Permit Y
C ITY OF TIGARD 'PI SEWER CONNECTION PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00037
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/28/2008
PARCEL: 2S 112DD - 01100
SITE ADDRESS: 15700 SW UPPER BOONES FERRY RD ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: HOLIDAY INN EXPRESS
Project Description: .1 EDU increase.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.0
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
BHGAH TIGARD, LLC FEES
PO BOX 1670 Description Date Amount
WILSONVILLE, OR 97070
[SWUSA] Sewer Connection Fee 3/28/2008 $250.00
[ SWUSA] Sewer Connection Fee 3/28/2008 $30.00
Phone: 503- 783 -5222
Total $280.00
•
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the
date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer
laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given.
If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon
law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through
OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued y : Pe r mittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
., City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
IIIII • .
• .,
's;EI`G
April 21, 2008
• BHGAH Tigard LLC
dba Sherwood Inc.
P.O. Box 1670
Wilsonville, OR 97070
Re: Permit No. SWR2008 -00037
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 15700 SW Upper Boones Ferry Rd.
Project Name: Holiday Inn Express
Job No.: N/A
Refund: ® Check #57002 in the amount of $250.00.
❑ Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: A walk - through by plumbing inspector determined that more fixtures were being
capped than added. Refund 100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
G6,
Dianna Howse
Building Division Services Coordinator
Enc.
I:\ Building\ Refunds \Adminis tration \LtrRefund- CanceIpernucdoc 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 Request for Permit Action or Refund form Of 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: BHGAH Tigard LLC DATE: 4/14/08
dba Sherwood Inc.
P.O. Box 1670 REQUESTED BY: Dianna Howse
Wilsonville, OR 97070 DEB
TRANSACTION INFORMATION:
Receipt #: 2008 -1033 Case #: SWR2008 -00037
Date: 3/28/08 Address /Parcel: 15700 SW Upper Boones Ferry
Pay Method: Check Project Name: Holiday Inn Express
EXPLANATION: Walk- through by plumbing inspector determined more fixtures were capped than
added. Refund 100% of permit fees.
`REFUND INFORMATION: , .. ' °..;. , _ , ` . „ , ' � '
Fee - Description From Receipt - ' "Revenue Account.No:'' :'- , . Refund -
Example:= ,[BUILD] Permit . - - . Example: 245 - 0000 - 432000'-: . $ Amount
[SWUSAl Sewer Connection Fee 500 - 0000 - 207000 $250.00
TOTAL REFUND: $250.00
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager i 2, � 1 /" . 1 4 / — 0 (i (I
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
r . ,- ,' - ' : , - , FOR TI-DEMARK;SYS ADMINIST. fSE:ONLY�', ..';
Case Refund Processed: I Date: I 0re I B I
1. \Building \ Refunds \RefundRequest.doc 05/23/07
CITY OF TIGARD 4/7/2008=
� � 13125 SW Flail Blvd. I2.55:49PM
Tigard, OR 97223 503.639.4171
- T,TGARD
Receipt #: 27200800000000001033
Date: 03/28/2008
Line Items: _
Case No Tran Code Description Revenue Account No Amount Paid
SWR2008 - 00037 [SWUSA] Sewer Connection Fee 500 0000 - 207000 250.00
Line Item Total: $250.00
Payments:
• Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Check BHGAH TIGARD LLC DBA DEB 0879 In Person 250.00
SHERWOOD INC
Payment Total: $250.00
rlteeript tpt Page I or I
E . Community Development RECEIVED
TIGARD Request for Permit Action NN rZ 7 2008
CITY OF T1GAR
BUILDING ONISION
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor X City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) a ft "7 G ds oo / ,JCS
V Mailing Address: \ P 1 ( 7 n 0 1 ® Cit /Zip: �1Lf of U �LL� CR 9 7070
y//`//0 475 Phone No.: 5A a
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
Alt CANCEL PERMIT APPLICATION.
El REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit)_
Permit #: p dOO$ ~ (X)O 3- n
Site Address or Parcel #: '15700 L1 1� , 5 ) j / Kb
Project Name: 1401- 1019`/ i p. E-X Pai.65 1I
Subdivision Name: NI Lot #:
EXPLANATION: F, x L Q� LOA L - Tt Qt.k `CJ ET-bail 1 1 06
x T t 05,5 Q- A-Pton> T4N) s7-1 lei .
�y5rs �1 -1- )`c3f c_e)A► -i9,XT rss PAtr •
Signature: Date: y /7 I $
Print Name: —7-)E66-1 AD ,F}l -I sk
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 apphcauon 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 S s Admire: Date i d Eal Rte to Bld t Admin: Date r B �!
