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ADJ2016-00109 City of Tigard December 15, 2016 John Davis 2850 SW Cedar Hills Blvd, #132 Beaverton, OR 97005 Re: Permit No. ADJ2016-00109 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8255 SW Durham Rd Project Name: Quail Park Apartments Job No.: N/A Refund Method: ® Check#223248 in the amount of$280.80. ❑ Credit card "return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit"receipt in the amount of$ Comment(s): Per applicant's request as adjustment was not required. Refund 80% of application fees. 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 z0 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: John Davis DATE: 12/12/2016 2850 SW Cedar Hills Blvd, #132 Beaverton, OR 97005 REQUESTED BY: Dianna Howse MB TRANSACTION INFORMATION: Receipt#: 404336 Case#: ADJ2016-00109 Date: 6/7/2016 Address/Parcel: 8255 SW Durham Rd Pay Method: Check Project Name: Quail Park Apartments EXPLANATION: Per applicant's reugest as adjustment was not needed. Refund 80%of application fees. Fed`: es ttpfi row R64eipti w but i n Ta r { Fain le ""Bu�I" J'erniit Feria '1 '3xf?Q( r,r Development Adjustment 100-0000-43116 $280.80 TOTAL REFUND: $280.80 APPROVALS: SIGNAT S DATE: 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: 1 / 4 / By: 1:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT = 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Receipt Number: 408249 - 01/06/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ADJ2016-00109 /��c�no�✓ �� 470 0000 �13�r�, $-280.80 Total: $-280.80 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 223248 DHOWSE 01/06/2017 $-280.80 Payor: John Davis Total Payments: $-280.80 Balance Due: $280.80 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Receipt Number: 404336 - 06/07/2016 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ADJ2016-00109 Development Adjustment 100-0000-43116 $351.00 Total: $351.00 PAYMENT METHOD CHECK# CC RUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1086 MBILODEAU 06/07/2016 $351.00 Payor: Quail Park Apartments Total Payments: $351.00 Balance Due: $0.00 Page 1 of 1 V 01 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENTI C Request for Permit Action /a//2//& AW- 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • wwxv.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) �n V h n Pov t J Mailing Address: Z 9 5 l; &C4 G1 # 1.3L City/State/Zip: ')El!/i V`IS t-C?rl Q(Z. C) 70 0 S Phone No.: 5u7 '7 1 ri 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#: 4 DJ 2 01 (a- o o �O c1 Site Address or Parcel#: (3'7—5 S S VV v i Ic l .nn Project Name: a,.)CA% ( P01 r k r Subdivision Name: S pR 101 1C Lot#: EXPLANATION: j h l S C 1JJ}rY--L'n + V\/(/1.i 0o i?- u�✓� Signature: nn Date: 12-1& 1 % Print Name: 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 34 weeks for processing refund requests. 3S7i &V FOR OFFICE USE ONLY Route to S s Admin: Date BN Route to Records: Date B Refund Processed: Date / ,s / By 4tW Invoice Processed: Date B Permit Canceled: Date /a B —Parcel Tag Added: Date B I:\Building\Forms\RegPermitAction_(0 l4. oc