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PFI2017-00198 1 i City of Tigard February 4, 2021 Harlan Borow 13030 SW 115'h Ave Tigard, OR 97223 Re:Permit No. PFI2017-00198 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: 13030 SW 115' Ave Project Name: Borow Partition Job No.: N/A Refund: ® Check#238114 in the amount of$5,608.50. ❑ Credit card"return"receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Refund maintence bond deposit. If you have any questions please contact me at 503.718.2430. Sincerely, Y Dianna Orhelas 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 ReguestforPermit-4ction 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 Harlan Borow DATE: 2/1/2021 TO: 13030 SW 115`s Ave Tigard,OR 97223 REQUESTED BY: Dianna Omelas TRANSACTION INFORMATION: Receipt#: 426224 Case #: PFI2017-00198 Date: 10/02/2019 Address/Parcel: 13030 SW 115d,Ave Pay Method: CreditCard Project Name: Borow Partition EXPLANATION: Refund 100%of customer deposit for maintenance period. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Customer Dc omt 640-0000-22000 165,608.50 TOTAL REFUND: $5,608.50 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager D. L. Orne" 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:I ell g 1-4. Bv: r I:\Budding\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT a 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Borow Partition Site Address: 13030 SW 115TH AVE Receipt Number: 436246 - 09/03/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12017-00198 $-5,608.50 Total: $-5,608.50 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 238114 DHOWSE 09/03/2021 $-5,608.50 Payor: Harlan Borow Total Payments: $-5,608.50 Balance Due: $5,608.50 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Borow Partition Site Address: 13030 SW 115TH AVE © A� 6-i 1,14 L, Receipt Number: 426224 - 10/02/2019 /�- CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12017-00198 Customer Deposit 640-0000-22000 $5,608.50 Total: $5,608.50 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 5619171 SCOPELAN 10/02/2019 $5,608.50 Payor: Harlan Borow Total Payments: $5,608.50 Balance Due: $0.00 Page 1 of 1 V City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT • ' Request for Permit Action 13125 SW Hall Blvd. - Tigard, Oregon 97223 - 503-718-2439-www.ti arg d-or. og_v TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPenmits@tigard-or.gov FROM: Check one ❑ Owner ❑ Applicant ❑Contractor 0 City Staff REFUND OR Name: INVOICE TO: (Business or Individual) Harlan Borow Mailing Address: 13030 SW 115th Ave. City/state/Zip: Tigard, Oregon 97223 Phone No.: 503-713-8627 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (v): ❑CANCEL/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#: PF12017-00198 Site Address or Parcel #: 13030 SW 115th Ave. Tigard, Oregon 97223 Subdivision Name: Borow Partition Lot #: 1&2 EXPLANATION: Customer used credit card for Maintenance period in Lieu of Maintenance Bond for the amount of $5,608.50. 77 i°--Clam Signature: Date: � /7 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%ofthe 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 OnI * Route to Sys Admin Date By: Route to Records Date& ,, By: Refund Processed Date By:2TT Invoice Processed Dace? By: Permit Canceled Da I Byo& Parcel Tag Added Dace By: Dianna Ornelas From: Trent Brickey Sent: Monday, January 25, 2021 4:56 PM To: Dianna Ornelas Subject: refund request Attachments: Trent Brickey.vcf Hey Dianna, I submitted a refund request for Borow partition (PF12017-00198) around the first week of December. The developer is asking the status of the refund. Would you happen to know? Sorry to bother you with this kind of stuff. Thanks Trent Brickey City of Tigard Engineering Tech II 1971}228-4269 Mobile tFentb@tigard-or.gov DISCLAIMER. E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-ma l 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." 1