Permit Support Document TIGARD
City of Tigard
August 9, 2019
Freiheit Architecture
929 108th Ave NE, Ste 210
Bellevue,WA 98004
Re: Permit No. BUP2018-00221
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 12388 SW Scholls Ferry Rd
Project Name: McDonald's
Job No.:
Refund Method: ® Check#232914 in the amount of$1,111.47.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
El Trust account"deposit"receipt in the amount of$
Comment(s): Scope of work changed and plans resubmitted under BUP2019-00140.
Refund 100% of plan review submittal fee as plan review was not completed.
If you have any questions please contact me at 503.718.2430.
Sincerely,
G e
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
. 0 " 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: Freiheit Architecture DATE: 8/2/2019
929 108th Ave NE, Ste 210
Bellevue, WA 98004 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 418579 Case#: BUP2018-00221
Date: 7/25/2018 Address/Parcel: 12388 SW Scholls Ferry Rd
Pay Method: Check Project Name: McDonald's
EXPLANATION: Scope of work changed and resubmitted under BUP2019-00140;refund 100%of plan
review fees as plan review was not completed.
I.REFUND INFORMATION: 4. ,,, a , , .. ,. , , , y
i Fee Description From Receipt Revenue Account No. I Refund
1I_xatuie: Building Permit Fee Example: 23000N-1-43104 $Amount _t
Plan Review 230-0000-43106 $1,111.47
TOTAL REFUND: $1,111.47
APPROVALS: SIGNATUR DA E:
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: SA lt?-/ By: (,
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
q
log CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: McDonalds
Site Address: 12388 SW SCHOLLS FERRY RD
Receipt Number: 436091 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
B U P2018-00221 $-1,111.47
Total: $-1,111.47
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232914 DHOWSE 08/27/2021 $-1,111.47
Payor: Freiheit Architecture
Total Payments: $-1,111.47
Balance Due: $1,111.47
Page 1 of 1
�y CITY OF TIGARD RECEIPT
f
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: McDonalds
Site Address: 12388 SW SCHOLLS FERRY RD72,�? /6/A/1/91.-
Receipt Number: 418579 - 07/25/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2018-00221 Plan Review 230-0000-43106 $1,111.47
Total: $1,111.47
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 36440 DHOWSE 07/25/2018 $1,111.47
Payor: Freiheit Architecture, Inc., P.S.
Total Payments: $1,111.47
Balance Due: $0.00