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
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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
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