MMD2008-00010 City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
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T I GARD
June 25, 2008
Clearwire US LLC
2495 NW 121 PI
Portland, OR 97229
Re: Permit No. MMD2008 -00010
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 10955 SW 65 Ave.
Project Name: Clearwire US LLC
Job No.: N/A
Refund: ® Check #57893 in the amount of $574.00.
❑ Credit card "return' receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Refund 100% of application fee as planning staff determined that project did not
require a minor modification.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
I:\ Building\ Refunds\ Admnistration \LtrRefund- CancelPemutdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
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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: Clearwire US LLC DATE: 6/16/08
2495 NW 121 P1
Portland, OR 97229 REQUESTED BY: Dianna Howse
ST
TRANSACTION INFORMATION:
Receipt #: 2008 -1961 Case #: MMD2008 -00010
Date: 6/9/08 Address /Parcel: 10955 SW 65th Ave.
Pay Method: Check Project Name: Clearwire US LLC
EXPLANATION: Determined by planning staff that project did not need to be a minor modification.
Refund 100% of application fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
[LANDUS] Minor Modification 100 - 0000 - 438000 $500.00
[LRPF] LR Planning Surchargeq 100 - 0000 - 438050 74.00
TOTAL REFUND: $574.00
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager
If under $22,500 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: 4 /4 /r? t I By:
I: \ Building \Refunds \RefundRequest.doc 05/23/07
CITY OF TIGARD 6/10/2008 •
13125 SW Hall Blvd. 8:57:1 1 AM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000001961
Date: 06/09/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MMD2008 - 00010 [LANDUS] Minor Modification 100- 0000 - 438000 500.00
MMD2008 -00010 [LRPF] LR Planning Surcharge 100- 0000 - 438050 74.00
Line Item Total: $574.00
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Anoint Paid
Check CLEARWIRE WIRELESS DLH 46670 In Person 574.00
Payment Total: $574.00
c Keceipl.rpl Page 1 of I
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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: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
REFUND OR Name: Clearwire US LLC
INVOICE TO: (Business or Individual)
Mailing Address: 2495 NW 121' P1
City /State /Zip: Portland, OR 97229
Phone No.: 503 - 469 -0234
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® 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 # : MMD2008 -00010
Site Address or Parcel # : 10955 SW 65t Tigard, OR
Project Name: Clearwire US LLC
Subdivision Name: Lot # :
EXPLANATION: It was determined by the planner, that this project did not need to be
a Minor Modification eecit xI d 4--T Az %
Signature: Date: 6/10/08
Shirley Treat
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 Sys Admin: Date By Rte to Admin: Date 6 2S /or By X1
Refund Processed: Date (t // 6/0E-- By, Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt #0�-./9/ / Date 'a /9/0,F Method c6 % Amount $
I:\ Building\ orms \RegPermitAction.doc 11ev 07/26/07