Permit Support Document a
s
TIGARD
City of Tigard
June 24,2019
MD Plumbing LLC
939 SW Willow Creek Dr
Beaverton, OR 9 7003
Re: Permit No. PLM2019-00146
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10050 SW Garrett St
Project Name: Garrett St
Job No.: N/A
Refund Method: ® Check#232418 in the amount of$84.07.
❑ Credit card"return"receipt in the amount of$
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): Refund 100%of permit fees paid by applicant online for a 'residential'
permit that should have been a 'commercial' permit (see PLM2019-00178).
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
City of Tigard
T GAR1) 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: MD Plumbing LLC DATE: 6/10/2019
939 SW Willow Creek Dr
Beaverton, OR 97003 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 422693 Case#: PLM2019-00146
Date: 4/11/2019 Address/Parcel: 10050 SW Garrett St
Pay Method: CreditCard Project Name: Garrett St
EXPLANATION: Refund 100%of plumbing permit fees paid by contractor for online'residential'permit
that should have been a'commercial'permit(see PLM2019-00178).
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plumbing Permit 230-0000-43101 $75.06
12%State surchage 100-0000-24001 8.01
TOTAL REFUND: $84.07
APPROVALS: SIGNAT 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
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: % fi ' / 21 By: '
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
II
CITY OF TIGARD RECEIPT
t I 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Garrett St
Site Address: 10050 SW GARRETT ST A
Receipt Number: 434457 - 05/21/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2019-00146 $-84.07
Total: $-84.07
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232418 DHOWSE 05/21/2021 $-84.07
Payor: MD Plumbing LLC
Total Payments: $-84.07
Balance Due: $0.00
Pane 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
- 503.639.4171
TIGAI1_D
Project Name: Garrett St
Site Address: 10050 SW GARRETT ST A
Receipt Number: 422693 - 04/11/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2019-00146 Clothes Washer 230-0000-43101 $25.02
PLM2019-00146 Sink 230-0000-43101 $25.02
PLM2019-00146 Laundry Tray 230-0000-43101 $25.02
PLM2019-00146 12%State Surcharge-Plumbing 100-0000-24001 $9.01
Total: $84.07
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 413615 PUBLICUSER111 04/11/2019 $84.07
Payor: mark logreco
Total Payments: $84.07
Balance Due: $0.00
Page 1 of 1
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
111114 r
= Request for Permit Action 4 ,t/,y -=`
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-o .gov ''
TO: CITY OF TIGARD RECEIVE
Building Division APR 2 9 2019
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 Tiga dBuildingPe> ltili:.1., .- . D
1 G [MON
FROM: ❑ Owner ❑ Applicant Contractor ❑ City Staff
Check(✓)one
M
REFUND OR Name: b P LVI,M G IN e" L L-C-
INVOICE TO: (Business or Individual) J c. Lexi G0
13 �'Mailing Address: q Sly &J�oo/ K
City/State/Zip: ( Ver cx' 6:31R 971-25 j
Phone No.: -5-6 5 - v2 4 7 - 3 9/ 7
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
O'"GANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
B7
INVOICE FOR FEES DUE (attach case fee schedule and
pr provide explanation below).
Permit#: VI In/LG-®1 -00l/ 6 Site Address or Parcel#: /e V SO Sh/ 6,,('8 4-1
Project Name: ''l64✓re-7' " / - k
Subdivision Name: i Lot#:
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EXPLANATION: �/1/.,'I- .�j pf' 4-7 �i-r, `C-•f-w,, - is�Ged
04► 4 ;cct -s.t- - L-0-) a 0,9 - i a 170
/e ce"rn /OD (2j --1/-b.,---Al 7.-Nr,--n-6 t-/ / /.S/" f an'rEz) . ,eaty
Signature: ?„,j%c Date: `� `� 11
Print Name: i t 5,�o c
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 service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date 7' .itiiBy i Route to Records: Dates ' 7„/ By 0
Refund Processed: Date 4, Fe /9 By ✓ Invoice Processed: Date By
Permit Canceled: Date W/oj q By V Parcel Tag Added: Date By
1:\Building\Forms\RegPermitAction_f20518.doc