PDR2007-00001 City of Tigard, Oregon 13125 SW Hall Blvd. • Tigard, .JR 97223
II
•
TI GAMY.
-
December 20, 2007
Douglas A. Fry
22151 SW 55th Ave.
Tualatin, OR 97062
Re: Permit No. PDR2007-00001
Dear Mr. Fry:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12625 SW 70th Ave.
Project Name: Red Rock Retail Center
Job No.:
Refund: ® Check#54963 in the amount of$5,584.00.
❑ Credit card "return" receipt in the amount of$ .
n Trust account"deposit" receipt in the amount of$ .
Notes: Application voided as it exceeds 180-day period.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
I:\Building\Refunds\Administration\LtrRefund-CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard-or.gov • TTY Relay: 503.684.2772
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: Douglas A. Fry DATE: 12/10/07
22151 SW 55th Ave.
Tualatin, OR 97062 REQUESTED BY: Dianna Howse
GBP
TRANSACTION INFORMATION:
Receipt#: 2007-2435 Case#: PDR2007-00001
SDR2007-00004
Date: 5/31/07 Address/Parcel: 12625 SW 70th Ave.
Pay Method: Check Project Name: Red Rock Retail Center
EXPLANATION: Application voided as it exceeds 180-day period.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245-0000-432000 . $Amount
[LANDUS] Conceptual Plan Revw 100-0000-438000 $4,866.40
[LRPF]LR Planning Surcharge 100-0000-438050 717.60
[LANDUS] SDR$1,000,000/over 100-0000-438000 5,483.20
[LRPF]LR Planning Surcharge 100-0000-438050 582.40
•
TOTAL REFUND: $11,649.60
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: Date: /c2//p`p 7 I By:
I:\Building\Refunds\RefundRequest.doc 05/23/07
11111 CITY OF TIGARD 5/31/2007
� r 13125 SW Hall Blvd. 4:17:13PM
Tigard,OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000002435
Date: 05/31/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
PDR2007-00001 [LANDUS] Conceptual Plan Revw 100-0000-438000 6,083.00
PDR2007-00001 [LRPF]LR Planning Surcharge 100-0000-438050 897.00
SDR2007-00004 [LANDUS] SDR$1,000,000/over 100-0000-438000 6,854.00
SDR2007-00004 [LRPF]LR Planning Surcharge 100-0000-438050 728.00
Line Item Total: $14,562.00
Payments:
Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid
Check DOUGLAS A FRY ST 2303 In Person 14,562.00
Payment Total: $14,562.00
cReceipt.rpt Page 1 of 1
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 El Applicant ❑ Contractor / City Staff
(check one)
REFUND OR Name: Douglas A. Fry
INVOICE TO: (Business or Individual)
Mailing Address: 22151 SW 55th Avenue
City/State/Zip: Tualatin, OR 97062
Phone No.: 503-638-2414
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
/2 CANCEL PERMIT APPLICATION.
■ REFUND PERMIT FEES (attach receipt,if available).
n INVOICE FOR FEES DUE (attach case fee schedule and explain below).
n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit#: SDR2007-00004/PDR2007-00001
Site Address or Parcel#: 12625 SW 70th Avenue,Tigard, OR 97235
Project Name: Red Rock Retail Center
Subdivision Name: NA Lot #: 00100
EXPLANATION:
Application is void as of November 28,2007 pursuant to ORS227.178(4) -- exceeds 180-day period.
,REJ�un/6 Flo 4=604
Signature: 6A-1 p, Date: 12/7/07
Gary Pagenstecher
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-gleig Admin: Date /V,2/,40� �.7 By
Refund Processed: Date %2Ap`p 7 By Invoice Processed: Date }' By
Permit Canceled: Date / fp O 7 By� Parcel Tag Added: Date By
Receipt# 6 T— 'MS DateS. 7j p 7 Method C' /L. Amount$
I:\Building\Forms\RegPermitAction oc ev 07/26/07