Permit Support Document 'W11111 If
TIGARD
City of Tigard
April 3,2020
Alpha Energy Savers Inc.
PO Box 588
Oregon City, OR 97045
Re: Permit No. MEC2019-00893
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9045 SW Westlund Ct
Project Name: Sighting
Job No.: N/A
Refund Method: ® Check#235090 in the amount of$80.64.
❑ Credit card "return"receipt in the amount of$ .
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 job 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
41
.:104 City of Tigard
1 c,n E,u 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: Alpha Energy Savers Inc DATE: 3/20/2020
PO Box 588
Oregon City, OR 97045 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 427552 Case#: MEC2019-00893
Date: 12/30/2019 Address/Parcel: 9045 SW Westlund Ct
Pay Method: CreditCard Project Name: Sighting
EXPLANATION: Per applicant's request as job was cancelled;refund 80%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Mechanical Permit 230-0000-43102 $72.00
12%State Surcharge 100-0000-24001 8.64
TOTAL REFUND: $80.64
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff -C9iCz(4 a a—J
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
POR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: c/,3/ By .0��
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
III
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Sighting
Site Address: 9045 SW WESTLUND CT
Receipt Number: 436220 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2019-00893 $-80.64
Total: $-80.64
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 235090 DHOWSE 09/03/2021 $-80.64
Payor: Alpha Energy Savers Inc
Total Payments: $-80.64
Balance Due: $80.64
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Sighting
Site Address: 9045 SW WESTLUND CT
Receipt Number: 427552 - 12/30/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2019-00893 Range Hood/Other Kitchen 230-0000-43102 $33.39
MEC2019-00893 Single Duct Exhaust(Bathrooms, Toilet, 230-0000-43102 $23.32
Utility Rooms)
MEC2019-00893 12% State Surcharge-Mechanical 100-0000-24001 $10.80
MEC2019-00893 Minimum Fee Adjustment-Mechanical 230-0000-43102 $33.29
Total: $100.80
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 5894433 PUBLICUSER332 12/30/2019 $100.80
Payor:
Total Payments: $100.80
Balance Due: $0.00
Page 1 of 1