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Permit 11 TIGARD City of Tigard September 2, 2021 Wyatt Fire Protection 9095 SW Burnham St Tigard, OR 97223 Re: Permit No. FPS2019-00147 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 7301 SW Kable St Project Name: Lifetime Remodeling Job No.: N/A Refund Method: ® Check#240462 in the amount of$60.24. ❑ Credit card"return" receipt in the amount of$ 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): Per applicant's request as scope of work changed. Refund 80% of permit fees. 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 • I'I G A R I) 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: Wyatt Fire Protection DATE: 8/27/2021 9095 SW Burnham Sst Tigard, OR 97223 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 427329 Case#: FPS2019-00147 Date: 12/11/2019 Address/Parcel: 7301 SW Kable St Pay Method: Check Project Name: Lifetime Remodeling EXPLANATION: Per applicant's request as scope of work changed. Refund 80% of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund ' Example Building Permit Fee . pl 300000-43104 $Amount,„ Permit Fee 230-0000-43104 $53.78 12%State Surcharge 100-0000-24001 6.46 TOTAL REFUND: $60.24 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager Yt If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board Case Refund Processed: Date: 17/V ?_1 By: 420 I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT .1111 Ai a 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Lifetime Remodeling Site Address: 7301 SW KABLE LN 300ittAi� A Receipt Number: 436288 - 09/04/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID FPS2019-00147 $-60.24 Total: $-60.24 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240462 DHOWSE 09/04/2021 $-60.24 Payor: Wyatt Fire Protection Total Payments: $-60.24 Balance Due: $60.24 Page 1 of 1 CITY OF TIGARD RECEIPT litil13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 i i '\P.L) Project Name: Lifetime Remodeling Site Address: 7301 SW KABLE LN 300 t972-(6 14/ Receipt Number: 427329 - 12/11/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID FPS2019-00147 Permit Fee-COM 230-0000-43104 $67.23 FPS2019-00147 12% State Surcharge-Building 100-0000-24001 $8.07 F'- FPS2019-00147 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $0.50 11x17) FPS2019-00147 Plan Review-Fire Life Safety-COM 230-0000-43108 $26.89 Total: $102.69 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 2067 BTAGGART 12/11/2019 $102.69 Payor: Wyatt Fire Protection, Inc. Total Payments: $102.69 Balance Due: $0.00 Page 1 of 1 I 2I 77 -, .du o City of Tigard • CONINIUNI`ry DEVELOPMENT DEPARTMENT RECEIVED Request for Permit Action74 OCT 2 8 2020 TIGARD 13125 SW Hall Blvd. ••Tigard, Oregon 97223 •• 503-718-2439 •• www.ttgarcOIr OF TIGARD DUILDINO DIVISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718.2439 Fax: 503-598-1960 TigardBuildingPermits@tigtrd-or.gov FROM: ❑ Owner (6 Applicant [" Contractor ❑ City Staff Chcck(°)nnc REFUND OR Name: v�l (466 01 INVOICE TO: illusmcss or Individual) �fr�/ Mailing Address: "W% 514 fi .rcyA.- City/State/Zip: T c O0.. 0A1P'$ Phone No.: SCs" —bit` v6 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): g CANCEL/VOID PERIrlIT 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). Permit#: r('?S tel _0Ot4.1 Site Address or Parcel#: 410I 'SL+/ zr.,,Ve tee- #30121 Lt `�p_ Project Name: t.,..kli fw ej t 9 0u/rolJ* Subdivision Name: Lot#: EXPLANATION: c COf( at- 11491. C4104604 Signature: ;Q6(1 1iv Date: 10 f 2�1J0 Print Name: aon, ' ( tp(,(l4( )refund Poke I 'the cuy`p 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°0 of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. , • Not more than 80°a of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the ongtinal payer in the form of a check via US postal service. 3 Please allow 3-1 weeks for processing;refund request; �j7 s•Z 3 S 3, /3, 'V S 12Z77-i9-167,/ "141-v 1, © 7 _ ' 4, `/f� - _//�_L/ s -7� . 30 tit.2' /SS, '4'4' FOR OFFICE USE ONLY Route to Sys Adnun: Date/V , ' ID By T. Route to Records: Date '' Y *Z/ By l Refund Processed: Date ,a` 7/. -/ By a Invoice Processed: Date By ��>�Permit Canceled: Date /fir By /9 Parcel Tag Added: Date By 1lltudd ',Dorms';ltcyrcrmitAction„..1311518 ec