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DIR2017-00001 INuu T I GARD City of Tigard May 2, 2017 Madrona Recovery Attn: John Thornton 500 Liberty Street SE, Suite 100 Salem, OR 97301 Re: Permit No. DIR2017-00001 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 6996 SW Varns St Project Name: Madrona Recovery Center Job No.: Refund Method: ® Check#224393 in the amount of$731.00. ❑ Credit card "return" receipt in the amount of$ . 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 to withdraw the application as city council resolution addressed the issue. Refund 100% 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 • www.tigard-or.gov City of Tigard 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: Madrona Recovery DATE: 4/17/2017 Attn: John Thornton 500 Liberty Street SE, Suite 100 REQUESTED BY: Dianna Howse Salem, OR 97301 GP TRANSACTION INFORMATION: Receipt#: 409119 Case#: DIR2017-00001 Date: 2/27/2017 Address/Parcel: 6996 SW Varns St Pay Method: CreditCard Project Name: Madrona Recovery Center EXPLANATION: Per applicant's request to withdraw the application as city council resolution addressed the issue. Refund 100% of application fees per Gary Pagenstecher. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Director's Interpretation 100-0000-43116 $731.00 TOTAL REFUND: $731.00 APPROVALS: SIGNA Ul,;._.D•TE: '4m 41 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 SYSTEMADMINISTRATION USE ONLY Case Refund Processed: Date: cz?f�3� F" By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 7111 CITY OF TIGARD RECEIPT ,, lI _ 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Madrona Recovery Center Site Address: 6996 SW VARNS ST Receipt Number: 415778 - 02/23/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID 01R2017-00001 $-731.00 Total: $-731.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 224393 DHOWSE 02/23/2018 $-731.00 Payor: Madrona Recovery Total Payments: $-731.00 Balance Due: $731.00 Page 1 of 1 CITY OF TIGARD RECEIPT a• 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGAP.D t,/-)fG i Receipt Number: 409119 - 02/27/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID DIR2017-00001 Director's Interpretation 100-0000-43116 $731.00 Total: $731.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 027072 PUBLICUSERO 02/27/2017 $731.00 Payor: John Thornton Total Payments: $731.00 Balance Due: $0.00 Page 1 of 1 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 71 NI n t ,'1 Request for Permit Action f 0v//7/, 2 x.C444-- TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov fk� 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 p Applicant ❑ Contractor ❑ City Staff Check(V)one REFUND OR Name: INVOICE TO: (Business or Individual) Terkil WV'„Yet)b 11 et gb7U, /C • , Mailing Address: „§'00 4itai*ci Shz e&7 5. 67.54.4, Ai I City/State/Zip: 5,2 /ji41 9/ l ! 713 1 Phone No.: 3 /8.') '7 23-0 PLEASE T. ACTION FOR THE ITEM(S) CHECKED (✓): ►i CANCELdVe ID PERMIT APPLICATION. 400-----' 2.,- -', it ERMIT FEES (attach copy of original receipt and provide explanation below). ■ ' OICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: 7/J 20/ 7 - 00(50/ Site Address or Parcel #: 74- 15/61 n 01706 6r71- 71dd 5W tVU ' Project Name: f/yJ/2L) OVA RE-60d067dF)-JIL Subdivision Name: /VA— Lot #: I°° i -7 3l EXPLANATION: k�j s? 7Q, Gal 77- p r�{E i4p1.i %/� 11v3 E” lAl D-6 /� c(7'7 /�C TaCfc r R gZ 7/OV/ gal)/4`` S,0 7 Matt C-� Cs /-05a/(GAJ •' ,-) 2a �Ef ' r s t f-( tiS 54' I ku �y� P Signature: ig , r. �' Date: -1 1 / 7 Print Name: tiQ7 G}- Q fl s'f L,.— 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. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date ' /2 /7 . By 1.9'!, Refund Processed: _ Date 9 / /7 B �/' Invoice Processed: Date By � � Permit Canceled: Date /f / By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_U9..314.doc Gary Pagenstecher From: Micah Braithwaite <micahbraithwaite@gmail.com> Sent: Tuesday, April 11, 2017 9:30 AM To: Gary Pagenstecher Cc: John Thornton; Gretchen Stone (gretchen@cbtwoarchitects.com) Subject: Re: Withdrawal and Refund of Director's Interpretation Attachments: Director Interp.pdf Follow Up Flag: Follow up Flag Status: Flagged Hello, As a representative of Madrona Recovery, I formally request a refund of the director's interpretation application fee. I have attached our invoice. Best, l�iicah Braithwaite On Mon, Apr 10, 2017 at 5:36 PM, Gary Pagenstecher<Garyp@tigard-or.gov> wrote: John, Would you please send me a formal request to withdraw the Director's Interpretation and refund the application fee. Thank you, Gary From: Micah Braithwaite [mailto:micahbraithwaite@gmail.com] Sent: Wednesday, April 05, 2017 10:20 AM To: Gary Pagenstecher Subject: CUP Notice Hello Gary, Last night was great, thank you for all your support. When will the city send out notice of our approved CUP? Best, 1 ` Micah Braithwaite , DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules -City General Records Retention Schedule."