PFI2016-00095 a
.
City of Tigard
February 11, 2021
Tigard Triangle Partners
12115 SW 70'Ave,#201
Tigard, OR 97223
Re: Permit No. PFI2016-00095
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: 12115 SW 70'Ave
Project Name: Red Rock Center
Job No.: N/A
Refund: ® Check#238250 in the amount of$24,100.00.
❑ Credit card"return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Return of customer deposit for end of 2-year maintenance period completed.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Ornelas
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 RequertforPermitAction 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 Tigard Triangle Partners DATE: 2/6/2021
TO:
12115 SW 70th Ave, #201
Tigard, OR 97223 REQUESTED BY: Dianna Omelas
TRANSACTION INFORMATION:
Receipt#: 417875 Case#: PFI2016-00095
Date: 6/18/2018 Address/Parcel: 12115 SW 70th Ave
Pay Method: Check Project Name: Red Rock Center
EXPLANATION: Refund customer deposit for 2-year maintenance bond as facility is now under city's
maintenance per Kenny Fisher.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fcc Example: 2300000-43104 $Amount
Customer Deposit 640-0000-22000 $24,100.00
TOTAL REFUND: $24,100.00
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If tinder$12,500 Division Manager
If under$25,000 Department Manager CJS Z
v s
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: By:
1:\Budding\Rcfunds\RcfundRcquest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
■ 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Red Rock Center
Site Address: 12625 SW 70TH AVE
Receipt Number: 436260 - 09/04/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12016-00095 $-24,100.00
Total: $-24,100.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 238250 DHOWSE 09/04/2021 $-24,100.00
Payor: Tigard Triangle Partners
Total Payments: $-24,100.00
Balance Due: $24,100.00
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Red Rock Center
Site Address: 12625 SW 70TH AVE
Receipt Number: 417875 - 06/18/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12016-00095 Customer Deposit 0/1- _>e-0000-22000 $24,100.00
lc`1� Total: $24,100.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 120 ALINDOR 06/18/2018 $24,100.00
Payor: Tigard Triangle Partners LLC
Total Payments: $24,100.00
Balance Due: $0.00
Page 1 of 1
RECEIVE®
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
3 2020
14 Request for Permit Action CTO CFF IGARD
9% 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-a lWr`lr' n"VISION
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigatdBuildingPermits@tigard-or.gov
FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: / t
INVOICE TO: TusinessorIndividual) 1n�YCr Tr.�tin�t �Ar }�it�S
Mailing Address: 1 Z1 15
City/State/Zip: j
Phone No.: - i c l - 4 a 9 4—
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓):
CA TVOID PERh1TT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
Ce&-3NV0ICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: ao se F T 12 (6 - 000 q Tnv. 7X36 7 C)
Site Address or Parcel #: -706 A we
Project Name: ZptALW-
Subdivision Name: -i4 A C .Q A. �� Lot #:
EXPLANATION: i�-Zt4 /G10�.f✓11-- LA-L45
i 4; cJ lc� S4LJi-t TVI.t fz}o< i 1 t ��L>- ewf,
Signature: Date: 111-3 l Zo
Print Name: c� L_ rr T_7-t�
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.
Route to Sys Admin: Date By Route to Records: Date Cl B
Refund Processed: Date 2 $ Invoice Processed: Date By
Permit Canceled: Date �/ , B (� Pazcel Ta Added: Date B
1:\Building\Forms\RegPennitAction_I2018.doc
Dianna Ornelas
From: Gary Pagenstecher
Sent: Thursday, November 5, 2020 7:39 AM
To: Jeremy Tamargo
Cc: Joe Wisniewski; Scott Barry; Dianna Ornelas
Subject: Re: PFI2016-00095 Refund Request
Thank you Jeremy
Sent from my iPhone
On 5 Nov 2020, at 7:09 AM,Jeremy Tamargo<ieremvt@tieard-or.gov>wrote:
Hi Gary and Dr. Scott,
My inspector for the project Kenny is out this week, but I will check with him upon his return on Monday
to see if the refund can be made.
