Permit Support Document q
.
TIGARD
City of Tigard
September 10, 2021
William&Shana White
14470 SW 100th Ave
Tigard, OR 97224
Re: Permit No. BUP2021-00091
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14470 SW 100th Ave
Project Name: White
Job No.: N/A
Refund Method: ® Check#240531 in the amount of$87.45.
❑ Credit card"return" receipt in the amount of$
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): Commercial building permit created in error (re-created as residential
permit MST2021-00151). Refund 100% of plan review fees paid under commercial permit.
If you have any questions please contact me at 503.718.2430.
Sincerel ,
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
. C " City of Tigard
T I G A K l) 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: William& Shana White DATE: 9/6/2021
14470 SW 100th Ave
Tigard, OR 97224 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 433879 Case#: BUP2021-00091
Date: 4/16/2021 Address/Parcel: 14470 SW 100th Ave
Pay Method: CreditCard Project Name: White
EXPLANATION: Commercial building permit created in error,recreated under residential permit
MST2021-00151. Refund 100%of plan review fees paid.
REVONI FiNFORMATION:
Fee Description From Receipt Revenue Account Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plan Review 230-0000-43106 $87.45
TOTAL REFUND: $87.45
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff p
If under$12,500 Division Manager 1 4,07 t.el-J
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: I f//1/71 I By: I
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
* 13125 SW Hall Blvd.,Tigard OR 97223
1114
503.639.4171
TIGARD
Project Name: White
Site Address: 14470 SW 100TH AVE
Receipt Number: 436374 - 09/10/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2021-00091 $-87.45
Total: $-87.45
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 240531 DHOWSE 09/10/2021 $-87.45
Payer: William White
Total Payments: $-87.45
Balance Due: $87.45
Page 1 of 1
CITY OF TIGARD RECEIPT
ijPIl kit 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TI GARD
Project Name: White
Site Address: 14470 SW 100TH AVE jgl 6-/N
Receipt Number: 433879 - 04/16/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2021-00091 Plan Review 230-0000-43106 $87.45 F
Total: $87.45
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 7630005 PUBLICUSERO 04/16/2021 $87.45
Payor:
Total Payments: $87.45
Balance Due: $0.00
Paae 1 of 1