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MMD2011-00009
I N I I Community Development TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Iall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor a City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City /State /Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL PERMIT APPLICATION. I ; y14 'REFUND PERMIT FEES (attach receipt, if available). ,; i P INVOICE FOR FEES DUE (attach case fee schedule and explain below). oe/,,, �t l n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: MMD2011 -00009 Site Address or Parcel #: 11920 SW Pacific Hwy Project Name: Mixers Bar & Grill Subdivision Name: Lot #: EXPLANATION: Created in error. Please void and transfer payment to DDR2011 -00003 , . 4) Signature: Date: 6/24/11 Kr Peerman 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 b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 S s Admin: Date B Rte to ' dmin: Date ., FAZE B ty�� Refund Processed: Date AlgrAM B '. Invoice Processed: Date B Permit Canceled: Date ., : • b B . JA., Parcel Ta• Added: Date B Recei s t # Date Method Amount $ I \ Building \ Forms \RegPermitAction.doc Rev 07 /26/07 CITY OF TIGARD • a 131 25 SW Hall Blvd., Tigard OR 97223 503.639.4171 . TIGARD • EGtf Receipt Number: 183047 - 06/28/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID DDR2011 -00003 DDR Compliance Letter (Type I) 1003100 -43116 $522.00 DDR2011 -00003 .DDR Compliance Letter - LRP 1003100 -43117 $77.00 Total: $599.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 19105 DHOWSE 06/28/2011 $599.00 Payor: Tumay Corporation DBA Mixers Bar & Grill • Total Payments: $599.00 Balance Due: $0.00 k4 y —' Accela 71- System Administration Finance Department Request Date: 0,-/// To: Liz Lutz ,/ Kathy Gende • From: Dianna Howse/ Re: Receipt #: 41 Vic" /C /e..7;G'`/'K, /f eL ?7 Please process this request as follows: Journal Entry (route copy of JE to Dianna Howse). Reversal (fees have been reversed on Revenue Account Report). Credit Card Return (fees have been reversed on Revenue Account Report). p — Other /Explanation: /ec'/= t c.,L, A 7Z' '7W-1 -Aff rc% 1 =c=-.a Tv ..- /.4 c.:!,7 , , ,r0 •7 C eV /`--, azzr 7j .. /` //ye 4 ct b, 6 inF /l ': . Gtr , Thank you! I:\ Building \Forms \RteSlip- FinanccReq.doc '��' S ' Page 1 of 1 CITY OF TIGARD RECEIPT II ; � . .. 13125 SW Hall Blvd.. Tigard OR 97223 503.639.4171 T[GA.RD OR /Er/ AM I___, Receipt Number: 183010 - 06/23/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MMD2011 -00009 Minor Modification to an Approved Plan 1003100 -43116 $522.00 MMD2011 -00009 Minor Modification to an Approved Plan - 1003100 -43117 $77.00 LRP Total: $599.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 19105 KPEERMAN 06/23/2011 $599.00 Payor: TUMAY CORPORATION DBA MIXERS BAR & GRILL Total Payments: $599.00 Balance Due: $0.00 Page 1 of 1 III CITY OF TIGARD RECEIPT a . - _ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD /'€Rita Receipt Number: 183046 - 06/28/2011 . CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID M M D2011 -00009 $- 599.00 Total: $ - 599.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 19105 DHOWSE 06/28/2011 $- 599.00 Payor: Tumay Corporation DBA Mixers Bar & Grill Total Payments: $ - 599.00 • Balance Due: $599.00 Page 1 of 1 • �� t Community Development 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: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEMS CHECKED ✓ CANCEL PERMIT APPLICATION. AONE` REFUND PERMIT FEES attach receipt,if available). ❑ ( p ) ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: MMD2011-00009 Site Address or Parcel#: 11920 SW Pacific Hwy Project Name: Mixers Bar and Grill Subdivision Name: Lot #: EXPLANATION: The Minor Modification was created in error. The correct application was a Downtown Design Review (DDR2011-00003). Also please correct the completed date for �DDR2011-00003 to be 6/24/2011 and not 2012 (see attached screen shot). Signature: Date: 2/27/12 Cheryl Caines Print Name: P O O 5 -dr✓ YoiD 41 ell,- Refund l/Refund Policy 1. The Director or Building Official may authorize the refund of: Cc CrE7A �/Ag`C- a) any fee which was erroneously paid or collected. /SG e b) not more than 80'.of the land use application fee when an applicat n is withdrawn or canceled before any_LpAew effort has been expended. c) not more than 80"o of the land use application fee for issued permits. d) not more than 80"o of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80"/o 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 B Rte to Admin: Date- 2 /2 B Refund Processed: Date 47WBy.,fMInvoice Processed: Date B Permit Canceled: Date( Ze % By Parcel Tag Added: Date B Receipt# Date Method Amount$ L\Building\horms\RegPermitAction.doc Rev 07/26/07 I I m i r I i I !fI a Ii o I I I I i i N I cr { f 1 - s i I ; I I 8O � O I ! G 1 x a o _ d Q I V V In httP9 e.ucela.com i—r, a�= . if XGv�yie P Fnarnes `�;�© g9:toil ircez. FL,P;en Slice CMM,,. It City Recorh-W blink Free Hahmil p kwla7ityrni Accde Aolemdbn$ • ® go• Per- Sddy. Tools.�. » OF �ttWR ®W�6a1q+' LCit•wEMlw� �tMPsr P( V�w9>t RecorO s J �sMaR• q;11dY uwc* _51f� 04S ��_imw "Y QuickQueries --Sekc:-- Mo" Planmrp ri w r .fl ,S,Qy, q Prglg,L[tlamz �g$g$taN5 1rumDer 3Ij-0i dame fy}(if-t ,�ui(j! 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