Correspondence A
N • CITY OF TIGARD
I I Building Division
TIGARD 13125 SW Hall Blvd.,Tigard,OR 97223 503-639-4171
INVOICE
TO: Delta Fire, Inc. Customer ID: 64174
14795 SW 72nd Ave. Invoice No.: INV2007-00012
Tigard, OR 97224 Invoice Date: 8/21/07
Attn: Michael Stewart Date Due: Upon Receipt
Case No. Site Address Subdivision-Lot#or Project Name Amount Due
BUP2006-00533 16037 SW Upper Boones Ferry Fanno Creek Place,Bldg.A $777.93
SO
' 1 ilairaN
aoo 7-390?
Invoice Total: $777.93
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: BUP2006-00533 Customer ID: 64174
Site Address: 16037 SW Upper Boones Ferry Invoice No.: INV2007-00012
Project: Fanno Creek Place Invoice Date: 8/21/07
Date Due: Upon Receipt
Invoice Total: $777.93
Amount Paid: $
Office Note: Invoice must be paid prior to request for inspections.
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
1111 CITY OF TIGARD 8/24/2007
•
i w 13125 SW Hall Blvd. 2:17:36PM
Tigard,OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000003908
Date: 08/24/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
BUP2006-00533 [BUILD] Addl Permit 245-0000-432000 525.63
BUP2006-00533 [TAX] 8%State Surcharge 100-0000-207020 42.05
BUP2006-00533 [FLS] Addl FLS PlnRv 245-0000-433020 210.25
Line Item Total: $777.93
Payments:
Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid
Check DELTA FIRE, INC. DLH 19044 By Mail 777.93
Payment Total: $777.93
cReceipt.rpt Page I of 1
„ CITY OF TIGARD 9:28.58AM
Fees Associated With
1 13125 SW Hall Blvd.
TIGARD Tigard,OR 97223 503.639.4171 Case #: BUP2006-00533
Fee Start End Revenue Created
Type Date Date Dept Description Account Number By Date Amount Due
PRMT 1/1/1990 12/31/2020 [BUILD] Permit Fee 245-0000-432000 BLD 11/2/2006 158.50 0.00
5PCT 1/1/1990 12/31/2020 [TAX] 8%State Surcharge 100-0000-207020 BLD 11/2/2006 12.68 0.00
FIRE 1/1/1990 12/31/2020 [FLS]FLS Pln Rv 245-0000-433020 BLD 11/2/2006 63.40 0.00
PRM2 1/1/1990 12/31/2020 [BUILD]Addl Permit 245-0000-432000 DAN 8/21/2007 525.63 525.63
5PCT 1/1/1990 12/31/2020 [TAX] 8%State Surcharge 100-0000-207020 DAN 8/21/2007 42.05 42.05
FIR2 1/1/1990 12/31/2020 [FLS]Addl FLS PInRv 245-0000-433020 DAN 8/21/2007 210.25 210.25
Total Due: $777.9-
Page 1 of 1 CaseFees..rpt
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r;
F • Community Development
T I G A R[) Request for Permit Action
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: n Owner [pplicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) Iti I ( P �� � , � -r Dtr LTA flt26
Mailing Address: I' 7�J� fAk) 72 kv
City/State/Zip: TT6-6 -17->, q7224-
Phone No.: 503 6,2O 4O2
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
n CANCEL PERMIT APPLICATION.
❑ 1.:lumi • : ERMIT FEES (attach receipt, if available).
' INVOICE 'OR FEES DUE (attach case fee schedule and explain below). b11•1 72.-- O(—�
❑ • • •VE CONTRACTOR FROM PERMIT (do not cancel permit). SEE Se#-€ t-(E
Permit#: g CI P 2036- co S 33
Site Address or Parcel #: I (0037 SUj vP ayE
Project Name: FA-MOO C F1 w BL
Subdivision Name: Lot #:
EXPLANATION: (// SE b VAL() PcTc ) •
ok._( ( a. _khdc !3io)000
Signature: '—:�`% 1a ° Date: I1 fJ
Print Name: . /1'�''
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 800'o 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°o of the land use application fee for issued permits.
d) not more than 80°0 of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80°'o 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 ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date By
Refund Processed: Date By Invoice Processed: Date c/.7//O? B
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt#1) ;.5 S0 Date ///.t/0(e Method C'/ c/_ Amount$
I:\Building\Forms\RegPermitAction.doc ev 07/26/07