PRE2020-00053 'TIGARD
City of Tigard
February 25, 2021
Michael French
11660 SW Fonner St
Tigard, OR 97223
Re: Permit No. PRE2020-00053
Dear Applicant:
The City of Tigard has canceled the above referenced permits) and encloses a refund for the
following:
Site Address: 11660 SW Fonner St
Project Name: French Partition
Job No.: N/A
Refund Method: ® Check#238417 in the amount of$344.00.
❑ Credit card"return"receipt in the amount of$ .
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit"receipt in the amount of$ .
Comment(s): Per applicant's request to cancel pre-app as proposal is not approvable.
Refund 100% of application fees.
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
TIGARD Accela Refund Request
!3!
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: Michael French DATE: 2/22/2021
11660 SW Fonner St
Tigard, OR 97223 REQUESTED BY: Dianna Omelas
LS
TRANSACTION INFORMATION:
Receipt#: 432239 Case#: PRE2020-00053
Date: 12/14/2020 Address/Parcel: 11660 SW Former St
Pay Method: CreditCard Project Name: French Partition
EXPLANATION: Per applicant's request to cancel pre-app as proposal is not approvable. Refund 100%
of application fees per Lina Smith.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Application Fee 100-0000-43116 S344.00
TOTAL REFUND: $344.00
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager «y
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: B`!:
I:\Building\Refunds\RcfundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIC;;'t1IT3
Project Name: French Partition
Site Address: 11660 SW FONNER ST
Receipt Number: 436249 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PRE2020-00053 $-344.00
Total: $-344.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 238417 DHOWSE 09/03/2021 $-344.00
Payor: Michael French
Total Payments: $-344.00
Balance Due: $344.00
Page 1 of 1
CITY OF TIGARD RECEIPT
q
y1E :> 13125 SW Hall Blvd.,Tigard OR 97223 T
503.639.4171
TIGARD
Project Name: French Partition
Site Address: 11660 SW FONNER ST /�� fA/
Receipt Number: 432139 - 12/14/2020 v
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PRE2020-00053 Application Fee 1 00-0000-4 31 1 6 $344.00 F
Total: $344.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 7139699 PUBLICUSERO 12/14/2020 $344.00
Payor:
Total Payments: $344.00
Balance Due: $0.00
Page 1 of 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT � Cj •�I /
Ns. V D
Request for Permit Action elrYe 19 211
T I G Air n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tiga r FTIGAR
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"YdiON
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
Check(i)one
REFUND OR Name: Michael French
INVOICE TO: (Business or Individual)
Mailing Address: 11660 SW Fonner St
City/State/Zip: Tigard, OR 97223
Phone No.: (503) 646-1804
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® 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 #: PRE2020-00053
Site Address or Parcel#: 11660 SW Fonner St
Project Name: French Partition
Subdivision Name: N/A Lot#: N/A
EXPLANATION: Proposal is not approvable, so applicant requested to cancel pre-app. Please
refund 100%. Thank you.
2/19/2021
Date:
Signature:
Print Name: Lina Smith
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 SO%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 S s Admin: Date B Route to Records: Date ,` 3/Z/ By , _
Refund Processed: Date 23 yl By IQ Invoice Processed: Date By
Permit Canceled: Date "12.2 . ." By OD Parcel Tag Added: Date By
I:\Building\Forms\ReciPermitAction_OOf!l2314 doc