DIR2017-00002 III Fil
.
TIGARD
City of Tigard
September 21,2017
Mildren Design Group P.C.
7650 SW Beveland Rd, Suite 120
Tigard, OR 97223
Re: Permit No. DIR2017-00002
Dear Applicant:
The City of Tigard has canceled the above referenced permits) and encloses a refund for the
following:
Site Address: 10145 SW Washington Square Rd
Project Name: Jaguar/Land Rover
Job No.: N/A
Refund Method: ® Check#226168 in the amount of$739.00.
❑ Credit card"return"receipt in the amount of$ .
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$ .
Comment(s): It was determined that director's interpretation was not needed. Refund
100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Mildren Design Group P.C. DATE: 9/14/2017
7650 SW Beveland Rd, Suite 120
Tigard, OR 97223 REQUESTED BY: Dianna Howse
SW
TRANSACTION INFORMATION:
Receipt#: 412438 Case#: DIR2017-00002
Date: 8/21/2017 Address/Parcel: 10145 SW Washington Square
Pay Method: Check Project Name: Jaguar/Land Rover
EXPLANATION: It was determined that director's interpretation was not needed. Refund 100%of
application fee.
'`REFUND INFORMATION:
..‘.Fee Description From Receipt Revenue Account No. '< .�►
Example: Building Permit Fee Example: 2300000-43104
Director's Interpretation 100-0000-43116 $739.00
TOTAL REFUND: $739.00
APPROVALS: SIGN T�' Si 9 ATE:
ez
If under$5,000 Professional Staff „if
If under$12,500 Division Manager
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: Date: 3f�3 f/� By: ����p
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD
1111 RECEIPT
# 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Project Name: Jaguar/Land Rover
Site Address: 10145 SW WASHINGTON SQUARE RD A0
Receipt Number: 416301 - 03/23/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
D I R2017-00002 $-739.00
Total: $-739.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 226168 DHOWSE 03/23/2018 $-739.00
Payor: Mildren Design Group P.C.
Total Payments: $-739.00
Balance Due: $739.00
Page 1 of 1
INCITY OF TIGARD RECEIPT
1 .. 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T1C;A 1'.1)
Project Name: Jaguar/Land Rover
Site Address: 10145 SW WASHINGTON SQUARE RD
Receipt Number: 412438 - 08/21/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
DIR2017-00002 Director's Interpretation 100-0000-43116 $739.00
Total: $739.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 14626 SWARREN 08/21/2017 $739.00
Payor: Mildren Design Group, P.C.
Total Payments: $739.00
Balance Due: $0.00
Page 1 of 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 1
Request for Permit Action
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 2rCity Staff
Check(✓)one
REFUND OR Name: AA
INVOICE TO: (Business or Individual) MIldcer- Pas 6,/,aS ;e,q i� v P Cr,
Mailing Address: ?660 S Lu zgs'e/o v;'/ j
City/State/Zip: T; a e D 2 9 709c3
Phone No.: 503--3 7.D -3 GS
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
g-',..-CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: j R 17--Ddv U Q.
Site Address or Parcel #: / D / 5 S Gtr Was h. ✓r, /p
Project Name: 7. /Lac,/ RD,er
Subdivision Name: Lot#:
EXPLANATION: _ de Ten 71-h 4 D,'/' - .
4e rp,r.4 4.4%-kc,r1 lA f a c ,- d 4 h e e aledi /2<4.1,..11 /DD fo e."ce.i
Signature: _ Date: -7//i 10 7
Print Name: Sc-.17 v e,- VV,% rre
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date. ' ". /f By
Refund Processed: Date "40 By , ._ Invoice Processed: Date By
Permit Canceled: Date //y /e7 By ,j-4, Parcel Tag Added: Date By
1:\Building\Forms\RegPermitAction_o§2314.doc