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PFI2015-00082
City of Tigard October 13,2021 Premium Property-Tigard LLC 2175 NW Raleigh St,Ste 104 Portland, OR 97210 Re: Permit No. PFI2015-00082 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: 12790 SW Ash Ave Project Name: Burnham&Ash Apartments Job No.: N/A Refund: ® Check#240765 in the amount of$1,580.00. ❑ Credit card"return'receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Refund remaining customer deposit for 3-year assurance completed. If you have any questions please contact me at 503.718.2430. Sincerely, D. L. Orvlela4 Dianna Omelas 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 Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the RequestforPermitAction 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: Premium Property-Tigard LLC DATE: 10/3/2021 2175 NW Raleigh St, Ste 104 Portland, OR 97210 REQUESTED BY: Dianna Omelas JT TRANSACTION INFORMATION: Receipt#: 411180 Case#: PFI2015-00082 Date: 6/13/2017 Address/Parcel: 12850 Attwell PI& 12790 SW Ash Ave Pay Method: Check Project Name: Burnham&Ash Apartments EXPLANATION: Refund remaining customer deposit for 3-year assurance completed. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Customer lle osit 100-0000-22000 $1,580.00 TOTAL REFUND: $1,580.00 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: Date: / 3 L Bp: 1:\Building\Refunds\RefundRequest.&c x 09/01/2010 CITY OF TIGARD RECEIPT 1! 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Burnham &Ash Apartments Site Address: A/4 Receipt Number: 437136 - 10/23/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12015-00082 $-1,580.00 Total: $-1,580.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240765 DHOWSE 10(23/2021 $-1,580.00 Payor: Premium Property-Tigard LLC Total Payments: $-1,580.00 Balance Due: $1,580.00 Page 1 of 1 CITY OF TIGARD RECEIPT 3 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Burnham&Ash Apartments Site Address: Receipt Number: 411180 - 06/13/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12015-00082 Customer Deposit 100-0000-22000 $1,580.00 Total: $1,580.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1730 BRUEF 06/13/2017 $23,100.00 Payor: Capstone Partners LLC Total Payments: $23,100.00 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.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: Check one ❑ Owner ❑ Applicant ❑Contractor ®City Staff REFUND OR Name: INVOICE TO: (Busmess or Individual) Premium Property-Tigard, LLC Mailing Address: 2175 NW Raleigh St, STE 104 City/State/Zip: Portland, Oregon 97210 Phone No.: 503 226 1972 x 116 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (v): ❑ VOID PERMIT APPLICATION. REFUND RMIT FEES (attach copy of original receipt and provide explanation below). CE FOR FEES DUE(attach case fee schedule and provide explanation below). ❑REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: PFI 2015-00082 Site Address or Parcel #: 12850 SW Attwell Pl. and 12790 SW Ash Ave. Tigard, Oregon 97223 Subdivision Name: Burnham Ash apartments Lot#: EXPLANATION: We have a customer deposit of$1,580.00 for a 3-year assurance. This is now over. I would like to return this final amount to the developer Premium Property-Tigard, LLC. Signature: Date: .,0a `Z 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 to 3 N By: Refund Processed Dat 9d 3 By:� Invoice Processed Dae By: Permit Canceled Date _// By Parcel Tag Added Dale By: Q5r City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit ActionGN 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439- www.tigard-or.eov 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) Premium Property-Tigard, LLC Mailing Address: 1015 NW l la'Ave, Ste 243 City/State/Zip: Portland, Oregon 97209 Phone No.: 503 226 1972 x 116 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (v): ❑CANCEL/VOID PERMIT APPLICATION. Z 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#: PFI 2015-00082 Site Address or Parcel #: 12850 SW Attwell Pl. and 12790 SW Ash Ave. Tigard, Oregon 97223 Subdivision Name: Burnham Ash apartments Lot#: EXPLANATION: We have a customer deposit of$23,100 for a maintenance assurance. We will return$21,520.00 for the 1 year assurance and hold the remainder of$1,580 for the completion of the 3 year assurance on the private water quality facilities. Signature: Date: Print Name: �V 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 befntt z/ (l/ 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 re4jmed to the original payer in the form of a check via US postal service. !� 4 1. Please allow 3-4 weeks cessing refund requests. "` or office Us Route to Sys Admin Date By: to Records Date By: Refund Processed Date By: Invoice Processed By: Permit Canceled to By Parcel Tag Added Date CITY OF TIGARD RECEIPT i 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Burnham &Ash Apartments Site Address: Receipt Number: 422726 - 04/12/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12015-00082 $-21,520.00 Total: $-21,520.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 230480 DHOWSE 04/12/2019 $-21,520.00 Payor: Premium Property-Tigard, LLC Total Payments: $-21,520.00 Balance Due: $0.00 Page 1 of 1 VOIDED P 12015 - 00082 BURNHAM & ASH APARTMENTS v TIGARD City of Tigard November 29, 2018 Premium Property-Tigard,LLC 1015 NW 11`'Ave., Suite 243 Portland, OR 97209 Re: Permit No. PFI2015-00082 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: 12850 SW Attwell PI& 12790 SW Ash Ave. Project Name: Burnham &Ash Apartments Job No.: N/A Refund: ® Check#230480 in the amount of$21,520.00. ❑ Credit card"return"receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Refund portion of deposit for 1 year maintenance assurance and hold remainder of $1,580 for complete of 3 year maintenance assurance of water quality facility. 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 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 RequestforPermitAction 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: Premium Property-Tigard,LLC DATE: 11/16/2018 1015 NW 11`h Ave, Suite 243 Portland, OR 97209 REQUESTED BY: Dianna Howse KL TRANSACTION INFORMATION: Receipt#: 411180 Case#: PFI2015-00082 Date: 6/13/2017 Address/Parcel: 12850 SW Attwell PI& 12790 SW Ash Ave Pay Method: Check Project Name: Burnham&Ash Apartments EXPLANATION: Refund portion of maintenance assurance per Khoi Le. iii 11 11111:11 RISEN! Customer Deposit 100-0000-22000 $21,520.00 + TOTAL REFUND: $21,520.00 APPROVALS: SIGNATURES/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 Case Refund Processed: Date: t/ iL ��. B I:\Building\Refunds\RefundRequest.doc x 09/01/2010 City Of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.�ov 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) Premium Property-Tigard, LLC Mailing Address: 1015 NW 11th Ave, Ste 243 City/State/Zip: Portland, Oregon 97209 Phone No.: 503 226 1972 x. 116 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). El INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: PFI 2015-00082 Site Address or Parcel #: 12850 SW Attwell Pl. and 12790 SW Ash Ave. Tigard, Oregon 97223 Subdivision Name: Burnham Ash apartments Lot #: EXPLANATION: We have a customer deposit of$23,100 for a maintenance assurance. We will return$21,520.00 for the 1 year assurance and hold the remainder of$1,580 for the completion of the 3 year assurance on the water quality facility. Signature: Date: JD/to Print Name: K KM Q LI 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 Dat el,;� By: Refund Processed Date / By: _�}��J Invoice Processed Date By: Permit Canceled Date By , �� Parcel Tag Added Date By: