PFI2011-00014 0
I
City®f Tigard
July 21, 2011
Jeff Maxwell
7810 SW Locust St.
Tigard, OR 97223
Re: Permit No. PFI2011-00014
Dear Mr. Maxwell:
The City of Tigard has processed a refund for the deposit of fees on the above referenced
permit for the following:
Site Address: 8275 SW Ross St.
Project Name: Mangold
Job No.: N/A
Refund: ❑ Check # in the amount of$
® Credit card "return" receipt in the amount of$2,500.00.
❑ Trust account"deposit" receipt in the amount of$
Notes: Release of customer deposit.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
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TTY Relay: 503.6�8b4.2772 0 www.tigard-or.gov
• �1
City of 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 forPermilAt-lion 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: Jeff Maxwell DATE: 7/21/2011
7810 SW Locust St.
Tigard, OR 97223 REQUESTED BY: Dianna Howse
Mike White
TRANSACTION INFORMATION:
Receipt#: 183319 Case#: PFI2011-00014
Date: 7/19/2011 Address/Parcel: 8275 SW Ross St.
Pay Method: CreditCard Project Name: Mangold
EXPLANATION: Refund cash assurance per Mike White.
REFUND INFORMATION:,
Fee Description From Receipt' Revenue Account No. Refund .
Example: Building Permit Fee Example: 2300000-43104 $Amount
Customer Deposit 100-0000-22000 $2,500.00
TOTAL REFUND: $2,500.00
APPROVALS: /
If under$5,000 Professional Staff l v l)
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: Date: �i �� By:
1:\Building\ltcfunds\ltcfundltcyucst.doc x 09/01/2010
CITY OF TIGARD RECEIPT
e V
Q 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Receipt Number: 183376 - 07/21/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12011-00014 $-2,500.00
Total: $-2,500.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 134883 DHOWSE 07/21/2011 $-2,500.00
Payor: Jeff A Maxwell
Total Payments: $-2,500.00
Balance Due: $2,500.00
Accela
System Administration
Finance Department Request
Date: °�� /
To: Liz Lutz
Kathy Gende
From: Dianna Howse/
Re: Receipt#:
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).
Other/Explanation:
nl�!5 a�dstT
Thank you!
I:\Building\Forms\RteSlip-Finance Reg.doc
Page 1 of 1
CITY OF TIG'ARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
.Receipt Number: 183319 - 07/19/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12011-00014 Customer Deposit 100-0000-2200.0 $2,500.00
Total: $2,500.00
PAYMENT METHOD CHECK# C prim ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
n
Credit Card i;y •KPEERMAN 07/19/2011 $2,500.00
Payor: JEFF A. MAXWELL
Total Payments: $2,500.00,
Balance Due: $300.0.0
Page 1 of 1
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 «%vw.tigard-or.gov
FROM: ❑ Owner ❑ .Applicant ❑ Contractor ® City Staff
(check one)
REFUND OR Name: Jeff Maxwell
INVOICE TO: (Business or Individual)
Mailing Address: 7810 SAX/Locust St.
City/State/Zip: Tigard, OR 97223
Phone No.: 503-839-7826
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ 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 #: PFI2011-00014
Site Address or Parcel#: 8275 SW Ross St.
Project Name: Mangold
Subdivision Name: Lot#:
EXPLANATION: Please expedite refund for$2500 Customer Deposit (cash assurance)
Signature: Date: -140 A/
Mike White
Print Name:
Refund Policv
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits.
d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80%of the building permit fee for issued permirs prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1-2 weeks for processing refunds.
• ' OFFICE USE ONLY
Rte to Sys Admin: Date 91.201.,l By Rte to dmin: Date 7
Refund Processed: Date ByfM Invoice Processed: Date B
Permit Canceled: Date B 7A/- Parcel Tag Added: Date B
Receipt#/ : Date Method L Amount$
I:\Building\Forms\RegPermitAction. oc ev 07/26/07