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PFI2013-00021 City of Tigard August 1, 2013 Lovett Inc. Attn: Joshua Sanderson PO Bos 86280 Portland, OR 97286 Re: Permit No. PF12013-00021 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 13652 SW Benchview Pl Project Name: Frances Job No.: N/A Refund Method: ❑ Check# in the amount of ® Credit card"return" receipt in the amount of$300.00. Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ Comment(s): Applicant did not tap public sewer line, able to repair existing private sewer per engineering staff. Refund 100% of application fee. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. 0 Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 0 www.tigard-or.gov City of Tigard ,am FAA Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the RequestforPermit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Lovett Inc. DATE: 8/1/2013 Attn: Joshua Sanderson PO Box 86280 REQUESTED BY: Dianna Howse Portland, OR 97286 I\NIW TRANSACTION INFORMATION: Receipt#: 191791 Case#: PFI2013-00021 Date: 6/13/2013 Address/Parcel: 13652 SW Benchview PI Pay Method: CreditCard Project Name: Frances EXPLANATION: Did not tap public sewer main line,able to repair existing private sewer. Refund 100% of application fee. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount PFI Permit Fee 100-0000-43114 $300.00 TOTAL REFUND: $300.00 APPROVALS: SIGNATU ATE: If under$5,000 Professional Staff cJ—J2_ 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 AgMINISTRATION USE ONLY Case Refund Processed: Date: F By: 1:\Building\Refunds\RefundRequest.doc x 09/01/2010 �V City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ■ " Request Permit Action 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.ti art d-or.gov TO: CITY OF TIGARD " ry Building Division Services Supervisor 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) (...,01J (iT(` ( N JUS`( 5r��i �as6►-� Mailing Address: F-t X 0,6 Z 8 0 City/State/Zip: 4-A e-P— -J 2 96 Phone No.: '503 - S "j -1 - D �/ q PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: 'PF1 ZO 127 " 0002 Site Address or Parcel#: l 6 S Z- -5u-,> fyr,C�N V Imo- �L Project Name: Subdivision Name: V) xx-H V 111 - rL f-. fii2 S Lot#: EXPLANATION: I ( D N aT -r" MA i t L I N f. . -C6-(1- Y u)4Lc Signature: G" Date: �1 l Print Name: j'l I LIV t4-)H I J-� 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 800/6 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 809/6 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 2-4 weeks for processing refunds. Rte to Sys admin: Date By Rte to Admin: Date / / B Refund Processed: Date �/ B Invoice Processed: Date B Permit Canceled: Date ,� B Parcel Ta Added: Date B Receipt# Date Method Amount$ I:\Building\Forms\RegPcrmitAction.doc Rev 05/25/2012 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12013-00021 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/13/2013 Parcel: 2S104DC00700 Jurisdiction: Tigard Site address: 13652 SW BENCHVIEW PL Subdivision: BENCHVIEW ESTATES Lot: 7 Project: Frances Sewer Lateral Replacement Project Description: Replace existing sanitary lateral. Run line from back patio to main line tee. Owner: FEES Description Date Amount PFI Permit Fee 06/13/2013 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: JOSH SANDERSON P.O. BOX 86280 PORTLAND, OR 97286 PHONE: 503-577-0994 Total $300.00 Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact information of responsible parties before beginning work. Permittee/Applicant Signature: Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY RECHVED JUN 13 2013 City of Tigard TY OF TIGARD PLANNING/ENGINEERINGPublic Facility Improvement (PFI) Permit General Information: RR FOR STAFF USE ONLY Property Address/Location(s):��5 oZ �� I JP[/�C��IeW Engineering ++ 1� Case No.: C�1��3--oa:a tG C1T �S'n oY— Receipt No.: � 7 Date: 6 13 2.0 l *Applicant's Name: TL^�L Application Accepted By: Address: � �0 Revised 7/1/10 City/State: ala (� CDC Zip: PrimaryContact: `j DY` REQUIRED SUBMITTAL INFORMATION Phone: —-5--7__7 —0°t q Fax: Professional Engineered Plans are required // __,,,, �� ,, for: Contractor's Name: loy 1�L • Street Widening CCB# Expiration: . Subdivision Infrastructure Address: too a c'�Y e :i-<6D aRo • Main utility line extension: City/State: �/f��tQL.�! � gip; �g�j 0 Storm Drain,Sanitary—Tigard 0 Water—Tigard Water Service Area Phone: — -�� —�Ra Fax: (includes Durham,King City and a portion of unincorporated Washington County) Plans By: **Note:See Engineered Plan Address: Submittal Checklist attached. City/State: Zip: For all other work:Submit scaled sketch of the Phone: Fax: work to be done.(see attached minimum sketch requirements and provided sketch area). Description of work: .e— l:eurpin\master\land use application\PFI app.docx .�v Estimated value of work(within the public right-of-way): $ Is work related to a LAND-USE DECISION? YES [] NO If so,please specify (MLP,SDR,SUB,etc.)case#: Is the work related to a BUILDING PERMIT? YES[—] NO If so,please specify (BUILDING PERMIT)case#: NOTE: Person specified as"Applicant"shall be designated"Permittee"and shall provide financial assurance for the work. City of Tigard 13125 SW Hall Blvd.,Tigard,OR 97223 1 503-718-2464 1 www.tigard-or.gov I Page 1 of 4 cn BENS . o x HVIEW pL o ,t s co 't z v+ 482 466 