PFI2018-00022 VOIDED
PFI2018 - 00022
BURLES
April 12, 2018 City of Tigard
Marion L Burles
15865 SW Oak Meadow Ln
Tigard, OR 97224
Re: Permit No. PFI2018-00022
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15865 SW Oak Meadow Ln
Project Name: Burles
Job No.. N/A
Refund Method: ® Check#228171 in the amount of$300.00.
❑ Credit card "return"receipt in the amount of$
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): All work was on private property, no work in the right of way. Refund
100% of permit fee.
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
41
City of 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: Marion L Burles DATE: 4/6/2018
15865 SW Oak Meadow Ln
Tigard, OR 97224 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 415377 Case#: PFI2018-00022
Date: 2/1/2018 Address/Parcel: 15865 SW Oak Meadow Ln
Pay Method: CreditCard Project Name: Burles
EXPLANATION: All work was on private property,no right of way work per Mike White. Refund 100%
of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example, 2300000-43104 $Amount
PFI Permit Fee 100-0000-43114 $300.00
TOTAL REFUND: $300.00
APPROVALS: SIGNATURES DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: ,;� f B
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
A
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) MA(t, av-1 L S
Mailing Address: S$(•57
City/State/Zip: '71CS"�, z Z
Phone No.: -7 Z - 7 49
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
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#:
Site Address or Parcel #: 58 Ls-
Project Name: (,�{. ,r
Subdivision Name: Lot#:
EXPLANATION: h L4L 1,•.)6"9-K d7,3 �1Q-i✓A-%E 0 A4 T;'
NO 9-00 u--.V-6W-4 . L E.. ,PPL I CA-4*l
• I�1 PT" '�`' 41S ?P77
Signature: Date: t �
Print Name: k1k&_ LOH i
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of-
Any
fAny 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 3 Z
Refund Processed: Date B Invoice Processed: Date B
Permit Canceled: Date B arcel Tag Added: Date B
1:\Bui]ding\Forms\RegPermitAction_ 23 4.doc