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
,
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