Permit Support Document V 0 1 D Vo //).
RECEIVED `'
o/ 9 ?0 �. 6 AUG 18 2020
City of Tigard • COMMUNITY EVELOPMENT DEPARTMENT 01 CITY
F TIGARD
.''! Request for Permit Action B�I�'�IOG D V SION
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TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 50.3-718-2439 • 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 E Applicant 21 Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: pE ><
INVOICE TO: (Business or Individual) Ne.„,04..,,y-\
Mailing Address: lt SA70 c1
City/State/Zip: ket,t, t ,c tvr-O e— cit. -1 0 {
Phone No.: S . b` j L-'
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
n INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: t ' ,,,,o ICJ-0 C t
Site Address or Parcel#: 5 to S s k i Ti o . - fi.; -
Project Name: 0 Cs 1 0
Subdivision Name: Lot#:
EXPLANATION: C U S`"0 t ,,, . Y" 11" ;' . ro ...-11-1\0 v
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Signature: C141t 'f t/3\'' Date: 57 -O
Print Name: {"", �- I r --i ;r
,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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. ��
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1.0l2 OF I IC1 l SL °NIA
Route to Sys Admin: Date By Route to Records: Date : By ,
Refund Processed: Date .2/,/mot/ B} Invoice Processed: Date By
Permit Canceled: Date �J,�J��.p By 01d Parcel Tag Added: Date By
mi I:\Building\Forms\RegPer rAction_1�i051 .doc
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TIGARD
City of Tigard
February 11, 2021
Pex Plumbing
Attn: Deanna Reith
1915 NE Stucki Ave, #400
Hillsboro, OR 97006
Re: Permit No. PLM2020-00313
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15805 SW Greens Way
Project Name: Ochs
Job No.: 732708
Refund Method: ® Check#238231 in the amount of$64.96.
❑ Credit card "return"receipt in the amount of$
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 permit for water line work was cancelled.
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
illil II
City of Tigard
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: Pex Plumbing DATE: 2/8/2021
1915 NE Stucki Ave, #400
Hillsboro, OR 97006 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 430601 Case#: PLM2020-00313
Date: 8/12/2020 Address/Parcel: 15805 SW Greens Way
Pay Method: CreditCard Project Name: Ochs #732708
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plumbing Permit 230-0000-43101 $58.00
12%State Surcharge 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager D. L. Ornelcus
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: 9/97 1-/ By: z
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
i '' 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TI GAR.O'
Project Name: Ochs#732708 Site Address: 15805 SW GREENS WAY Jo'
/�7 ;At
Receipt Number: 436265 - 09/04/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2020-00313 $-64.96
Total: $-64.96
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 238231 DHOWSE 09/04/2021 $-64.96
Payor: Pex Plumbing
Total Payments: $-64.96
Balance Due: $64.96
Page 1 of 1
CITY OF TIGARD RECEIPT
$ 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T[G.AP..1)
Project Name: Ochs#732708
Site Address: 15805 SW GREENS WAY /')
Receipt Number: 430601 - 08/12/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2020-00313 Water Service 230-0000-43101 $62.54
PLM2020-00313 12% State Surcharge-Plumbing 100-0000-24001 $8.70
PLM2020-00313 Minimum Fee Adjustment-Plumbing 230-0000-43101 $9.96
Total: $81.20
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 6678365 PUBLICUSER263 08/12/2020 $81.20
Payor:
Total Payments: $81.20
Balance Due: $0.00
Page 1 of 1
11/9-. k..t- f..l E3-
Dianna Ornelas
From: PEX Plumbing <scheduling@pexpdx.com>
Sent: Tuesday, August 18, 2020 10:44 AM
To: #Building Permit Technicians
Cc: Deanna Renae Reith
Subject: RE: Adding water service#PLM262O-00290 Ochs
l-ti ZO 00-7 a3
Caution!This message was sent from outside your organization.
Hello Dianna,
Well, as life would have it, we just found out today that the customer doesn't need the water service. It
stemmed from a misunderstanding regarding the type of pipe that the customer currently has at their
home. Can you please advise on what the process is to get a refund on this permit fee? Thank you.
Best regards,
Cheryl Zion
PEX Plumbing
PH: 503-886-8664
M-F 8:00am-4:00pm
scheduiirig@pexpdx.corn
---- On Wed, 12 Aug 2020 19:27:40 -0700 #Building Permit Technicians
<TigardBuildingPermits@tigard-or.gov> wrote ----
Hi Cheryl,
Good choice and thanks for letting us know!
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: PEX Plumbing <scheduling(&pexpdx.com>
Sent: Wednesday, August 12, 2020 9:34 AM
To: #Building Permit Technicians <TigardBuildingPermitsOtigard-or.gov>
Cc: Deanna Renae Reith <officeCc�pexpdx.com>
Subject: RE: Adding water service #PLM2020-00290 Ochs
Hello all,
As we are scheduled to install the water service next week, along with the repiping, I went ahead and
ordered the water service separately. Thank you for getting back to me regarding this.
Best regards,
1
J
Cheryl Zion
PEX Plumbing
PH: 503-886-8664
M-F 8:00am-4:00pm
sch dulinq_c`ip x _ corer,
---- On Tue, 11 Aug 2020 16:33:51 -0700 #Building Permit Technicians
<TigardBuildingPermitsOtigard-or.gov> wrote ----
Hello Cheryl,
Please complete the attached application and in the description write "please add to existing permit
PLM2020-00290" and then check the quantity of the fixtures in the column on the right.
Email completed application to TigardBuildingPermitsOtigard-or.gov. Upon receipt, it will be placed in
the que for processing.
Due to the current remote working conditions, we are experiencing significant delays in processing
permits. Please allow 1-3 weeks for processing. It is not necessary to contact us regarding the status of
your permit as this will further delay the process. Please know that the permit technicians will contact
you as soon as the permit is ready to issue and with instructions to pay fees due online.
Thank you for your patience during this time.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: PEX Plumbing <schedulingC&pexpdx.com>
Sent: Monday, August 10, 2020 12:06 PM
To: #Building Permit Technicians <TigardBuildingPermits(&tigard-or.gov>
Cc: Deanna Renae Reith <officeCapexpdx.com>
Subject: Adding water service #PLM2020-00290 Ochs
Hello,
We would like to add water service to the above permit (50 linear feet) for the site at 15805 SW Greens
Way in Tigard. Would you kindly let us know once this is done, so that I can pay the additional fee for
it? Thank you in advance.
Best regards,
Cheryl Zion
PEX Plumbing
PH: 503-886-8664
M-F 8:00am-4:00pm
sch o uIin .@p'xpdx,com.
2
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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."
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