VAR2007-00007 . City of Tigard, Oregon 13125 SW Hall Blvd. • Tigard, jR 97223
T I GARD
April 2,2007
Casa Terra LLC
c/o Palmer&Associates,Inc.
9200 SW Nimbus Ave.
Beaverton, OR 97008
Ann: Kirsten Van Loo
Re: Permit No. VAR2007-00007
Dear Ms.Van Loo:
The City of Tigard has canceled the above referenced permits) and enclose a refund for the
following:
Site Address: 12630 SW Walnut St.
Project Name: Walnut Crossing
Job No.: N/A
Refund: ® Check#50664 in the amount of$301.00.
❑ Credit card "return" receipt in the amount of$
❑ Trust account "deposit" receipt in the amount of $
Notes: Determined that variance was not required. Refund 100% of application fee.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Permit Specialist
E nc.
I:\Building\Refunds\Administration\LtrRefund-CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard-or.gov • TTY Relay: 503.684.2772
•
City of Tigard
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 Riund 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: Casa Terra LLC DATE: 3/23/07
do Palmer&Associates,Inc.
9200 SW Nimbus Ave. REQUESTED BY: Dianna Howse
Beaverton,OR 97008 ST
Attn: Kasten Van Loo
TRANSACTION INFORMATION:
Receipt#/: 2007-484 Case#: VAR2007-00007
Date: 2/5/07 Address/Parcel: 12630 SW Walnt St.
Pay Method: Check Project Name: Walnut Crossing
EXPLANATION: Determined that variance was not necessary. Refund 100% of application fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD]Permit Fee Example: 245-0000-432000 $Amount
[LANDUS]Special Adjust 100-0000-438000 $262.50
[LRPF]LR Planning Surcharge 100-0000-438050 38.50
TOTAL REFUND: $301.00
APPROVALS:
If under$500 Professional Staff
If under$5,000 Division Manager R I*-A3
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: 1 Date: 1 �F c ) By: . L___
I:\Building\Refunds\RefundRequest.doc 09/15/06
• •
CITY OF TIGARD
3/21/2007
s 13115 SW Hall Blvd. 11:50:31 AM
Tigard,OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000000484
Date: 02/05/2007
Line Items:
Case No I ran ('ode Description Revenue Account No Amount I'aitl
SUB2007-00002 [LANDUS] Prelim Plat w/o PD 100-0000-438000 5,158.0(1
SUB2007-00002 [LRPF]LR Planning Surcharge 100-0000-438050 624.00
VAR2007-00006 [LANDUS] Special Adjust 100-0000-438000 262.50
VAR2007-00006 [LRPF] LR Planning Surcharge 100-0000-438050 38.50
VAR2007-00007 [LANDUS]Special Adjust 100-0000-438000 262.50
VAR2007-00007 [LRPF]LR Planning Surcharge 100-0000-438050 38.50
Line Item Total: $6,384.00
Payments:
Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid
Check CASA TERRA LLC ST 6828 In Person 5,782.00
Check CASA TERRA LLC ST 131 In Person 602.00
Payment Total: $6,384.00
cReceipt.rpt Page 1 of 1
" Planning Division
Request for Permit Action or Refund
TIGARD
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
Name: Palmer and Associates,Inc. Attn: Kirsten Van Loo
(Business or Individual)
J 0 f fJ Mailing Address: 9200 SW Nimbus Avenue
City/State/Zip: Beaverton, OR 97008
Phone No.: 503-452-8003
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(✓):
® CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt,if available).
❑ REMOVE CONTRACTOR FROM PERMIT(do not cancel permit).
Permit#: VAR2007-00007
Site Address or Parcel#: 12630 SW Walnut St.,Tigard, OR 97223
Project Name: Walnut Crossing
Subdivision Name: Walnut Crossing Lot#:
EXPLANATION: Determined that a second Variance was not necesssary
/EuNL /co % ap
Signature: dLC(,¢ Date: 3/21/07
Print Name: d(IL( ((-f G-
Refund Policy
I. The Director may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80 percent of the application fee when an application is withdrawn or canceled before any review effort
has been expended.
2. Refunds will be returned to the original Payer in the same method in which payment was received.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date 3 A4 e7 By
Refund Processed: Date - , B ,1�. Invoice Processed: Date B
Permit Canceled: Date _ WDI B .;iiaj Parcel Ta: Added: Date B
Receipt#e)7- - Date _ ,r/D7 Method Amount$
I:\Citywide\Tidemark orms\RegPermi Action-Ping.doc Rev 02/27/06