Regards,
Jeremy
Jeremy Tamargo, PE
City of Tigard
Principal Engineer
Direct: (971) 713-0281
From: Gary Pagenstecher<GaryP@tieard-or.gov>
Sent:Tuesday, November 3, 2020 5:35 PM
To:Joe Wisniewski<joew@tieard-or.gov>;Jeremy Tamargo<leremvt@tieard-or.gov>
Cc:Scott Barry<drbarrvendo@gmail.com>; Dianna Ornelas<Dianna tieard-or.gov>
Subject: FW: PF12016-00095 Refund Request
Jeremy,
Please see the attached Request for Permit Action for refund of a cash assurance(invoice #206270) paid
in lieu of a performance bond for PF12016-00095 for Red Rock Center. Dr. Scott Barry filled out the form
and is copied on this email. If the refund can be made, then let Dianna know and she can process the
request(I believe).
Please let me know if you have any questions.
Thanks,
Gary
Gary Pagenstecher,AICP CUD
Project Planner, Urban Design
Community Development
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
Phone: 503-718-2434
1
Email:garvp@tigard-or.gov
From:Scott Barry<drbarrvendo@gmail.com>
Sent:Tuesday, November 3, 2020 4:48 PM
To:Gary Pagenstecher<Garvp@tigard-or.gov>
Subject: PF12016
Caution!This message was sent from outside your organization. Allow sender I Block sende
Hi Gary,
This is a separate one that is not related to the other permit fee I cannot locate yet.
Thanks for your help.
Scott
Dr.Scott L. Barry
Advanced Endodontics
Portland, Oregon
503.718.0095
DrBarrvEndo @gmail.com
www.DrScottBarrV.com
www.RootCanalPdx.com
CONFIDENTIAL OR PRIVILEGED: This communication contains information intended only for the use of
the individuals to whom it is addressed and may contain information that is privileged, confidential or
exempt from other disclosure under applicable law. If you are not the intended recipient, you are
notified that any disclosure, printing, copying, distribution or use of the contents is prohibited. If you
have received this email in error, please notify the sender immediately by telephone or by returning it
by reply email and then permanently deleting the communication from your system.Thank you.
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."
2
VOIDED
PFI2016 - 00095
RFD ROCK
CENTER
n
City of Tigard
August 9,2018
Tigard Triangle Partners LLC
12115 SW 70'Ave, Suite 201
Tigard, OR 97223
Re:Permit No. PFI2016-00095
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: 12625 SW 706'AVe.
Project Name: Red Rock Center
Job No.. N/A
Refund: ® Check#229431 in the amount of$10,131.25.
❑ Credit card"return"receipt in the amount of$
❑ Trust account"deposit"receipt in the amount of$
Notes: Refund customer deposit for work completed.
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 Request forPermitAction 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: Tigard Triangle Partners LLC DATE: 8/3/2018
12115 SW 70t'Ave, Suite 201
Tigard, OR 97223 REQUESTED BY: Dianna Howse
KF
TRANSACTION INFORMATION:
Receipt#: 417954 Case#: ' PFI2016-00095
Date: 6/21/2018 Address/Parcel: 12625 SW 70d,Ave.
Pay Method: Check Project Name: Red Rock Center
EXPLANATION: Refund customer deposit for work that has been completed.
WAN
Customer Deposit 100-0000-22000 $10,131.25
TOTAL REFUND: $10,131.25
APPROVALS: SIGN RE 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: By:
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.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: ElOwner 1:1Applicant Contractor �
Check one City Staff
REFUND OR Name:
INVOICE TO: (Business or lndn idual) _T160"
(C^yt" � ytr� �- ®'N L 4.. C-
Mailing Address: 1'2- 1 ( S>- L,) -76® F. 5 0t 7r, 2-0
City/State/Zip: 716At-� , C7L -7 2-Z �
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V):
❑ CANCEL/VOID PERMIT APPLICATION.
1A 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#: ' f 1 2--0 J(
Site Address or Parcel #: 1-1.
r., he, 44k.�-,��—
Subdivision Name: Lot #:
EXPLANATION: F-1-vN-0 c) 5 ro'YV, l ,g 11�
L6A-2F— I2.P.FUt- 11 61JT194, 1�lr�517' J0 131 as-
Signature:
sSignature: � �� Date: 4f,-2—1 9 p-
Print Name: 'Ea&j'
Refund Policv
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.
L Please allow 3-4 weeks for processing refund requests.
*For Office Use Only*
Route to Sys Admin Date By: Route to Records Date S By:
Refund Processed Dater/0� By:,A& Invoice Processed Date By:
Permit Canceled Da�� X Parcel Tag Added Date By: