Plans Fi zz
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
1 11111
•
• T I GARD i
January 6, 2011
Delta Fire, Inc.
14795 SW 72n Ave.
Portland, OR 97224
Attn: Heidi Scarbrough
Re: Permit No. FPS2010 -00122
Dear Heidi:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 13221 SW 68 Pkwy, Ste. 120
Project Name: Ethics Point - Server Room
Job No.: N/A
Refund: ® Check #200408 in the amount of $57.82.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as submitted for wrong address; refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
1 'CW / en%
Dianna Howse
Building Division Services Supervisor
Enc.
I: \Building\ Refunds \Administ ration \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 , • www.tigard - orgov • TTY Relay: 503.684.2772
•
M il I City of Tigard
•
T[GAKD Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Delta Fire, Inc. DATE: 12/28/2010
Attn: Heidi Scarbrough
14795 SW 72n Ave. REQUESTED BY: Dianna Howse
Portland, OR 97124
TRANSACTION INFORMATION:
Receipt #: 179970 Case #: FPS2010 -00122
Date: 10/19/2010 Address /Parcel: 13221 SW 68th Pkwy, Ste 120
Pay Method: Check Project Name: Ethics Point - Server Room
EXPLANATION: Per applicant's request as submitted for wrong site address.
REFUND INFORMATION: - _ '
Fee _Description From Receipt Revenue Account No Refund
'Example:. :Building Permit "Fee ' ° - Example: 2300000-43104 ' $ Amount,
Permit Fee 2300000 -43104 $51.63
12% State Surcharge 1003100 -24001 6.19
TOTAL REFUND: $57.82
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager '" .J !, O J.__
If under $25,500 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: I Date: I /!p /// I By: I ,, --
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
DEC /08 /2010 /WED 03:12 PM FAX No. P. 002
RECEIVED
Community Development DEC 8 2010
Request for Permit Action CITY OF TIGARD
TIGARD
BUILDING ft VISION
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223 •
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: [] Owner [] Applicant G. Contractor ❑ City Staff
(check one)
REFUND OR Name: Delta Fire, Inc.
INVOICE TO: (Business or Individual)
Mailing Address: 14795 SW 72n Ave.
City /State /Zip: Portland, OR 97124
Phone No.: 503 -620 -4020
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓):
11 CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: FPS2010 -00122
Site Address or Parcel #: 13221 SW 68 Parkway Suite 120
Project Name: Ethics Point - Server Room
Subdivision Name: Triangle Corporate Park Lot #:
EXPLANATION: Permit Pulled in wrong City
Signature: , Date: 12/8/2010
Hei• Scarbrough
Print Name:
Bound Poop.,
1. The Director or Building Official may authorise the refund of
a) any fee which wss cetoueoody paid or collected.
b) not snore than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more then 80% of the building plans review fee when an application is canceled before any plan review effort hes been expended
e) not more than 80% of the building fee for issued permits prior to ant inspection rerluests.
2. Refunds will be returned to the original Payer is the same method in which payment was received. Please allow 1.2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S. s Adrnin: Date is �ie��
��'1;��1/7 Rte to lil. � Adrnin: Date /
Refund Processed: Date /A} B. :12 Invoice Processed: Date B
Permit Canceled: Date / .t8] B ; �; Parcel T. _ Added: Date
Recei • t # /7" 70 Date /6 �m Method C Amount $
I :\ Building \Forms \RegPermitAction.do Re 07/26/07