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PFI2016-00095 a . City of Tigard February 11, 2021 Tigard Triangle Partners 12115 SW 70'Ave,#201 Tigard, OR 97223 Re: Permit No. PFI2016-00095 Dear Applicant: The City of Tigard has processed a refund for the deposit of fees on the above referenced permit for the following: Site Address: 12115 SW 70'Ave Project Name: Red Rock Center Job No.: N/A Refund: ® Check#238250 in the amount of$24,100.00. ❑ Credit card"return" receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: Return of customer deposit for end of 2-year maintenance period completed. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Ornelas 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 Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the RequertforPermitAction 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 Tigard Triangle Partners DATE: 2/6/2021 TO: 12115 SW 70th Ave, #201 Tigard, OR 97223 REQUESTED BY: Dianna Omelas TRANSACTION INFORMATION: Receipt#: 417875 Case#: PFI2016-00095 Date: 6/18/2018 Address/Parcel: 12115 SW 70th Ave Pay Method: Check Project Name: Red Rock Center EXPLANATION: Refund customer deposit for 2-year maintenance bond as facility is now under city's maintenance per Kenny Fisher. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fcc Example: 2300000-43104 $Amount Customer Deposit 640-0000-22000 $24,100.00 TOTAL REFUND: $24,100.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If tinder$12,500 Division Manager If under$25,000 Department Manager CJS Z v s If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: By: 1:\Budding\Rcfunds\RcfundRcquest.doc x 09/01/2010 CITY OF TIGARD RECEIPT ■ 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Red Rock Center Site Address: 12625 SW 70TH AVE Receipt Number: 436260 - 09/04/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12016-00095 $-24,100.00 Total: $-24,100.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 238250 DHOWSE 09/04/2021 $-24,100.00 Payor: Tigard Triangle Partners Total Payments: $-24,100.00 Balance Due: $24,100.00 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: Red Rock Center Site Address: 12625 SW 70TH AVE Receipt Number: 417875 - 06/18/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PF12016-00095 Customer Deposit 0/1- _>e-0000-22000 $24,100.00 lc`1� Total: $24,100.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 120 ALINDOR 06/18/2018 $24,100.00 Payor: Tigard Triangle Partners LLC Total Payments: $24,100.00 Balance Due: $0.00 Page 1 of 1 RECEIVE® City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 3 2020 14 Request for Permit Action CTO CFF IGARD 9% 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-a lWr`lr' n"VISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigatdBuildingPermits@tigard-or.gov FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: / t INVOICE TO: TusinessorIndividual) 1n�YCr Tr.�tin�t �Ar }�it�S Mailing Address: 1 Z1 15 City/State/Zip: j Phone No.: - i c l - 4 a 9 4— PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (✓): CA TVOID PERh1TT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). Ce&-3NV0ICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: ao se F T 12 (6 - 000 q Tnv. 7X36 7 C) Site Address or Parcel #: -706 A we Project Name: ZptALW- Subdivision Name: -i4 A C .Q A. �� Lot #: EXPLANATION: i�-Zt4 /G10�.f✓11-- LA-L45 i 4; cJ lc� S4LJi-t TVI.t fz}o< i 1 t ��L>- ewf, Signature: Date: 111-3 l Zo Print Name: c� L_ rr T_7-t� 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. Route to Sys Admin: Date By Route to Records: Date Cl B Refund Processed: Date 2 $ Invoice Processed: Date By Permit Canceled: Date �/ , B (� Pazcel Ta Added: Date B 1:\Building\Forms\RegPennitAction_I2018.doc Dianna Ornelas From: Gary Pagenstecher Sent: Thursday, November 5, 2020 7:39 AM To: Jeremy Tamargo Cc: Joe Wisniewski; Scott Barry; Dianna Ornelas Subject: Re: PFI2016-00095 Refund Request Thank you Jeremy Sent from my iPhone On 5 Nov 2020, at 7:09 AM,Jeremy Tamargo<ieremvt@tieard-or.gov>wrote: Hi Gary and Dr. Scott, My inspector for the project Kenny is out this week, but I will check with him upon his return on Monday to see if the refund can be made. Regards, Jeremy Jeremy Tamargo, PE City of Tigard Principal Engineer Direct: (971) 713-0281 From: Gary Pagenstecher<GaryP@tieard-or.gov> Sent:Tuesday, November 