Correspondence CITY OF TIGARD
Building Division
TIGARD 13125 SW Hall Blvd.,Tigard,OR 97223 503-639-4171 ECE
INVOICE MAR 2 9 2007
CII Y Or mould)
TO: Four D Construction Customer ID: 71037
P.O. Box 1577 Invoice No.: INV2007-00004
Beaverton, OR 97075 Invoice Date: 3/23/07
Date Due: Upon Receipt
Case No. Site Address Subdivision-Lot#or Project Name Amount Due
MST2006-00254 11198 SW Forest Ln. •• • • Lot 2 $582.43
i 1 •
=ice.
Invoice Total: $582.43
Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MST2006-00254 Customer ID: 71037
Site Address: 11198 SW Forest Ln. Invoice No.: INV2007-00004
Project: Stonechase,Lot 2 Invoice Date: 3/23/07
Date Due: Upon Receipt
Invoice Total: $582.43
Amount Paid: $ 5 S."2 , </3
Office Note: /Remove parcel tag when paid A y
„eis - f- 5371
Please mail payment to:
City of Tigard,Building Division
13125 SW Hall Blvd.
Tigard, OR 97223
Attn: Dianna Howse
I:\Building\Accounting\Invoice.doc 04/06
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liAl CITY OF TIGARD 3/29/2007 ""-
•
g 13125 SW Han Blvd. 1:36:42PM
Tigard,OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000001358
Date: 03/29/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MST2006-00254 [CDCPLN]CDC Pln Rev 100-0000-433060 45.00
MST2006-00254 [LRPF]LR Planning Surcharge 100-0000-438050 6.00
MST2006-00254 [BUPPLN]Pln Rv Balance 245-0000-433000 489.83
MST2006-00254 [ERPLN]Erosn Pln Rv CWS 100-0000-207308 20.80
MST2006-00254 [EROSN]Erosn Pln Rv COT 245-0000-433010 20.80
Line Item Total: $582.43
Payments:
Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid
Check FOUR D CONSTRUCTION CO DLH 5570 By Mail 582.43
Payment Total: $582.43
cReceipt.rpt Page 1 of 1
3/23/2007 '
71 CITY OF TIGARD Fees Associated With 83 2:06AM
13125 SW/tail Blvd.
TIGARD Tigard,OR 97223 503.639.4171 Case #: MST2006-00254
Fee Start End Revenue Created
Type Date Date Dept Description Account Number By Date Amount Due
BPLC 1/1/1990 12/31/2020 [BUPPLN] Pln Rv Deposit 245-0000-433000 BB 10/20/2006 250.00 0.00
CDCP 1/1/1990 12/31/2020 [CDCPLN]CDC Pln Rev 100-0000-433060 LW 11/17/2006 45.00 45.00
LRP1 12/28/2004 12/31/2020 [LRPF] LR Planning Surcharge 100-0000-438050 LW 11/17/2006 6.00 6.00
BPLD 1/1/1990 12/31/2020 [BUPPLN] Pln Rv Balance 245-0000-433000 LW 11/17/2006 489.83 489.83
ERPU 1/1/1990 12/31/2020 [ERPLN] Erosn Pln Rv CWS 100-0000-207308 LW 11/17/2006 20.80 20.80
ERPC 1/1/1990 12/31/2020 [EROSN] Erosn Pln Rv COT 245-0000-433010 LW 11/17/2006 20.80 20.80
Total Due: $582
Page I of I CaseFees..rpt
4
Building Division
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 4 City Staff
(check one)
REF ► I OR Name:
NVOICE 0: (Business or Individual) \ D C U •W - l tiVt
Mailing Address: Pa-_ ,&n /5--
j 7
V 0 1 D City/State/Zip: J`,,7/ , A 9' 7,0 13
Phone No.: 3-- 3 - S 7b .o d d 5
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt,if available).
RINVOICE FOR FEES DUE (attach case fee schedule and explain below).
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: MS r ac90(9 -()0-1- ! 6-w A ace6- oaa 1/3
Site Address or Parcel#: /1/ 9 f S(,t) i%vie,--,-
,
Project Name:
Subdivision Name: C5it- Lot#: _,,,2_
EXPLANATION/ / &A,) ,6,141)-1-y1:4)±4S. (. _ M51.g 001' OOO 6'6>
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i'Sr;20 0 2-v 006,0 /1‘(.9//1‘(.9/ �2oo 7 -lG0 70
Signature: Date:
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more 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.
c) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
d) not more than 80%of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1-2 weeks for processing refunds.
FOR OFFICE USE ON LY
Rte to S s Admin: Date 3 l 9 0 B $ ' Rte to Bld. Admin: Date , -a'AME B -,411.4■1111—"
Refund Processed: Date B Invoice Processed: Date ...FA� D 7 B i u '
Permit Canceled: Date, 4 f r , - Firfam Parcel Ta• Added: Date J0 2 BA/ TAIM
Receipt# Date Method Amount$
I:\Building\Forms\RegPermitAction.doc Rev 05/24/06