Permit Support Document 1111 q
TIGARD
City of Tigard
September 10, 2021
Caliber Plumbing&Mechanical Inc
2615 NW St. Helens Rd
Portland, OR 97210
Re: Permit No. MEC2021-00674
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 12680 SW Walnut St
Project Name: PCC Writers House
Job No.: N/A
Refund Method: ® Check#240472 in the amount of$134.49.
❑ Credit card "return"receipt in the amount of$
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 applied for- see
MEC2021-00589. 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
111111 : ° 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: Caliber Plumbing&Mechanical Inc DATE: 9/6/2021
2615 NW St Helens Rd
Portland, OR 97210 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 436145 Case#: MEC2021-00674
Date: 8/31/2021 Address/Parcel: 12680 SW Walnut St
Pay Method: CreditCard Project Name: PCC Writers House
EXPLANATION: Per applicant's request as duplicate permit- see MEC2021-00589. Refund 80%of
permit fees.
REFUND INFORMATION:
Fee Description From Receipt. r-Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-4310 - $Amount
Mechanical Permit Fee 230-0000-43102 $120.08
12%State Surchage 100-0000-24001 14.41
TOTAL REFUND: $134.49
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager ,(Qc�3� ., .e__ /eC--4___.)
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FORACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: '2/jd7� By: c . ,
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
101
CITY OF TIGARD RECEIPT
a , " 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TICAR.J_3
Project Name: PCC Writers House
Site Address: 12680 SW WALNUT ST / 'J� fi
Receipt Number: 436377 - 09/10/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
M E C2021-00674 $-134.49
Total: $-134.49
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 240472 DHOWSE 09/10/2021 $-134.49
Payor: Caliber Plumbing& Mechanical Inc.
Total Payments: $-134.49
Balance Due: $134.49
Page 1 of 1
(
,
CITY OF TIGARD RECEIPT
14$ 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TtC_,A,k.11
Project Name: PCC Writers House
Site Address: 12680 SW WALNUT ST ®i/ -r Ai/9-i.—_
Receipt Number: 436145 - 08/31/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2021-00674 Furnaces < 100K BTU 230-0000-43102 $46.75
MEC2021-00674 Duct Work 230-0000-43102 / $23.32
MEC2021-00674 Flue/Vent For Any of Above 230-0000-43102 /50s/0 $23.32
MEC2021-00674 Flue Vent for Water Heater or Gas 230-0000-43102 �`� Ve; $23.32
Fireplace c /.?-0
MEC2021-00674 Clothes Dryer Exhaust 230-0000-43102 ��` yf $33.39
MEC2021-00674 12%State Surcharge-Mechanical 100-0000-24001 $18.01
Total: $168.11
9V6 /3 L/e Vq
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 8208791 PUBLICUSER170 08/31/2021 $168.11
Payor:
Total Payments: $168.11
Balance Due: $0.00
Page 1 of 1