3, 2020 5:35 PM To:Joe Wisniewski<joew@tieard-or.gov>;Jeremy Tamargo<leremvt@tieard-or.gov> Cc:Scott Barry<drbarrvendo@gmail.com>; Dianna Ornelas<Dianna tieard-or.gov> Subject: FW: PF12016-00095 Refund Request Jeremy, Please see the attached Request for Permit Action for refund of a cash assurance(invoice #206270) paid in lieu of a performance bond for PF12016-00095 for Red Rock Center. Dr. Scott Barry filled out the form and is copied on this email. If the refund can be made, then let Dianna know and she can process the request(I believe). Please let me know if you have any questions. Thanks, Gary Gary Pagenstecher,AICP CUD Project Planner, Urban Design Community Development City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Phone: 503-718-2434 1 Email:garvp@tigard-or.gov From:Scott Barry<drbarrvendo@gmail.com> Sent:Tuesday, November 3, 2020 4:48 PM To:Gary Pagenstecher<Garvp@tigard-or.gov> Subject: PF12016 Caution!This message was sent from outside your organization. Allow sender I Block sende Hi Gary, This is a separate one that is not related to the other permit fee I cannot locate yet. Thanks for your help. Scott Dr.Scott L. Barry Advanced Endodontics Portland, Oregon 503.718.0095 DrBarrvEndo @gmail.com www.DrScottBarrV.com www.RootCanalPdx.com CONFIDENTIAL OR PRIVILEGED: This communication contains information intended only for the use of the individuals to whom it is addressed and may contain information that is privileged, confidential or exempt from other disclosure under applicable law. If you are not the intended recipient, you are notified that any disclosure, printing, copying, distribution or use of the contents is prohibited. If you have received this email in error, please notify the sender immediately by telephone or by returning it by reply email and then permanently deleting the communication from your system.Thank you. DISCLAIMER. E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 2 VOIDED PFI2016 - 00095 RFD ROCK CENTER n City of Tigard August 9,2018 Tigard Triangle Partners LLC 12115 SW 70'Ave, Suite 201 Tigard, OR 97223 Re:Permit No. PFI2016-00095 Dear Applicant: The City of Tigard has processed a refund for the deposit of fees on the above referenced permit for the following: Site Address: 12625 SW 706'AVe. Project Name: Red Rock Center Job No.. N/A Refund: ® Check#229431 in the amount of$10,131.25. ❑ Credit card"return"receipt in the amount of$ ❑ Trust account"deposit"receipt in the amount of$ Notes: Refund customer deposit for work completed. 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 0 www.tigard-or.gov - ° 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 forPermitAction 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: Tigard Triangle Partners LLC DATE: 8/3/2018 12115 SW 70t'Ave, Suite 201 Tigard, OR 97223 REQUESTED BY: Dianna Howse KF TRANSACTION INFORMATION: Receipt#: 417954 Case#: ' PFI2016-00095 Date: 6/21/2018 Address/Parcel: 12625 SW 70d,Ave. Pay Method: Check Project Name: Red Rock Center EXPLANATION: Refund customer deposit for work that has been completed. WAN Customer Deposit 100-0000-22000 $10,131.25 TOTAL REFUND: $10,131.25 APPROVALS: SIGN RE 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 Case Refund Processed: Date: By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 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: ElOwner 1:1Applicant Contractor � Check one City Staff REFUND OR Name: INVOICE TO: (Business or lndn idual) _T160" (C^yt" � ytr� �- ®'N L 4.. C- Mailing Address: 1'2- 1 ( S>- L,) -76® F. 5 0t 7r, 2-0 City/State/Zip: 716At-� , C7L -7 2-Z � Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V): ❑ CANCEL/VOID PERMIT APPLICATION. 1A 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#: ' f 1 2--0 J( Site Address or Parcel #: 1-1. r., he, 44k.�-,��— Subdivision Name: Lot #: EXPLANATION: F-1-vN-0 c) 5 ro'YV, l ,g 11� L6A-2F— I2.P.FUt- 11 61JT194, 1�lr�517' J0 131 as- Signature: sSignature: � �� Date: 4f,-2—1 9 p- Print Name: 'Ea&j' Refund Policv 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. L Please allow 3-4 weeks for processing refund requests. *For Office Use Only* Route to Sys Admin Date By: Route to Records Date S By: Refund Processed Dater/0� By:,A& Invoice Processed Date By: Permit Canceled Da�� X Parcel Tag Added Date By: