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Permit Support Document ,a. ii ‘,, , r, . City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEk ` + 11)11 Request for Permit Action //2,/ ' o , , is l, 13125 SW Mall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD REGH‘A:1) Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 19 2020 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov. , !:aMRD FROM: ❑ Owner ❑ Applicant ontractor ❑ City Staff i DIVISION Check(1)one REFUND OR Name: 11-7 INVOICE TO: (Business or lndivklual) f( i/ FA j A'4tJ e. /4. 7 IL 7.t/ Cl Mailing Address: /5'4'( 3 6 (izek_./‹.. ('Qv7 • City/State/Zip: m 4//a .J/..r(-e Cf 2 9- ?c 7 Phone No.: J 0 3, 3 re_ / r PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): R- ANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit #: gZ,2,C. a.) 20 Gx2 Site Address or Parcel #: //. 3Q CO-) a. 4.12 A) t.LC)S C I. Project Name: /4 i l�-Gi ) zc Subdivision Name: Lot#: EXPLANATION: /c,C,.t t /L W-C �j p /-./ II Q, CjiGa"d°/`;©N c. ( /lite rl' AlQq 7 P4, 7,ZL/- . 4aficill f e�°1L' -� 'S i7 �t t�v�Jl` 'Lu g l �' �11� }�At' j f'"r�/L'c� �A)Sp. p /ZFA:t.. .c,/.Ls /e Z' /SS/ ' Signature: %",�" Date: / Print Name: Q4,9 A/Aeau)iii'E � f 7C Refund Policy / 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will he returned to the original payer in the form of a check via I'S postal service. 3. Please allow 3-4 weeks for processing refund requests. /`7C �v EJ S72e„ p) /�►NyL /,;:ct /Ati f`? ) � -c c /-7 77 T . /14=-7 729 e, Route to Sys Admin: Date$?,7/ ) Bye- . Route to Records: Date/ 2 3/L-/ By .. Refund Processed: Date,9/�t/y./ By t' Invoice Processed: Date _ By Permit Canceled: Date '& >'' !i By Parcel Tag Added: Date By - 1:\Building\Fors\RegPennitAction_1 Y518.dfic n 7 • TIGARD City of Tigard October 3, 2021 Equity Enhancement LLC 14468 SW Creekside Dr Milwaukie, OR 97267 Re: Permit No. MEC2020-00281 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11580 SW Glenwood Ct Project Name: Equity Enhancement LLC Job No.: N/A Refund Method: ® Check #20¢32-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 duplicate permit was applied for (see MEC2020-00069). Refund 100% of permit fees paid. 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 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: Equity Enhancement LLC DATE: September 20,2021 14468 SE Creekside Dr Milwaukie,OR 97267 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 429410 Case#: MEC2020-00281 Date: 5/18/2020 Address/Parcel: 11580 SW Glenwood Ct Pay Method: CreditCard Project Name: Equity Enhancement LLC EXPLANATION: Duplicate permit,see MEC2020-00069. Refund 100%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Mechanical Permit Fee 230-0000-43102 $90.00 12%State Surcharge 100-0000-24001 10.80 TOTAL REFUND: $100.80 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager D. L. Ov v 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: t/J71r3/2/ By: „pi- I:\Builciing\Refunds\RefundRequest.doc x 09/01/2010 IN CITY OF TIGARD RECEIPT 111 , 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: kitchen remodel Site Address: 11580 SW GLENWOOD CT g--kt. A Receipt Number: 437132 - 10/23/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID M E C2020-00281 $-100.80 Total: $-100.80 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240632 DHOWSE 10/23/2021 $-100.80 Payor: Equity Enhancement LLC Total Payments: $-100.80 Balance Due: $100.80 Page 1 of 1 IIICITY OF TIGARD RECEIPT 8 ` ` 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TTGA12D Project Name: kitchen remodel Site Address: 11580 SW GLENWOOD CT Receipt Number: 429410 - 05/18/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2020-00281 Range Hood/Other Kitchen 230-0000-43102 $33.39 MEC2020-00281 12%State Surcharge-Mechanical 100-0000-24001 $10.80 MEC2020-00281 Minimum Fee Adjustment-Mechanical 230-0000-43102 $56.61 Total: $100.80 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6379478 PUBLICUSER338 05/18/2020 $100.80 Payor: Total Payments: $100.80 Balance Due: $0.00 Page 1 of 1