HOP2006-00026
t
CITY OF TIG D
OREGON
September 18, 2006
Joana Cristurean 12785
12785 SW Summit Ridge St.
- Tigard,-OR -97224 - - - - . _ =
Re: Permit No. HOP2006-00026
Dear Ms. Cristurean:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for
the following:
Site Address: 12785 SW Summit Ridge St.
Project Name: Peace-of Mind ACH
Job No.: N/A
Refund: Check #N/A in the amount of $N/A.-
Credit card "return" receipt in the amount of $38.00.
Notes: Foster care home does not require home occupation permit. Refund 100% of
permit fee.
If you have any questions please contact me at (503) 718-2430.
Sincerely,
,~7 ;
Dianna Howse
Permit Specialist
Enc.
i:\Building\Refunds\LtrRefund-CancelPermit.doc 05/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 TDD (503) 684-2772
City of Tigard
Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees paid by
all methods. Receipts, documentation and the Request for Permit Action or Refund form (if applicable)
must be attached to this form. Refund requests are due to Tidemark System Administrator by
Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to
Tidemark System Administrator for distribution. Please allow 1-2 weeks for processing.
PAYABLE TO: Joana Cristurean DATE: September 18, 2006
12785 SAX/ Summit Ridge St.
Tigard, OR 97224 REQUESTED BY: Dianna Howse
ST
TRANSACTION INFORMATION:
Receipt 2006-906 Case HOP2006-00026
Date: 2/23/06 Address/Parcel: 12785 SW Summit Ridge St.
Pay Method: Credit Card Project Name: Peace of Mind ACH
EXPLANATION: Case created in error; foster care home does not require HOP. Refund 100% of
application fee.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Exam le: 245-0000-432000 $ Amount
[LANDUS] Type I Permit Fee 100-0000-438000 $33.00
RP LR Planning Surcharge 100-0000-438050 5.00
TOTAL REFUND: $38.00
APPROVALS:
If under $500 Professional Staff
If under $5,000 Division Manager
f
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: B :
I:\Building\Refunds\RefundRequest.doc 09/15/06
" Planning Division
Request for Permit Action or Refund
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
Name: Joana Cristurean
D (Business or Individual)
V 0 f Mailing Address: 12785 SW Summit Ridge St
City/State/Zip: Tigard, OR 97224
Phone No.: 503-624-4874
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED
® CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt, if available).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit HOP2006-00026
Site Address or Parcel 12785 SW Summit Ridge St
Project Name: Peace of Mind, ACE
Subdivision Name: N/A Lot N/A
EXPLANATION: Case created in error- Foster Home Care does not require an HOP
Signature: Date: 9/14/2006
Print Name: Shirley Treat
Refund Poli
cv
1. The Director may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80 percent of the application fee when an application is withdrawn or canceled before any review effort
has been expended.
2. Refunds will be returned to the original Payer in the same method in which payment was received.
FOR OFFICE USE ONLY,
Rte to S Admin: Date By I Rte to Bldg Admin: Date B
Refund Processed: Date B Invoice Processed: Date B
Permit Canceled: Date e4 By4W Parcel Tag Added: Date B
Receipt # & - p/o Date Ol., Method Amount $ 27R. 39
I:\Gtywide\Tidemark\Fomis\Req enT i tion-Ping.doc Rev 02/27/06
CITY OF TIGARD 9/18/2006
13125 SW Hall Blvd. 9:58:01 AM r
Tigard, Oregon 97223
a (503) 639-4171
Refund Receipt 27200600000000004554
Date: 09/18/2006
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
HOP2006-00026 Reversal - [LANDUS] Type I Per 100-0000-438000 (33.00)
HOP2006-00026 Reversal - [LRPF] LR Planning 100-0000-438050 (5.00)
Line Item Total: ($38.00)
Refund:
Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid
Credit Reversal JOANA CRISTUREAN 024083 In Person (38.00)
Refund Total: ($38.00)
cReceipt.rpt Page 1 of I
CITY OF TIGARD 2/23/2006
13125 SW Hall Blvd. 12:53:31PM ,
Tigard, Oregon 97223
(503) 639-4171
Receipt 27200600000000000906
Date: 02/23/2006
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
HOP2006-00026 [LANDUS] Type I Permit Fee 100-0000-438000 33.00
HOP2006-00026 [LRPF] LR Planning Surcharge 100-0000-438050 5.00
BUSTAX Business Tax - 50.3800 @ $1.0000 100-0000-430000 50.38
Line Item Total: $88.38
Payments:
Method Payer User ID AcctJCheck No. Approval No. How Received Amount Paid
CreditCard JOANA CRISTUREAN ST 024083 In Person 88.38
Payment Total: $88.38
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