PFI2018-00065 41
rzil I
ia
City of Tigard
August 9, 2019
Kazem Ken Nadri
11905 SW 69h Ave.
Tigard, OR 97223
Re: Permit No. PFI2018-00065
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: 11905 SW 69 h Ave.
Project Name: Nadri Sidewalk Curb
Job No.: N/A
Refund: ® Check#232931 in the amount of$1,851.90.
❑ Credit card"return"receipt in the amount of$
❑ Trust account"deposit"receipt in the amount of$
Notes: Return 10% of customer deposit held for 1-year warranty period.
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
44
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: Kazem Ken Nadn DATE: 8/2/2019
11905 SW 69 h Ave
Tigard, OR 97223 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 416998 Case#: PFI2018-00065
Date: 4/30/2018 Address/Parcel: 11905 SW 691hAve
Pay Method: Check Project Name: Nadri Sidewalk Curb
EXPLANATION: Return customer deposit of 10%held for one-year warranty period.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Exam le:,Buildin Permit Fee Exatn le; ,2 00000-43104 $Amount:
Customer Deposit 100-0000-22000 $1,851.90
TOTAL REFUND: $1,851.90
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: 773 7 B
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Nadri Sidewalk Curb
Site Address:
Receipt Number: 436096 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF 12018-00065 $-1,851.90
Total: $-1,851.90
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232931 DHOWSE 08/27/2021 $-1,851.90
Payor: Kazem Ken Nadri
Total Payments: $-1,851.90
Balance Due: $1,851.90
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
Project Name: Nadn Sidewalk Curb
Site Address:
Receipt Number: 416998 - 04/30/2018 C/
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00065 Customer Deposit 100-0000-22000 $1,851.90
Total: $1,851.90
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 010873858 ALINDOR 04/30/2018 $18,519.D0
Payor: On Point Credit Union Cashier's Check
Total Payments: $18,519.00
Balance Due: $0.00
Page 1 of 1
City of Tigard - COMMUNITY DEVELOPMENT DEPARTMENT
. ' Request for Permit Action
13125 SW Hall Blvd. - Tigard, Oregon 97223 - 503-718-2439 - www.tiaard-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:
Check one ❑ Owner
❑Applicant Contractor ®City Staff
REFUND OR Name:
INVOICE TO: (Business or Individual) Kazem Ken Nadri
Mailing Address: 11905 SW 69t Ave.
City/State/Zip: Tigard, OR 97223
Phone No.: (503) 799-3451
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (v):
❑CANCEL/VOID PERMIT APPLICATION.
ZREFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
LJ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: PFI2018-00065
Site Address or Parcel #: 11905 SW 69thAve.
Tigard,OR 97223
Subdivision Name: SW 69th ANT Frontage Improvements Lot #:
EXPLANATION: Return the customer hold back amount of$1,851.90 held for the one-year warranty period.
Signature: r4`n" Date: L(3
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.
1. Please allow 3-4 weeks for processing refund requests.
*For Office Use Only*
Route to Sys Admin Date By: Route to Records Date � By:
Refund Processed Dater- y//y By: ,j. Invoice Processed Date By:
Permit Canceled Date By `. Parcel Tag Added Date By:
q
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Nadri Sidewalk Curb
Site Address:
Receipt Number: 422548 - 04/05/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00065 $-16,667.10
Total: $-16,667.10
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 229404 DHOWSE 04/05/2019 $-16,667.10
Payor: Kazem Ken Nadri
Total Payments: $-16,667.10
Balance Due: $0.00
Page 1 of 1
VOIDED
PFI2018 - 00065
NADRI
FPO.-
TIGARD
City of Tigard
August 9, 2018
Kazem Ken Nadri
11905 SW 69'Ave
Tigard, OR 97223
Re: Permit No. PFI2018-00065
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: 11905 SW 69`'Ave.
Project Name: Nadri
Job No.. N/A
Refund: ® Check#229404 in the amount of$16,667.10.
❑ Credit card "return" receipt in the amount of$
❑ Trust account "deposit" receipt in the amount of$
Notes: Refund customer deposit,less 10%hold back for one year.
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 9 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 PermitAction 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: Kazem Ken Nadri DATE: 8/2/2018
11905 SW 69`h Ave
Tigard, OR 97223 REQUESTED BY: Dianna Howse
KF
TRANSACTION INFORMATION:
Receipt#: 416998 Case#: PFI2018-00065
Date: 4/30/2018 Address/Parcel: 11905 SW 69thAve.
Pay Method: Check Project Name: Nadri
EXPLANATION: Refund of customer deposit,less 10%hold back for one year.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Exam le: Building Permit Fee Example: 2300000-43104 $Amount
Customer Deposit 100-0000-22000 $16,667.10
TOTAL REFUND: $165,667.10
APPROVALS: SIGNATURES MATE:
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: .S / B
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
EeCity Of Tigard • C0NINIUNITY 1)I�;,VE'1,01)NIENT DFl)AWPM I?NT
= Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 www.tiVard-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
Chcck(✓)one
REFUND OR Name:
INVOICE TO: (Business or lndivldual) Kazem Ken Nadri
Mailing Address: 11905 SW 69th Ave.
City/State/Zip: Tigard, Oregon 97223
Phone No.: 503-799-3451
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓):
❑_ CANGEL/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#: PF12018-00065
Site Address or Parcel #: 11905 SW 69th Ave. Tigard, Oregon 97223
Project Name: SW 69th Ave. Frontage Improvements
Subdivision Name: West Portland Heights Lot#:
EXPLANATION: Return the customer deposit assurance in the amount of$18,519.00 minus
10% ($1,851.90) hold back for a year. The amount to be returned is $16,667.10
�/sof ig
Signature: lL��l. Date:
Print Name: t s u t2
Refund Policy
1. The city's Community Development Director,Building Official or City I;ngineer 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 By
Refund Processed: Date By Invoice Processed: Date B
Permit Canceled: Date /t/ By Parcel Tag added: Date B
I:ABuilding\Dorms\RcgPermitAction_092314.doc