Permit Support Document (2) 114
TIGARD
City of Tigard
August 9, 2019
Excellence Plumbing LLC
7913 SW Nimbus Ave.
Beaverton, OR 97008
Re: Permit No. MEC2019-00334
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11100 SW Walnut St
Project Name: Kahn
Job No.: N/A
Refund Method: IN Check#232913 in the amount of$100.80.
❑ Credit card"return" receipt in the amount of$ .
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 this was a duplicate permit obtained online (see
MEC2019-00300). Refund 100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
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
c n It n 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: Excellence Plumbing,LLC DATE: 8/2/2019
7913 SW Nimbus Ave
Beaverton, OR 97008 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 423697 Case#: MEC2019-00334
Date: 5/23/2019 Address/Parcel: 11100 SW Walnut St
Pay Method: CreditCard Project Name: Kahn
EXPLANATION: Per applicant's request as duplicate permit was obtained online (see MEC2019-00300).
Refund 100%per 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 $90.00
12%State Surcharge 100-0000-24001 10.80
TOTAL REFUND: $100.80
APPROVALS: SIGNA S DATE:
If under$5,000 Professional Staff ''
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
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: a 7/.2-./ By: el
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
741 44
CITY OF TIGARD RECEIPT
s 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: NW Residential
Site Address: 11100 SW WALNUT ST
Receipt Number: 436083 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
M E C2019-00334 $-100.80
Total: $-100.80
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232913 DHOWSE 08/27/2021 $-100.80
Payor: Excellence Plumbing LLC
Total Payments: $-100.80
Balance Due: $100.80
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CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIC;.A R l?
Project Name: NW Residential
Site Address: 11100 SW WALNUT ST O
6 ( &7
Receipt Number: 423697 - 05/23/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2019-00334 Fuel Piping 230-0000-43102 $14.15
MEC2019-00334 12%State Surcharge-Mechanical 100-0000-24001 $10.80
MEC2019-00334 Minimum Fee Adjustment-Mechanical 230-0000-43102 $75.85
Total: $100.80
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 230519E3D-AB9, PUBLICUSER110 05/23/2019 $100.80
Payor: Shelly D Eugenio
Total Payments: $100.80
Balance Due: $0.00
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