K iY 7 Fl p si F =•Ejx'arri "` "1'e�• =�Buil'aiii` rPer%riit, ,, x 300000�43��'04� > b�G Arii�ourit Sewer Connection Fee 500 -0000 -25500 $3,100.00 Sewer Inspection Fee 230- 0000 -43118 35.00 Reimbursement District Fee 500- 0000 -48001 6,000.00 TOTAL REFUND: $9,135.00 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board ;.,,z,..:�• `,.h`. - It;: - IDEIVIARKaa Y "PE �' 'IN;IST- RAT.`..,,; _ ( _, S,E, ,._ " - ,;LL,^�;&;`;': °x�`��;;�;.:�,..�. Case Refund Processed Date. /t Ze B : eta I \Bw1dmg \ Refunds \RcfundRcqu doc s 09/01/2010 City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request Jr o Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Kathleen N Kakesako DATE: 10/20/2011 13635 SW 114t Ave. Tigard, OR 97223 REQUESTED BY: Dianna Howse Debbie Adamski TRANSACTION INFORMATION: Receipt #: 184144 Case #: SWR2011 - 00142 Date: 10/05/2011 Address /Parcel: 13635 SW 114th Ave. Pay Method: CreditCard Project Name: Kakesako EXPLANATION: Clean Water Services sewer connection and inspection fee, the City of Tigard's reimbursement district fees to be paid through promissory note with City of Tigard. y� . ..r. _a. - _ - -- ;,x�v h - - iy:m, �?s.';:i�i£':�� "`4a.:' �� r> zre;.y�.�i�;�, °- c. - .s� „ ,--- �x��. . �.= .:a � REF'UND?I_N= ®'RMA_TIO'N = t ' ,. i i _ n �;: , pi s „ .. , ?,....m ...�._ .,. �'.. zui4; n,! t��. r K; 7-` , ,ax ^e'^�,'�.:. # :�.`Fx ::.�¢�::, :1K s.*_.,�.tzt� a :' vr..a��v�'."v%:'�,�d�.' � %�§` � ���ix*�a?�.�'�`�'v �`F�,�f � " 4tt ,^,T." - .�7;sh,r'.i�1�": u '^4 ���z� ". "'"(::A"Tx�"a;': - F�„� -tau, S�, - �C"c: `.� �' "` ., '° ;;�s,7 ".� � �,-aa�'�, ' ..� w Fee Descri non From:Recei °'try i e; 3 _° � A r ':�v =l * ,, , i 4 F. t- -; I? ; -s Revenue Ace- s ,- „:,��= � �a��;: �,� >.� • �x4'�, �- ��:ry��:�a= a�.:� � yp 1 ��: � �� �"�� � ; ,�,Refiirid:' „a,, :�sn - _ n • �? � c Kc'�: ri `?, r . ,;. rr' ..r *,, : 5g$; �s, x, y .:.�.. ncn° „P� ",.' �` t4x Exam a'l61,3ulldtn iPermtt e 4_:w - ' ' : *Aht ... -. ��.. p.....,.x° >a °.w .�.g.� =- �,�.,..... ��,� a;`� ��;���rr; ����� Exam lye• �23000�00 °4�3 „10., g �. �. � ,�t . '.�.n�- � 3 : P. ;��, - - 4 :,�:;:.: °���._ °�$;.A:m'ounyt�; Sewer Connection Fee 500 - 0000 -25500 $1,400.00 TOTAL REFUND: $1,400.00 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager ± 31) 'L OW 1 If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board ' a r 'N: ` , hx ' zV :Q'R3T`IDEMARK r$ T :. ._. : ��x,,,' .. t, t,��i:���.:..�:r:y.k.- �..,.V,.� �.E -u � . �...u�,..,,.._,.,.��_Y,S= EIVI` >ADNII. ION'�.IJSE "�ON�I' %' _k�x:�s�; �, ° �.x� ���°;�= N'IST�RAT � "� Case Refund Processed: Date: /i/ C1 /,/ By: 1 \Buildin \ Refunds \RufundRe doc s 09/01/2010 RECE • Communi Development OCT 122011 TIGARD Request for Permit Action CITY OF TIGARD Bi Rpm DIVISION TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: ❑ Owner ❑ Applicant n Contractor ® City Staff (check one) REFUND OR Name: Kathleen N. Kakesako INVOICE TO: (Business or Individual) • Mailing Address: 13635 SW 114 Ave City /State /Zip: Tigard, OR 97223 Phone No.: 503 - 624- 894 CQ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V): ❑ CANCEL PERMIT APPLICATION. n REFUND PERMIT FEES (attach copy of original receipt). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: SWR2011 -00142 Site Address or Parcel #: 13635 SW 114t Ave Project Name: Kakesako Subdivision Name: N/A Lot #: N/A EXPLANATION: Fees to be paid through Promissory Note with City of Tigard. Refund consis two .: ment methods: Check = $9,135.00, Credit Card = #1,400.00 Signature: _ / _. � �� Date: 10/12/11 - ebie R. Adamski Print Name: Refund Policy 1. The Director or Building Official may authonze 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 2 -4 weeks for processing refunds. FOR OFFICE USE,ONLY _Rte to Sys Admin. Date o J I' !J Rte to Bld! Admin: Date / Ld B .i. Refund Processed: Date /0 Zd // B i %, Invoice Processed: Date B Permit Canceled: Date r / ,9- By , - - Parcel Tag Added: Date By Receipt # Date Method Amount $ I \Building \ Forms \RegPermi Action doe Rev 04/26/2011 . 7 ND .iii � .ss ,s City of Tigard October 20, 2011 Randall M & Kathleen N Kakesako 13635 SW 114 Ave. Tigard, OR 97223 Re: Permit No. SWR2011 -00142 Dear Mr. & Mrs. Kakesako: The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 13635 SW 114 Ave. Project Name: Kakesako Job No.: N/A Refund: ® Check #204286 in the amount of $9,135.00. ® Credit card "return" receipt in the amount of $1,400.00. Note: Please allow 2 -5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account "deposit" receipt in the amount of $ . Comments: Refund sewer connection and reimbursement fees to be paid through promissory note with the City of Tigard. If you have any questions please contact me at 503.718.2430. Sincerely, ' --47-</ Dianna Howse Building Division Services Supervisor • Enc. • I: \ Building \ Refunds1L3126s&WntriallfElArchuRZigaccdoifavogon 97223 ® 503.639.4171 TTY Relay: 503.684.2772 e www.tigard - or.gov n CITY OF TIGARD RECEIPT >a . • _ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 184295 - 10/20/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID S WR2011 -00142 $- 9,135.00 Total: $- 9,135.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 204286 DHOWSE 10/20/2011 $- 9,135.00 Payor: Randall M & Kathleen N Kakesako Total Payments: $- 9,135.00 Balance Due: $10,535.00 Page 1 of 1 CITY OF TIGARD RECEIPT 1[1 3 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD 047./G / �i� C, • Receipt Number: 184145 - 10/05/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2011 -00142 Sewer Connection Fee 500 - 0000 -25500 $3,100.00 SWR2011 -00142 Sewer Inspection - Residential 230 - 0000 -43118 $35.00 SWR2011 -00142 Reimbursement District Revenue 5000000 -48001 $6,000.00 Total: $9,135.00 • PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 15288 DADAMSKI 10/05/2011 $9,135.00 Payor: Randall M & Kathleen N Kakesako Total Payments: $9,135.00 Balance Due: $0.00 • • • • • • Page 1 of 1 1111 . City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Kathleen N Kakesako DATE: 10/20/2011 13635 SW 114t Ave. Tigard, OR 97223 REQUESTED BY: Dianna Howse Debbie Adamski TRANSACTION INFORMATION: Receipt #: 184144 Case #: SWR20 1 1 -001 42 Date: 10/05/2011 Address /Parcel: 13635 SW 114th Ave. Pay Method: CreditCard Project Name: Kakesako EXPLANATION: Clean Water Services sewer connection and inspection fee, the City of Tigard's reimbursement district fees to be paid through promissory note with City of Tigard. REFUND. INFORMATION: • "Fee Description From Receipt .• • 1 • Revenue Account No. Refund. Example: Permit :Pee • •: "Example:'. 2300000 -43104 $ Amount Sewer Connection Fee 500- 0000 - 25500 $1,400.00 TOTAL REFUND: $1,400.00 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager If under $25,500 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 /6/2e/// I By: I �,?-j2 „ 1: Building \Refunds \RcfundRcqucst.doc x 09/01/2010 11111 CITY OF TIGARD RECEIPT II a . 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD / /f N , Receipt Number: 184294 - 10/20/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2011 -00142 S - t &tJ Z. deivAt1 d i /cN r" ,SAO o a4' - -zS"Sc7D $- 1,400.00 Total: S- 1,400.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 30335A DHOWSE 10/20/2011 $- 1,400.00 Payor: Kathleen N Kakesako Total Payments: $- 1,400.00 Balance Due: $1,400.00 • • Page 1 of 1 1- CITY OF TIGARD RECEIPT q g ... 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 184144 - 10/05/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2011 -00142 Sewer Connection Fee 500- 0000 -25500 $1,400.00 Total: $1,400.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 30335A DADAMSKI 10/05/2011 $1,400.00 Payor: Kathleen N Kakesako Total Payments: $1,400.00 Balance Due: $0.00 • • Page 1 of 1 I: a; • 1 +s '.. r, • 11111 1111 Community Development Request for Permit Action TIGARD t 34 � �hrth! V .t', :t'` TO: CITY OF TIGARD Building Division Services Supervisor 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: Kathleen N. Kakesako INVOICE TO: (Business or Individual) Mailing Address: 13635 SW 114T Ave City /State /Zip: Tigard, OR 97223 Phone No.: 503- 624 -8904 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ❑ CANCEL PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: SWR2011 -00142 Site Address or Parcel #: 13635 SW 114` Ave Project Name: Kakesako Subdivision Name: N/A Lot #: N/A EXPLANATION: Fees to be paid through Promissory Note with City of Tigard. Refund consis . • • ment methods: Check = $9,135.00, Credit Card = #1,400.00 Signature: ,�, Date: 10/12/11 - • vie R. Adamski 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 2 -4 weeks for processing refunds. FOR OFFICE USE ONLY _ Rte to Sys Admin: Date oiffnintallWitall Rte to Bldg Admin: Date €1 2 o ,/ B o - . Refund Processed: Date / - e/ J ;`j/ By vrA • Invoice Processed: Date By Permit Canceled: Date N/ By %..' • Parcel Tag Added: Date By Receipt # Date Method Amount $ I:\ Building \Forms \RegPermiNction.doc Rev 04/26/2011 CITY OF TIGARD SEWER CONNECTION PERMIT '''' COMMUNITY DEVELOPMENT Permit #: SWR2011 -00142 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/05/2011 Parcel: 2S 103DC00808 Jurisdiction: Tigard Site address: 13635 SW 114TH AVE Project: Kakesako Subdivision: VIRGINIA ACRES Lot: 6 Project Description: Connect existing house to sewer service. Contractor: Owner: KAKESAKO, RANDALL M & KATHLEEN N 13635 SW 114TH TIGARD, OR 97223 PHONE PHONE FAX: • FEES Description Date Amount Specifics: Sewer Connection Fee 10/05/2011 $4,500.00 Sewer Inspection - Residential 10/05/2011 $35.00 Type of Use: SF Reimbursement District Revenue 10/05/2011 $6,000.00 Class of Work: ALT Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $10,535 00 Required Items and Reports (Conditions) 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 • egon Utility Notification Center. Th rule. are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the /ules or direct questions to OUNC calling 503 2 .1987 .800 332.2344. Issue By: I Permittee Signature: ; ±% Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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.