Refund Processed: Date r/jy Os- By Al Invoice Processed: Date By
Permit Canceled: Date y � yfOr By ; Parcel Tag Added: Date By
Receipt # #10./_/ Date / /Z�Ap- Method CLA--- Amount $
I. \Budding \ Forms \RegPermitAcnon doc Rev 07/26/07
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 {'
®1
•
April 14, 2008
Steven D. Bowers
826 Red Cloud Ln. SE
Salem, OR 97317
Re: Permit No. SWR2008 -00037
Dear Mr. Bowers:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 15700 SW Upper Boones Ferry Rd.
Project Name: Holiday Inn Express
Job No.: N/A
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $30.00.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Walk - through by plumbing inspector determined that more fixtures were capped
than added. 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.
I: \Building\ Refunds \Admirustra tion \LtrRefund- CancelPerrtutdoc 01/16/07 •
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
a '
: 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: Steven D. Bowers DATE: 4/14/08
826 Red Cloud Ln. SE
Salem, OR 97317 REQUESTED BY: Dianna Howse
DEB
TRANSACTION INFORMATION:
Receipt #: 2008 -1034 Case #: SWR2008 -00037
Date: 3/28/08 Address /Parcel: 15700 SW Upper Boones Ferry
Pay Method: CreditCard Project Name: Holiday Inn Express
EXPLANATION: Walk - through by plumbing inspector determined that more fixtures were capped than
added. Refund 100% of permit fees.
REFUND INFORMATION: _ .
Fee Description From Receipt - •- , Revenue Account No. '• ',Refund;,:
Example: [BUILD] Permit Fee Example:- 245. 432000 ,$ Amount
[SWUSA] Sewer Connection Fee 500- 0000 - 207000 $30.00
TOTAL REFUND: $30.00
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager ` e% ..- 0
If under $22,500 Department Manager •
If under $50,000 City Manager
If over $50,000 Local Contract Review Board •
• EOR TI• DEMARKSYSTEMADMINISTR _ATION.USE'ONLY. , .;, , ti
Case Refund Processed: I Date: I ,%/0/ I B I
I. \Building \Refunds \RefundRequest doc 05/23/07
-. ` - CITY OF TIGARD 4/14/2008
, I 13125 SW Hall Bl d. 12:43 3ZPM
'v'.:{' Tugard, OR 97223 503.639.4171
Ti[GARD;
Refund Receipt #: 27200800000000001221 ie<c -
Date: 04/14/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SWR2008 - 00037 Reversal - [SWUSA] Sewer Conne 500 - 0000 - 207000 (30 00)
Line Item Total: ($30.00)
Refund:
Method Payer User ID Acct. /Check No. Approval No. Flow Received Amount Paid
Credit Reversal STEVEN D BOWERS 01670B In Person (3000)
Refund Total: ($30.00)
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I _
j4 h.;'- CITY OF TIGARD 4/7/2008
Ilk
,,, o k 1312; SW flan BIN d. 1 2 56 O=�PM
=f Tigard, OR 97223 5113.639.4171
. p TIGJ Ri7
Receipt #: 27200800000000001034 C IZ/& //1/
Date: 03/28/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
S W R2008 - 00037 [S W USA] Sewer Connection Fee 500 - 0000 - 207000 30.00
Line Item Total: $30.00
Payments:
Method Payer User ID Acct. /Check No. Approval No. l-lom Received Amount Paid
CreditCard STEVEN D BOWERS DEB 01670B In Person 30 00
Payment Total: $30.00
li eccq'r Ipr Pair I or I
e 111 Communi Develo ment RECEWD
tY p
Request for Permit Action NNK 7 70n9
TIGARD CITY OF TIGARD
IUIWUING DIVISION
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 g City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) b-r- j oe�r�-
V 0 e O Mailing Address: 8 a rp Cot L)
y//9 City/State/Zip: / D 57 5/ 7
PhoneNo.: Jo� 7C/- DSO/
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
® CANCEL PERMIT APPLICATION.
M , 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 #: $1,0P ano $ -coo37
Site Address or Parcel #: (' 7 00 (APPil: a 5 i2 Y .
Project Name: A0Li i� e0 0 EaaSS
Subdivision Name: )3/6- Lot #: /Jf -
EXPLANATION: , X ruQ f (..0f} Lpl ► FtQ_". - trr&H 1 Er° P pip i njb
xru CA-PS €D —r Prbb �c7 . ' R - `i)O%
kt5 41-1`n
Signature: Date: q17 108
Print Name: l) tP P 1 Q 5 K'
Refund Policy
1. The Director or Budding 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 1 -2 weeks for processing refunds
FOR OFFICE USE ONLY
Rte to S s Admin: Date SMAIMEMS)10 Rte to Bld• Admin: Date / B
Refund Processed: Date M B .46, Invoice Processed: Date B
Permit Canceled: Date y// p By F Parcel Tag Added: Date By
Receipt 4611 y Date j Method CC Amount $gyp ,
1: \Building \Forms \RegPcmutAction.doc R v 07/ .:1b- — --- -- —
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
,1
. .
