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Permit Support Document V 0 1 a/p// 40 RE '��, E pCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT NQI . CO20 is Request for Permit Action cn q _ riGAR0 lAl 1-, �p� I I ti A R D 13125 SW Ball Blvd. •Tigard,Oregon 97223 . 503-718-2439 •www.tigarc)" . y ©MSl �r� 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 El Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Caliber Plumbing&Mechanical Inc. Mailing Address: 2615 NW St Helens Rd City/State/Zip: Portend,OR 97210 Phone No.: 503-206-7591 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). Permit#: PLM2020-00452 Site Address or Parcel#: 10855 SW Summer Lake Dr Tigard OR 97223 i Project Name: Hardiman Subdivision Name: Lot#: I EXPLANATION: We accidentally used the wrong address. The jobsite is actually in Milwaukie. NO WORK has been done at this address or on this permit. This was issued earlier today. 21Signature: % � 7 Date: November 10,2020 Print Name: Daniel Hannah tl 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. 12-co - Se-,at) — /y.S0 Y70 - ' 6.p � • . _ 1 �-0 ' N 9r: / . z Route to Sys Admin: Date By Route to Records: Date q y ,Z.,/ By C' t Refund Processed: Date ,� Z-G7 ByeQ Invoice Processed: Date B) Permit Canceled: Date:v� �Z.,) Byre Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 2051 .doc IIIN TIGARD City of Tigard February 11, 2021 Caliber Plumbing&Mechanical Inc. 2615 NW St Helens Rd Portland, OR 97210 Re: Permit No. PLM2020-00452 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10855 SW Summer Lake Dr Project Name: Hardiman Job No.: Refund Method: /1 Check#238193 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 obtained permit for the wrong address. 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 11111 City of Tigard L i c n R D 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: Caliber Plumbing&Mechanical Inc DATE: 2/8/2021 2615 NW St Helens Rd Portland, OR 97210 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 431745 Case #: PLM2020-00452 Date: 11/10/2020 Address/Parcel: 10855 SW Summer Lake Dr Pay Method: CreditCard Project Name: Hardiman&Musgrove Bath EXPLANATION: Per applicant's request as permit was obtained online for the wrong address;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. Orvie�,a a $ 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: 9/40-7 By: AO I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARDIII RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 T[GAP,D Project Name: Hardiman&Musgrove Bathroom Site Address: 10855 SW SUMMER LAKE DR Receipt Number: 436267 - 09/04/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2020-00452 $-64.96 Total: $-64.96 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 238193 DHOWSE 09/04/2021 $-64.96 Payor: Caliber Plumbing & Mechanical Inc. Total Payments: $-64.96 Balance Due: $64.96 Page 1 of 1 CITY OF TIGARD RECEIPT g • 13125 SW Hall Blvd.,Tigard OR 97223 A r♦ 503.639.4171 r F i GA I?° Project Name: Hardiman& Musgrove Bathroom Site Address: 10855 SW SUMMER LAKE DR ( 6 Receipt Number: 431745 - 11/10/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2020-00452 Tub/Shower/Shower Pan 230-0000-43101 $12.51 PLM2020-00452 12% State Surcharge- Plumbing 100-0000-24001 $8.70 PLM2020-00452 Minimum Fee Adjustment-Plumbing 230-0000-43101 $59.99 Total: $81.20 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 7017508 PUBLICUSER170 11/10/2020 $81.20 Payor: Total Payments: $81.20 Balance Due: $0.00 Page 1 of 1 Dianna Ornelas From: Caliber Accounts <Accounts@calibermechanical.com> Sent: Tuesday, December 29, 2020 12:06 PM To: #Building Permit Technicians Cc: Caliber Finance; Kristy Kuni Subject: RE: PLM2020-00452 Refund Request Caution!This message was sent from outside your organization. Good afternoon: I am writing to follow up on this refund request. It's been about 6 weeks now. Please advise. Thank you, Respectfully, Galen McMahon accounts@calibermechanical.com Phone: 503.206.7591 Caliber Plumbing &Mechanical Inc. From:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Sent: Friday, November 13, 2020 06:43 PM To: Caliber Accounts<Accounts@calibermechanical.com> Cc: Kristy Kuni <Kristy@calibermechanical.com> Subject: RE: PLM2020-00452 Refund Request Hello Galen, Thank you for your refund request. Please allow 3-4 weeks to process and mail a refund check. 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: Caliber Accounts<Accounts@calibermechanical.com> Sent:Tuesday, November 10, 2020 2:21 PM To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Cc: Kristy Kuni <Kristycalibermechanical,com> Subject: PLM2020-00452 Refund Request Please see the attached refund request for permit PLM2020-00452 which was obtained today. Unfortunately we had the incorrect address when applying. Note that no work was done at the incorrect address. Thank you, Respectfully, Galen McMahon accounts@calibermechanical.com Phone: 503.206.7591 Caliber Plumbing&Mechanical Inc. 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 •