PFI2015-00087 n
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City of Tigard
December 10, 2015
Polygon WLH LLC
Attn: Chris Walther
109 E 13"' Street
Vancouver,`YIA 98660
Re: Permit No. PFI2015-00087
Dear Applicant:
The City of Tigard has processed a refund for the deposit of fees on the above referenced
permit for the following:
Site Address:
Project Name: Polygon at West River Terrace
Job No.: N/A
Refund: ® Check#219502 in the amount of$114,475.00.
❑ Credit card "return" receipt in the amount of$
❑ Trust account "deposit" receipt in the amount of$
Notes: Refund of deposits for erosion control$47,000.00 and grading only$67,475.00.
If you have any questions please contact me at 503.718.2430.
Sincerely,
K(51
W`70--r�
Dianna
Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. ® Tigard, Oregon 97223 O 503.639.4171
TTY Relay: 503.684.2772 a www.tigard-or.gov
s
City of Tigard
® Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the RequestforPemyitAction 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 alloy up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Polygon WLH LLC DATE: 12/7/2015
Arm: Cluis Walther
109 E 13"' St REQUESTED BY: Dianna Howse
Vancouver, WA 95660 1%AV
TRANSACTION INFORMATION:
Receipt #: 202339 Case#: PFI-2015-00087
Date: 3/26/2015 Address/Parcel:
Pay Method: Check Project Name: Polygon at West River Terrace
EXPLANATION: Refund of erosion control$47,000.00 and grading only deposit$67,=175.00.
REFUND'INFORMATION ..
Fee Descnpnon From Receipt' Revenue Account No �' `Refund
Edam le Bivldu' Permit Fee F,. _„ tir Elam le 2300000_ X310
$Amo.unt '
Customer Deposit 100-0000-22000 $114,175.00
TOTAL REFUND: $114475.00
APPROVALS: SIGNATURES/DATE:
If under 55,000 Professional Staff
If under $12,500 Division Manager
If under$25,500 Department 1,Ianager
If under $50,000 City-Manager
If over$50,000 Local Contract Review Board
FOR TIDE7VLARK SYSTEM ADMINISTRATIONUSE:ONLY
Case Refund Processed: Date: By:
f:\Building\Refunds\RefundReducst.doc x 09/01/2010
City of Tigard - COMMUNITY DI?\'I.1.OP1t4RN'I' D1iP:11i7'tilsN l
Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • %vw-w.uga,id_
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor XCity Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) ?6 L
Mailing Address: /O q E i3 t y7.
City/State/Zip: AtJ 4-otl VE—e2— Lt�JA rj 660
c � CSS Phone No.:
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#: 'FF 1 gzl r - coo e7
Site Address or Parcel #:
Project Name: { L.; A--T (o fh V4 0 W— TCW-�
Subdivision Name: -5YEnt,0: Lot #:
EXPLANATION: 1U iJIvD p F f,"slaA_, c�,4T2vc ai r f /fib
Cwt,Y + 6 71 47S ° 4?�—
Q�GE(PT T� - '3 X177
Signature: 1 Date: 12 7 A S_
Print Name: /yr ��p' r Iy i 1 174,
Refund Policv
1. 'Che city's Community Development Director,Building Official or Cite I?ngineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original paver in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
• ' OFFICE USE ONLY
Route to Svs Adrnin: Date By I Route to Records: L Date /d /s B
Refund Processed: Date /p2 /d / By Invoice Processed: Date By
Permit Canceled: Dare Afji
±1 By arce1 Tag added: Date
I:\Building\I-orms\RcyPirmir 1rti-m_I191311.doc