TIGARD:
April 14, 2008
Steven D. Bowers
826 Red Cloud Ln. SE
Salem, OR 97317 •
Re: Permit No. SWR2008 -00037
Dear Mr. Bowers:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 15700 SW Upper Boones Ferry Rd.
Project Name: Holiday Inn Express
Job No.: N/A
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $30.00.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Walk - through by plumbing inspector determined that more fixtures were capped
than added. Refund 100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely, •
tie A
Dianna Howse
Building Division Services Coordinator
Enc.
I: \ 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
T 1 G A RD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request forPermit 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: Steven D. Bowers DATE: 4/14/08
826 Red Cloud Ln. SE
Salem, OR 97317 REQUESTED BY: Dianna Howse
DEB•
TRANSACTION INFORMATION:
Receipt #: 2008 -1034 Case #: SWR2008 -00037
Date: 3/28/08 Address /Parcel: 15700 SW Upper Boones Ferry
Pay Method: CreditCard Project Name: Holiday Inn Express
EXPLANATION: Walk - through by plumbing inspector determined that more fixtures were capped than
added. Refund 100% of permit fees.
0 "-P NI? . INF07t,1kiAT
_ ON's
F
a -
�esci'` "tioii�Fro�ii.•Recei .i;'• -
P, p, �:3: _ - Reveiiu�e Accouiat;No.:. D efii'rid. :
.1. _ .r : t' - .i: � �
U]LD Per iut Fee ::w : t : ti Ezani le::.245= 0000 - 432000 `'
[SWUSA] Sewer Connection Fee 500 - 0000 - 207000 $30.00
TOTAL REFUND: $30.00
APPROVALS:
If under $500 Professional Staff 7/.
If under $7,500 Division Manager / / 4 ( - / <; '.
If under $22,500 Department Manager . i
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
T MMARI .SYST:Irl•t:A )MIN.I!ST :9"1{_TON`
Case Refund Processed: I Date: I s% /•:/ I B I
l: \ Building \Refunds \RefundRequest.doc 05/23/07
�! ;7 CITY OF TIGARD
4/14/20
F
13125 SW Hall Blvd.
:' l e
;.- Tigard, OR 97223 503.639.4171 I2:43:32PM
T1GARD:
-
Refund Receipt #: 27 200800000000001221 ,v;9-t_
Line Items:
Date: 04/14/2008
Case No Tran Code Description
Revenue Account No Amount Paid
• SWR2008 -00037 Reversal - [SWUSAJ Sewer Comic 500- 0000 - 207000
(30.00)
Refund:
Line Item Total: ($30.00)
Method Payer User ID Acct. /Check No. Approval No.
PI How Received Amount Paid
• Credit Reversal STEVEN D BOWERS 01670B
In Person (30.00)
Refund Total: ($30.00)
•
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Page I of I
CITY OF TIGARD 4/7/2008 •
r~!.._. ! � ; 13125 SW Hall Blvd. 1 2:6:0 4PM
Tigard, OR 97223 503.639.4171
�FFG¢RIy:
Receipt #: 27200800000000001034
Date: 03/28/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SWR2008 -00037 [SWUSAJ Sewer Connection Fee 500- 0000 - 207000 30.00
•
Line Item Total: $30.00
Payments:
• Method Payer User ID Acct. /Check No. Approval No. How Received
Amount Paid
CreditCard STEVEN D BOWERS DEB 01670B In Person 30.00
Payment Total: $30.00
cRcccipi.rpn
Page I or I
" ; mss tty
r 9 :A `�yta q'
Community Development - � �y ;
T I V A It D Request for Permit Action
'j' E 4'
` �FB��I i !;i'OSi i
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 vt City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business orindividual) }r \ \ ~Z\ su joE G,
Mailing Address: O p../p C L
Y//0e." �" City/State /Zip: � R-1.e OP- 57 5/ 7
Phone No.: 7 9 - 2 SO /
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® CANCEL PERMIT APPLICATION.
M ., 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 #: (� E)Cj 8 —00O37
Site Address or Parcel #: 1 f57QU �� L 3 1L Y �� .
