Loading...
Permit Support Document • City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENTRECEIVED _ * Request for Permit Action OCT ? 52I TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard�d TIGARD l nl PAC DIViGiON TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 ////y/7i/ , (/ Phone: 503-718-2439 F x: 503-598-1960 TigardBuildingPermits@gard-or.gov FROM: ❑ Owner Applicant iContractor ❑ CityStaff Check(✓)one REFUND OR Name: f INVOICE TO: (Business or Individual) ...t / Mailing Address: I / Ali 404//d.: . City/State/Zip: 01 /J 14 0/ . "/ -72 ,0 Phone No.: 60 1 -gills PLEA E TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). E INVOICE FOR FEES DUE (attach case fee schedule and provide exp anation below). Permit #: M EC OL , ( ' 003 Site Address or Parcel #: 0 5'55 S IV . 4IiüjP/t Project Name: S I e,O/ I Ii' Subdivision Name: J Lot #�Dp�lo(x� ! tikr?it Q �j ,vli-eTI N: i n -et- Pr PMm' r /7 1L, . Signature: ,5 Date: / t ./g`al Print Name: .e r6 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 be returned to the original payer in the form of a check via US postal sery c A. >Zc•�"e�.✓ 3. Please allow 3-4 weeks for processing refund requests. ��� 20�Ci 6K M/T /9© .. V Z! - 2 , /O .c () / /Yrr /fS'4 /or ,,i-C) Pt), y , i 4. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date ' kottiA By Refund Processed: Date///y`Z' By„ e Invoice Processed: Date By Permit Canceled: Date/ //y/z/ B yd e, Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 220518.doc I1 TIGARD City of Tigard 11/19/21 Heat Relief Heading& Cooling 13122 NE David Cir, #800 Portland, OR 97230 Re: Permit No. MEC2021-00834 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address or Parcel No.: 9555 SW Shady P1 Project Name: Slenning Refund Check: #241337 in the amount of$80.64. Comment(s): Per applicant request as permit was obtained in error. Refund 80% of permit fees. If you have any questions,please contact me at 503.718.2470. Sincerely, Holly Van De Wege Program Development Specialist 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov T I GARD City of Tigard 11/19/21 Heat Relief Heading& Cooling 13122 NE David Cir, #800 Portland, OR 97230 Re: Permit No. MEC2021-00834 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address or Parcel No.: 9555 SW Shady P1 Project Name: Slenning Refund Check: #241337 in the amount of$80.64. Comment(s): Per applicant request as permit was obtained in error. Refund 80%of permit fees. If you have any questions,please contact me at 503.718.2470. Sincerely, Holly Van De Wege Program Development Specialist 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Heat Relief Heating& Cooling DATE: 11/14/2021 13122 NE David Cir, #800 Portland, OR 97230 . REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 437054 Case#: MEC2021-00834 Date: 10/19/2021 Address/Parcel: 9555 SW Shady P1 Pay Method: CreditCard Project Name: Slenning EXPLANATION: Per applicant request as permit was obtained in error. Refund 80%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example.. 2300000-43104 ),$Amount Mechanical Permit 230-0000-43102 $72.00 12%State Surcharge 100-0000-24001 8.64 TOTAL REFUND: $80.64 APPROVALS: SIGNATURES/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 FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: \\\14\Z1 By: \ I:\Building\Refunds\RefundRequest.doc x 09/01/2010 7111 CITY OF TIGARD RECEIPT 7 $ . 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD j�; t„�b Project Name: Crescent Grove Cemetary V Site Address: 9925 SW GREENBURG RD Receipt Number: 437659 - 11/19/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID E LC2021-00611 $-482.00 Total: $-482.00 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 241308 HVANDEWEGE 11/19/2021 $-482.00 Payor: Protech Power Total Payments: $-482.00 Balance Due: $482.00 Page 1 of 1 CITY OF TIGARD RECEIPT IIIl 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: SLENNING Site Address: 9555 SW SHADY PL ` /lA9-L_._- Receipt Number: 437054 - 10/19/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2021-00834 Fuel Piping 230-0000-43102 $14.15 MEC2021-00834 12% State Surcharge-Mechanical 100-0000-24001 $10.80 MEC2021-00834 Minimum Fee Adjustment-Mechanical 230-0000-43102 $75.85 Total: $100.80 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 8418911 PUBLICUSER107 10/19/2021 $100.80 Payor: Total Payments: $100.80 Balance Due: $0.00 Page 1 of 1