PFI2015-00141 N
' 1
City of Tigard
March 3, 2016
Nathan Cokeley
8490 SW Monica Ct.
Portland, OR 97223
Re: Permit No. PFI2015-00141
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: 6619 SW Walnut Ter
Project Name: Cokeley
Job No.: N/A
Refund: ® Check#220315 in the amount of$6,000.00.
❑ Credit card"return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Refund customer deposit for work completed.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 0 www.tigard-or.gov
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 Req«extforPemiitAaion 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 SystemAdministrator for distribution to applicant.
PAYABLE TO: Nathan Cokeley DATE: 2/25/2016
8490 SAS' Monica Ct
Portland, OR 97223 REQUESTED BY: Dianna Howse
Ray Woolf
TRANSACTION INFORMATION:
Receipt#: 400287 Case#: PFI2015-00141
Date: 10/26/2015 address/Parcel: 6619 S%1 Walnut Ter
Pay Method: CreditCard Project Name: Cokeley
EXPLANATION: Refund customer deposit for work completed.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No.. Refund
Example. Building Permit Fee Example: 2300000-43104 $Amount
Customer Deposit 100-0000-22000 $6,000.00
TOTAL REFUND: $6,000.00
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,500 Department hfanager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: / By:
L\Building\Refunds\RefundReyuest.doe x 09/01/2010
1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
13125 SW Hall Blvd. • 'Tigard, Oregon 97223 • 503-718-2439 • www.dgard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ,g City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) 411 y, ro�161(4
Mailing Address: 9fo 'S k) /140a i c'a C,4
City/State/Zip: P- y)lm4p 1!?r �JgA 3
Phone No.: S d,3 --sc2 y_ 6 Sc
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
VOID PERMIT APPLICATION.
CA:!R ERMIT 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 #: q
Site Address or Parcel#: T
Subdivision Name: L Lot#:
EXPLANATION: 411 PFI pelrm i4 cea /lbo riS heyye,
4- DD
Signature: Date: alp-e3 �
Print Name:
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• 1ny 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. :111 refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR • ONLY
Route to S s Admin: I Date 1 Route to Records: Date
Refund Processed: Date J //o B Invoice Processed: Date By
Permit Canceled: Date ^/ B Parcel Tag added: Date By
1:\Building;\I-orms\Req Permit\etion_09.314.doc