TUP2018-00021 VOIDED
TUP2O18 - 00021
EMBASSY SUITES
uI
TIGARD
City of Tigard
November 29, 2018
Embassy Suites
9000 SW Washington Square Rd
Tigard, OR 97223
Re: Permit No. TUP2018-00021
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9000 SW Washington Square Rd
Project Name: Embassy Suites
Job No.: N/A
Refund Method: ® Check#230478 in the amount of$361.00.
❑ Credit card "return"receipt in the amount of$
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): Only allowed one event per calendar year and applicant already had an
event in January 2018. Refund 100% of application 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
: . q
IN
City of Tigard
r I GA RD 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: Embassy Suites DATE: 11/16/2018
9000 SW Washington Square Rd
Tigard, OR 97223 REQUESTED BY: Dianna Howse
LS
TRANSACTION INFORMATION:
Receipt#: 419898 Case#: TUP2018-00021
Date: 10/11/2018 Address/Parcel: 9000 SW Washington Sq Rd
Pay Method: Check Project Name: Embassy Suites
EXPLANATION: Only allowed one event per calendar year and applicant already had an event in January
2018. Refund 100%of application fee per Lina Smith.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Application Fee 100-0000-43116 $361.00
TOTAL REFUND: $361.00
APPROVALS: SIG • -R S DATE:
If under$5,000 Professional Staff tw 1
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 ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: 'V/2--// . By: A
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT v i ? I
111
Request for Permit Action /061,AW
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
;urs
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: Denise Hyatt
INVOICE TO: (Business or Individual) Embassy Suites
Mailing Address: 9000 SW Washington Square Road
City/State/Zip: Tigard, OR 97223
Phone No.: (503) 929-0427
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).
Li REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: TUP2018-00021
Site Address or Parcel #: 9000 SW Washington Square Road
Project Name: Embassy Suites
Subdivision Name: N/A Lot#: N/A
EXPLANATION: Only allowed to have one event per calendar year (CDC 18.440.050.A.1),
and applicant already had one event in January 2018. Please refund 100% of
applicant's $361 check, and void application and any remaining fee balance.
10/29/2018
Date:
Signature:
Print Name: Lina Smith
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 '/y /y By 4er
Refund Processed: Date ///4, By ,/jj Invoice Processed: Date By
Permit Canceled: Date ,7 /k i<c-i By ,.`_- Parcel Tag Added: Date By
I:\Building\Forms\RcgPcrnutAction_0 314. oc
‘, 4, ,e1 r or
/// / RECEIVED
IICity of Tigard
II OCT 112018
C()MMUN ITY DEVELOPMENT DEPARTMENT
Temporary lJ �e T e I Apphr
yp -%
,,, ,.... .., . .. .
PROPOSAL SUMMARY (Brief description)
REQUIRED SUBMITTAL
Temporary use approval to allow: e i ELEMENTS
(2.,j 71.,e? t 4, ,1y. -7 - 'Z's ) Ic o �-
El Owner's signature/
writtenten authorization address/location(s): C;/.5..,...,.. 1� —7-77.....4---..f(
6 J � �4c.. � {� [i] Two(2)copies of the site/plot
plan indicating:
Tax map and tax lot #(s): I. Location of the Temporary Use
2. Jot size
3. Square footage and location of
Site size: existing buildings
4. Current uses of existing buildings
Start date:/0 / ?1 / /& End date: /J / • -3 / /ig 5. Number of existing parking spaces
6. Square footage of any space to be
Please check one: used as additional parking
eason/special event ? C> j — 7. Driveway locations
Unforeseen/emergency situation / ❑ Site/plot plan(reduced to 8.5"x111/2")
CI Temporary sales office/model homes ❑ Applicant`s statement address criteria:
18,440,0_s)(2 copies)
ernporary use in commercial and industrial zone
❑ Filing fee(unless exempt)
APPLICANT`
,r-
FOR STAFF USE ONLYBusiness name: --/t44cif"d r 1:--- --1 i-74 --
�pvc� �G,✓ L��. �-s-- ,��• Case No.: �� 2O/ -Q��01
Address:
Related Case No.(s):
City/state: 7 .G''4''�' ` c.7 IL. Zip: �I Z Z
7J vL�e � Application Fcc: t �
Contact name: /G--
Ph#: ,S a.� 9 Z`r Email: C i2•4--4e,--,/ 41, /®
Application accepted:
o(e2 7 ',Y,re-Inn'Y rfr..-c? •t. Cc.A1+4 By: I / Date:10240
Application determined complete:
PROPERTY OWNER/DEED HOLDER(S)•(Attach list if more than one) By:5 Date:
Name: t—do. Eve--&4,-7.-.4.-44... .4--� E:t t�
r / t:\Communhy Development\Lend Use Applications\02_Forms and
Templates\land Use Applications Rev.T2/14/2017
Address: 14)5"7 /4"" -`4`4-5. off ' - , 7C2::-:
City/state: /- 1"--" 6foi'f-C ` 'f Zip: 7‘="4:'/S?
Contact name:/4,,,i' '"/• Ph# —`7 — 2 7/ 4.----2 7 3
* When the owner and the applicant arc different people,the applicant:must be the purchaser of record or a lessee in possession
with written authorization from the owner or an agent of the owner.The owner(s) must sign this application in the space
provided on the back of this form or submit a written authorization with this application.
a
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page I. of 2
APPLICANTS
To consider an application complete,you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS
as described on the front of this application in the"Required Submittal Elements"box.
(Detailed Submittal Requirement Information sheets can be obtained,upon request,for all types of Land Use Applications.)
THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or imposed upon the subject property
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
• All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and
the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application.
SIGNATURES of each owner of the subject property required.
Den/Se M. i&att Denise M Hyatt 10/10/2018
Applicant's signature Print name Date
WIdeali 94, ;1
4 1 1 1;4_PI 41 dek./0'
91/•10/g
Owner's signature Print nameDa
Owner's signature Print name Date
Owner's signature Print name Date
f$i>CJS$:617ikiur�'iitL +....,.�.ra..s,�....m..�;4r,Tn•-a' 136Z"ti..fY. „#+:T7 "'wzac;s.. ?.ice,:+ r. ,, - _
TEMPORARY USE—TYPE I APPLICATION(TUP)
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 2
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