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Permit Support Document (2) 111 H • City of Tigard August 9, 2019 Watts Heating& Cooling 580 Portland Ave Gladstone, OR 97027 Re: Permit No. MEC2019-00453 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 13170 SW Wall St Project Name: Grow Job No.: N/A Refund Method: ® Check#232964 in the amount of$136.77. ❑ Credit card "return" receipt in the amount of$ 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 was obtained online in error as a residential permit and commercial permit is required (see MEC2019-00437 that was already applied for). 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 III a ° 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: Watts Heating& Cooling DATE: 8/2/2019 580 Portland Ave Gladstone, OR 97027 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 424444 Case#: MEC2019-00453 Date: 6/28/2019 Address/Parcel: 13170 SW Wall St Pay Method: CreditCard Project Name: Grow EXPLANATION: Per applicant's request as duplicate permit was obtained online for RES in error;permit already applied for MEC2019-00437 as COM. Refund 100%per permit fees. REFUND INFORMATION: _ Fee Description From Receipt Revenue Account No. Refund _Example: Building Permit Fee Example: 2300000-4 3104 $Amount Mechanical Permit 230-0000-43102 _ $122.12 12%State Surcharge 100-0000-24001 14.65 TOTAL REFUND: $136.77 APPROVALS: SIGN RES 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 Case Refund Processed: I Date: .-7 e -f By: ,_ I:\Building\Refunds\RefundRequest.doc x 09/01/2010 11111 CITY OF TIGARD RECEIPT I ' 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 T 16.A It D Project Name: Ductless Heat Pumps Site Address: 13170 SW WALL ST A/ /\ Receipt Number: 436085 - 08/27/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID M EC2019-00453 $-136.77 Total: $-136.77 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 232964 DHOWSE 08/27/2021 $-136.77 Payor: Watts Heating&Cooling Total Payments: $-136.77 Balance Due: $136.77 Page 1 of 1 71 CITY OF TIGARD RECEIPT a 13125 SW Hall Blvd.,Tigard OR 97223 • 503.639.4171 TIGARD Project Name: Ductless Heat Pumps Site Address: 13170 SW WALL ST 41// - A7/91—C.-- Receipt Number: 424444 - 06/28/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2019-00453 Heat Pump 230-0000-43102 $122.12 MEC2019-00453 12%State Surcharge-Mechanical 100-0000-24001 $14.65 Total: $136.77 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 280619E3C-D92: PUBLICUSER108 06/28/2019 $136.77 Payor: Lisa Thurber Total Payments: $136.77 Balance Due: $0.00 Page 1 of 1