PFI2016-00065 i 1
July 29, 2016 City of Tigard
J. T. Smith Company
Attn: Jesse Nemec
5285 Meadows Rd., Suite 171
Lake Oswego, OR 97035
Re: Permit No. PFI2016-00065
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 9300 SW Edgewood St.
Project Name: Crisp-Pavila Partition
Job No.: N/A
Refund: ® Check#221849 in the amount of$325.00.
❑ Credit card "return"receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Refund overpayment of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
ZAP���-
Dianna Howse
Building Division Services Coordinator
Enc.
I:\Building\Refundst l2&i�WorU4Ue d,,e,OpaT4ag44(,Qfegon 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 Request for Permit 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: J.T. Smith Company DATE: 7/22/2016
Attn: Jesse Nemec
5285 Meadows Rd, Suite 171 REQUESTED BY: Dianna Howse
Lake Oswego, OR 97035 BR
TRANSACTION INFORMATION:
Receipt#: 404820 Case#: PFI2016-00065
Date: 7/6/2016 Address/Parcel: 9300 SW Edgewood St.
Pay Method: Check Project Name: Crip-Pavila Partition
EXPLANATION: Overcharged customer. Refund difference.
REFUND INFORMATION:
Fee.Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Cash Over 100-0000-48001 $325.00
TOTAL REFUND: $325.00
APPROVALS: SIGNATURESAI&TE:
If under$5,000 Professional Staff
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 ADMINISTRATION USE ONLY
Case Refund Processed: Date: /--'--? /-4 B
1:\Building\Refunds\RefundRequest.doc x 09/01/2010
MCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
r
■ Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
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 City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address: Z 8 S Q /.S ooy,+e- 11
City/State/Zip: CA1< f �C)S
Phone No.: 50-Y Stip l
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓):
d❑ 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 #: �'f l 2010- (DO0& s
Site Address or Parcel#: ,T (�)ryl 1 Ory-Z
Pro)ect Name:
Subdivision Name: Lot#:
EXPLANATION: VC, b S
Signature: (' ' Date:
Print Name: y '
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer 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 payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
1`01Z OFFICE USE, ONLY
Route to Sys Admin: Date By Route to Records: Date B
Refund Processed: Date 7 / B - Invoice Processed: Date B
Permit Canceled: Date /V B Parcel Tag Added: Date B
I:\Building\Forms\RegPermitAction_092314.doc
■
City of Tigard
J.T.Smith Company
5285 Meadows Road, Suite 171
Lake Oswego,Oregon 97035
Jesse Nemec
RE: Crisp-Davila Partition—PFI2016-00065
An Engineering Agreement, Subdivision Compliance Agreement and three different types of
Performance Assurance forms for the above-named project are enclosed (only one
Performance Assurance form need be used and returned). After signature by the principals and
notary, please return all documents to me along with a check payable to the City of Tigard,
Oregon, in the sutra of twelve thousand eight hundred sixty-two dollars and eight cents ($12,862.08)
for payment of the fees described below
A breakdown of these fees is as follows:
Erosion Control Fees $472.80 X 100%u $472:50
Remaining Engineering Fee $8,540.00 less<130U0>paid $8,240,00
Streetlight Energy&Maintenance $899.28 $899.28
City-installed Traffic.Controls $2,925.00 $2,925.00
`1"otaL $12,562.08.
12% Water Line Cost Estimate $2,500.00 X.12 $300.00
After City execution and acknowledgment,we will provide copies to you for your file.
Thereafter,you will need to schedule a pre-construction meeting with Al Dickman,Senior
Engineering Technician, at 503.718. 2463. The approved grading only or public improvement
construction plans will be issued at the meeting or shortly-thereafter.
Sin y,
Al Dickman
Senior Engineering Technician
•
City of Tigard
. T. Smith Company
5285 Meadows Road, Suite 171
Lake Oswego,Oregon 97035
Jesse Nemec
RE: Crisp-Davila Par6tion—PF12016-00065
An Engineering Agreement, Subdivision Compliance Agreement and three different types of
Performance Assurance forms for the above-named project are enclosed (only one
Performance Assurance form need be used and returned).After signature by the principals and
notary, please return all documents to me along with a check payable to the City*of Tigard,
Oregon, in .the sur,of twelve thousand eight hundred sixty-two dollars and eight cents ($12,862.08)
for payment of the fees described below
A breakdown of these fees is as follows:
Erosion Control Pees $4472.80 Y 100% $472.80
Remaining Engineering Fee $%540.00 less<$30U0>paid $8,240.00
Streetlight Energy&Maintenance $899.25 $899.28
Cit}--imtalled Traffic Controls $2;925.00 $2,925.00
Total: $12,562.08
12%Water Line Cost Estimate $2,500.00 X.12 $300.00
After City execution and acknowledgment,we will provide copies to you for your file.
Thereafter,you will need,to schedule a pre-construction meeting with Al Dickman,Senior
Engineering Technician, at 503.718. 2463. The approved grading only or public improvement
construction plans will be issued at the meeting or shortly-thereafter.
Sin y,
Al Dickman
Senior Engineering Technician