PRE2019-00046 I C
TIGARD
City of Tigard
January 28,2020
Giulietti/Schouten AIA Architects
2800 NW Thurman St
Portland, OR 97210
Re:Permit No. PRE2019-00046
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 9925 SW Greenburg Rd
Project Name: Crescent Grove Cemetery
Job No.:
Refund: ® Check#234464 in the amount of$475.00.
❑ Credit card "return"receipt in the amount of$ .
❑ Trust account"deposit"receipt in the amount of$ .
Notes: Applicant was charged as a Type III land use application,but it was determined that
it only requires a Type II. Refund difference of$475.00.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
L\Boilding\RefunkAQUEm}\i. efdAI •ipaT P1 gon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
II 44
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: Giulietti/Schouten AIA Architects DATE: 1/17/2020
2800 NW Thurman St
Portland, OR 97210 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 426598 Case#: PRE2019-00046
Date: 10/23/2019 Address/Parcel: 9925 SW Greenburg Rd
Pay Method: CreditCard Project Name: Crescent Grove Cemetery
EXPLANATION: Charged as a Type III but determined by Lina Smith that it only requires a Type II.
Refund difference of$475.00.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Pre-Application Conference 100-0000-43116 $475.00
TOTAL REFUND: $475.00
APPROVALS: SIGNAT ES 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: 977/2-f By: t,4:1(1
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
:ilk 0 13125 SW Hat Blvd.,Tigard OR 97223
503.639.4171
TI CAP.D
Project Name: Crescent Grove Cemetery Administrative Building
Site Address: 9925 SW GREENBURG RD , uN A
Receipt Number: 436206 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PRE2019-00046 $-475.00
Total: $-475.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 234464 DHOWSE 09/03/2021 $-475.00
Payor: Giulietti/Schouten AIA Architects
Total Payments: $-475.00
Balance Due: $475.00
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Crescent Grove Cemetery Administrative Building
Site Address: 9925 SW GREENBURG RD
Receipt Number: 426598 - 10/23/2019 /216=r,i./ c.�
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PRE2019-00046 Pre-Application Conference -Type III 1 00-0000-431 1 6 G c5. V?$' crb $816.00
Total: $816.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 4092 [SMITH 10/23/2019 $816.00
Payor: GIULIETTI SCHOUTEN, AIA
Total Payments: $816.00
Balance Due: $0.00
Page 1 of 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
11111 R
2. Request for Permit Action
T i G A R D 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: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
Check(V)one
REFUND OR Name: Giulietti / Schouten AIA Architects
INVOICE TO: (Business or Individual) Attn:Jake Weber
Mailing Address: 2800 NW Thurman St.
City/State/Zip: Portland, OR 97210
Phone No.: (503) 223-0325
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
ID PERMIT APPLICATION.
® REFUND EI3XvIIT 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 #: PRE2019-00046
Site Address or Parcel#: 9925 SW Greenburg Road
Project Name: Crescent Grove Cemetery Administrative Building
Subdivision Name: N/A Lot#: N/A
EXPLANATION: Originally charged as a Type III pre-application conference,but upon
review, it only requires a Type II. Please refund the difference of$475.
Thank you.
11/19/2019
Date:
CI 7 l/�
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 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than SO%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. ,(P, — 3C/,/, p"v r 117 s •
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date <j/j/7ry/ By / /
Refund Processed: Date.07/2e2o B !t Invoice Processed: Date By
Permit Canceled: Date I By 1F- Parcel Tag Added: Date By
I:\Bwlding\Forms\RegPemvtAction_09 1 doc