MMD2006-00015 ('a 6/61 4-0, 7,pt.
City of Tigard, Oregon 13125 SW Hall Blvd. • Tiga , OR 97223
.. ,
TIGARD
December 19, 2006
Dolan and Company LLC
1919 NW 19th Ave.
Portland, OR 97209
Attn: Dan Dolan
Re: Permit No. MMD2006-00015
Dear Mr. Dolan:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for
the following:
Site Address: 12500 SW Main St.
Project Name: C.I.D.A.
Job No.: N/A
Refund: Check#48900 in the amount of$200.00.
Credit card"return"receipt in the amount of$N/A.
Notes: MMD application withdrawn and resubmitted as PRE application. Transfer fees
from MMD to PRE and refund difference of$200.00.
If you have any questions please contact me at(503) 718-2430.
Sincerely,
6f9
Dianna Howse
Permit Specialist
Enc.
is\Building\Refunds\LtrRefund-CancelPermit.doc 05/04
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard-or.gov • TTY Relay: 503.684.2772
S
se
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees paid by
all methods. 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: Dolan and Company LLC DATE: 12/4/06
1919 NW 19`' Ave.
Portland, OR 97209 REQUESTED BY: Dianna Howse
Attn: Dan Dolan ST
TRANSACTION INFORMATION:
Receipt#: 2006-4942 Case#: MMD2006-00015
Date: 10/13/06 Address/Parcel: 12500 SW Main St.
Pay Method: Check Project Name: C.I.D.A.
EXPLANATION: Withdraw MMD application and submit a PRE application. Transfer fees from MMD
to PRE and refund balance.
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 S174.00
[LRPF] LR Planning Surcharge 100-0000-438050 26.00
TOTAL REFUND: 5200.00
APPROVALS:
If under S500 Professional Staff
If under$5,000 Division Manager
I f under 522,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE O
t/ Case Refund Processed: 1 Date: I / ," /" ' 1 By: I
I:\Building`,Refunds Re fund Rcques t.doc 09/15/06
111 CITY OF TIGARD 12/ai2oo6
= r 13125 SW hall Blvd. 2:39:22PM
Tigard,OR 97223 503.639.4171
TIGARD
Receipt #: 27200600000000004942
Date: 10/13/2006
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MMD2006-00015 [LANDUS] Minor Modification 100-0000-438000 490.00
MMD2006-00015 [LRPF] LR Planning Surcharge 100-0000-438050 72.00
Line Item Total: $562.00
Payments:
ill
Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid
Check DOLAN AND COMPANY,LLC ST 1927 In Person 562.00
Payment Total: $562.00
III
:Rt eIrn.rpI Page 1 of I
11
• "
Planning Division
TIGARD Request for Permit Action or Refund
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
Name: Dolan and Company
(Business or Individual)
V 0 1 0 Mailing Address:
40 B Bryn /47 19 hl Gi' lertLr AVE-
/.2/0‘, 4f7---- City/State/Zip: P and, OR 97 2 /3 p-Or✓IS DID 97°20 5
Phone No.: I)Ani f✓R!J
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(✓):
® CANCEL PERMIT APPLICATION.
RED PERMIT FEES (attach receipt,if available). /l( [% . e)
❑ REMOVE CONTRACTOR FROM PERMIT(do not cancel permit).
Permit#: MMD2006-00015
Site Address or Parcel#: 12500 SW Main St.
Project Name: CIDA,Inc.
Subdivision Name: Lot#:
EXPLANATION: Applicant originally submitted for an MMD ($562). It has been
determined that applicant needs to do a Pre-Application Conference
($362) and then apply for a land use SDR application. Instead of
refunding the $562, applicant wants to transfer$362 for the Pre-
?-Application and applwite remainder($200)diffidiFttiteFe=giailfiffe. REFuA/•a Ed .
P4g..2.1104/ — 00/05
Signature: tJ,ea Date: 10/23/06
Shirley Tre t
Print Name:
Refund Policy
1. The Director may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80 percent of the application fee when an application is withdrawn or canceled before any review effort
has been expended.
2. Refunds will be returned to the original Payer in the same method in which payment was received.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt# Date Method Amount$
I:\Gtywide\Tidemark\Forms\RegPermitAction-Ping.doc Rev 02/27/06