Project Name: , ►Dl,ti) 6• ad a65
SS
Subdivision Name: �� Lot #: N44
EXPLANATION: F ,xr t et L.O,gL1ti -iffy Dtrt,21-4 I Lb 140k_i_ kit NR ,nicb
xrut2sc , CJPPtit) {'tbt . 71. cuti 'r or
-- r - >¢DLLOPNs.t T -rub
Signature: C9-14A-4- Date: i 17 lo g
Print Name: 0,, e ( Q. I
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 S s Admin: Date f� �;�
/'w Rte to Bld: Admin: Date /y B
Refund Processed: Date / jy O Byr - Invoice Processed: Date By
Permit Canceled: Date y�iy /fr By F Parcel Tag Added: Date By
Receipt ,-70,5 y Date 3/2„4 /A?%- Method CC Amount $ ;e1 , re
I:\ Building \Forms \RegPermitAction.doc R 607/26/07
•
. City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
If
T I GARD
April 21, 2008
BHGAH Tigard LLC
dba Sherwood Inc.
P.O. Box 1670
Wilsonville, OR 97070
Re: Permit No. SWR2008 -00037
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 15700 SW Upper Boones Ferry Rd.
Project Name: Holiday Inn Express
Job No.: N/A
Refund: ® Chcck #57002 in the amount of $250.00.
❑ Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: A walk- through by plumbing inspector determined that more fixtures were being
capped than added. 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- CancelPermitdoc 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 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: BHGAH Tigard LLC DATE: 4/14/08
dba Sherwood Inc.
P.O. Box 1670 REQUESTED BY: Dianna Howse
Wilsonville, OR 97070 DEB
TRANSACTION INFORMATION:
Receipt #: 2008 -1033 Case #: SWR2008 -00037
Date: 3/28/08 Address /Parcel: 15700 SW Upper Boones Ferry
Pay Method: Check Project Name: Holiday Inn Express
EXPLANATION: Walk - through by plumbing inspector determined more fixtures were capped than
added. Refund 100% of permit fees.
REF ND.
LJ N•F,ORMATI .: }( '�:'�' `s': ;i;,�.�' .. . 'r:. , ...,,,.:;
Fee- Descii Flom Recei " "`' 'f �'� Y ^ Re Refund
. "• •'d1, - •r'K]Y, :� �.�••�.- `. , ,�i: .. _ •�.
: E x a m p l e : • : P U I I ' . . ) r T , P e m u ff ee' ,; : ; � ;' � , f ! : Exafrijile •- 245 =y0000 432000. .$'Amount
[SWUSA1 Sewer Connection Fee 500- 0000 - 207000 $250.00
TOTAL REFUND: $250.00
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager V2 7 ^ / tf — C e
If under $22,500 Department Manager
If under $50,000 City Manager
•
If over $50,000 Local Contract Review Board
Case Refund Processed: I Date: � /��e I By: Le* 1
I: \Building \Refunds \RefundRequest.doc 05/23/07
111 CITY OF TIGARD 4/7/2008
q
13125 SW Hall Blvd. 1 2:55:49PM
• Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000001033
Date: 03/28/2008 .
Line Items:
Case No Tran Code Description . Revenue Account No Amount Paid
SWR2008 - 00037 [SWUSA] Sewer Connection Fee 500 0000 - 207000 250.00
Line Item Total: $250.00
Payments:
' Method Paver User ID Acct. /Check No. Approval No. How Received Amount Paid
Check BHGAH TIGARD LLC DBA DEB 0879 In Person 250.00
SHERWOOD INC
Payment Total: $250.00
eRcccipl.rpi Page I of I
Community Development RE .1"/ED
TIGARD Request for Permit Action h r K 7 2008
CITY Or T!GAR7
BALIAN° 51s.ON
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 X City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) H ff I /�H � - C � J P �A � !f�,2tvoo.D , k.
Mailing Address: Nn y I ( Q - 7n
V 0 1 D City /State /Zip: LO1 L5 t_LL CR, 97070
00 , Phone No.: 5D3 5-aA a
• PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
Alt 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 #: de08 QOO 3-)
Site Address or Parcel #: • (57Q0 Lopa 3?„ S
Project Name: Ltt)fj`/ 1 131.) ( GX r 5
Subdivision Name: Lot #: 1V�ft
EXPLANATION: r , „ r �.. Q LOA Ll+. - Tit Q 'Dtn./211i
tJCT H L t't_t i� -t) ►�Co
x ru 24-5 e-ftPP Tit Rit, & ` (9 � �2
rs3fcr)PH --1f Jr ' s 1--(>. •
Signature: � �p a Date: O 7 to
Print Name: T )e66-I ( T'D l6k1
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 Adrnin: Date i( 0 r, Rte to Bldg Admin: Date By
Refund Processed: Date * /j/ By ;'- Invoice Processed: Date By
. Permit Canceled: Date /jy eV By , - - Parcel Tag Added: Date By
Receipt # _ Date 3/ ,per Method Amount $
l: \Building \Forms \RegPermitAction.doc Rev 07/26/07