Fillable APPEAL OF CIVIL PENALTY ASSESSED UNDER BEAVERTON CODE (City of Beaverton)

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APPEAL OF CIVIL PENALTY ASSESSED UNDER BEAVERTON CODE (City of Beaverton)

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Form B70-1083 Page 1 of 2 REV 2/16
CITY OF BEAVERTON
Community Development Department
Building Division
12725 SW Millikan Way / PO Box 4755
Beaverton, OR 97076
Phone: (503) 526-2493 Fax: (503) 526-2550
General Information (503) 526-2222 V/TDD
BeavertonOregon.gov
APPEAL OF CIVIL PENALTY ASSESSED UNDER BEAVERTON CODE 8.02.125
Appeal of ___________________________________ Date Submitted ___________________
(Name of project or development)
Permit No. ________________________________ Received by _______________________
Job Address ________________________________ Fee Paid _______________________
Please type or print all information below
Appellant (if different than owner) All Property Owners
(Person to be notified of hearing) (If more than 1 owner, attach separate sheet)
Name ________________________________ Name _________________________________
(please print) (please print)
Company Name ______________________________________________________________
Address ___________________________________ Address ___________________________________
City____________________ State _____________ City_________________ State _________________
Zip Code ________ Phone ( )______________ Zip Code _________ Phone ( ) _____________
Legal or property interest – (Lessee, Legal or property interest – (Lessee,
contract purchaser, builder, mortgager) contract purchaser, builder, mortgager)
Appellant requests a hearing on the determination of the civil penalty for the following reasons:
Describe the nature of the determination being appealed; the reason the determination is incorrect; and
what the correct determination of the appeal should be (attach additional pages if necessary):
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Clear Form
Form B70-1083 Page 2 of 2 REV 2/16
Applicable code reference(s):
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
VERIFICATION
I verify that the statements contained in this application are true. I understand that if this
application contains a false statement, I can be prosecuted under BC 5.08.600 and, if
convicted, I could be subject to a fine of up to $1,000.00 or imprisonment of up to six
months, or both. Note: All parties who are named as appellants must sign this notice of
appeal.
_________________________________________ ____________________
Signature Date
_________________________________________ ____________________
Signature Date
_________________________________________ ____________________
Signature Date
The Construction Board of Appeals meets the first Tuesday of each month. All appeals must be filed a
minimum of 15 days prior to the meeting date. Appellant has the right to be notified by mail at least ten days
before the hearing, of the date, time and place for the hearing, unless the right to the notice is waived.
* * * * * * * * *
Appellant may waive the ten-day written notice by signing the following waiver.
I understand that I have the right to ten days written notice of the date, time and place for the hearing. I
choose to waive the ten-day-written notice of Construction Appeals hearing date, time and place.
__________________________________________ _____________________________________
Signature Date
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APPEAL OF CIVIL PENALTY ASSESSED UNDER BEAVERTON CODE (City of Beaverton)

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Completed 2 August 2020

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