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SGN2012-00052 TIGARD City of Tigard March 30, 2012 Joseph Platt 2424 SE Holgate Blvd. Portland, OR 97202 Re: Permit No. SGN2012 -00052 Dear Mr. Platt: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 12023 SW 70 Ave. Project Name: Red Rock Center Job No.: N/A Refund Method: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $132.00. 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 $ Comment(s): Per applicant's request as customer changed mind and did not want new sign. Refund 80% of applicantion fees. If you have any questions please contact me at 503.718.2430. Sincerely, / Dianna Howse Building Division Services Supervisor Enc. I: \ Building \ Refunds \}3421 t> R illlfilAcellPe rig dql cf �i v'egon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard or.gov 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: Josepth Platt DATE: 3/23/2012 2424 SE Holgate Blvd. Portland, OR 97202 REQUESTED BY: Dianna Howse Shirley Treat TRANSACTION INFORMATION: Receipt #: 186005 Case #: SGN2012 -00052 Date: 3/20/2012 Address /Parcel: 12023 SW 70th Ave. Pay Method: CreditCard Project Name: Red Rock Center EXPLANATION: Refund 80% of sign permit application fees per applicant's request to cancel permit. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Sign Permit 100 - 0000 -43115 $115.20 Sign Permit - LRP 100 - 0000 -43117 16.80 TOTAL REFUND: $132.00 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager_ �r / / If under $25,500 Department Manager • i- 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 �J�‘)//- I B I I: Building \Rcfunds \RcfundRc s 09/01/2010 • CITY OF TIGARD RECEIPT 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 186144 - 03/30/2012 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SGN2012 -00052 S f /1/ A- iet1ii `OCR '0000 -93//5 // s' I CJ > $- 132.00 f,'6A/ P02ey/ f /oo - 0000 - /3 // 7 /6 • Total: $ - 132.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 52856P DHOWSE 03/30/2012 $- 132.00 Payor: Joseph Platt Total Payments: $ - 132.00 Balance Due: $132.00 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD G 2 / C— in/,y Receipt Number: 186005 - 03/20/2012 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID 5GN2012 -00052 Sign Permit 100- 0000 -43115 $144.00 SGN2012 -00052 Sign Permit - LRP 100 -0000 -43117 $21.00 Total: $165.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 52856P STREAT 03/20/2012 $165.00 Payor: Joseph Platt Total Payments: $165.00 Balance Due: $0 00 Page 1 of 1 • IM 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: I I Owner n Applicant ❑ Contractor 171 City Staff (check one) REFUND OR Name: Joseph Platt • INVOICE TO: (Business or Individual) Mailing Address: 2424 SE Holgate Blvd City /State /Zip: Portland, OR 97202 Phone No.: 503 - 546 -7114 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): M CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). n INVOICE FOR FEES DUE (attach case fee schedule and explain below). n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: SGN2012 -00052 Site Address or Parcel #: 12023 SW 70 Ave Project Name: Red Rock Center Subdivision Name: Lot #: EXPLANATION: Meridian Acupuncture & Wellness changed their mind and do not want this sign Signature: _2-1,11 J,( Date: 3/22/12 Shirley Treat Refund Policy 1. The Director or Building Official may authorize the refund of a) any fee which was erroneously paid or collected. 1 >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 B Rte to Admin: Date j/30//...1.— By ,i Refund Processed: Date d i— By Invoice Processed: Date By Permit Canceled: Date Si ,i d /'' By ,Q Parcel Tag Added: Date By Receipt # J O0 ,> Date �,4 , 4 ..t . . Method CL' Amount $ /45; eV ma I: \Building \Forms \RegPeitAction.doc R¢v 07/26/07 / Y.y - ,. S. 2 o f '' zo .. .1,I q SIGN PERMIT APPLICATION City of Tigard Permit Center 13125 SIV Hall Blvd., Tigard, OR 97223 TIGARD Phone: 503.639.4171 Fax: 503.598.1960 GENERAL INFORMATION Name of Development /Project /� FOR STAFF USE ONLY Site - ��/ J r c..�./ Address / Street Address Permit No.: %1.) a491.9--- Does S Location / 2 4 Sit) 7v• -' Expiration Date: Suite /Bldg.# Cite /Scare Zip ' �� / 7? f 40 .d 64e 97277 Receipt #: �s Name SJ / . „,. Approved By: Date: 3/0 (l. Property WIG) " /.�. r /� Owner Mailing Address / Suite Map /TL #: AS(0 1 44 0L/ / /zo2___.? .reo 7 w• zoning: ' LCO is U Ciy /State Zip Phone 7 7 ' 9 7zp Electrical Permit Required? ❑ Yes j"No Tenant or Na to Business INS Gam /4� / /9G �t/ diG �y Building Permit Required? ❑Yes �No Name y �1 / Q". / R.ev.7 /1/09 is \cutpin\ masters \land use applications \sign permit app.doc Sign Security Signs Contractor Mailing Address Suite (Prior to permit 2424 SE Holgate Blvd lope of REQUIRED SUBMITTAL ELEMENTS copy of all Ciny, Stain Zip Phone licenses are (Note: applications will not be accepted required if Portland, OR 97202 503.546 without the required submittal elements) expired in the Oregon Const. Cont. Board License # Exp. Date City of Tigard's database) 1 22 809 ❑ Completed Application Form Proposed ig Permanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale Sign ❑ Temporary ❑ Wall ❑ Electronic (3 copies, if a building permit is required) (Check all that El Other El Billboard ❑ Balloon size requirement: 8 x11", or 11" x 17" PP.) �l El New sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale Sign Dimensions i ' v ,� (3 copies, if a building permit is required) Tom' — V S d X 2 _6 2 size requirement: 8 x 11 ", to 24" x 36" Total Sign Area (sq. ft.): f .r.V ❑ $40.00 Fee (Permanent sign, any size) Total Wall Area (sq. ft.) Sign Data ,Z,.! ❑ $19.00 Fee (Temporary sign, any type) (Complete all Direction Wall Faces (circle one): items in this NOTES: section) 0 s © W NE NW SE SW Height to top of sign (feet): e v f ♦ Wall signs do not need to be drawn to scale, but Projection From Wall (inches): / Fe must include dimensions of wall face and sign placement. Copy: ♦ Wall signs do not require site /plot plans. Materials: 17 4 p0,.... • Freestanding signs over 6 ft. required a building Will sign have illumination? ❑ Yes ® No permit. Type: ❑ Internal IN 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 ❑ Yes ❑ No NULL AND VOID. If "yes ", a list or diagram of all sign dimensions and square footage must also be submitted. (OVER FOR SIGNATURES) E. 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. DATED this day of s" C 4 , 20 / z Signature f Owner /Agent • • • • - 503.546.7114 Contact Person Name Phone No.