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Permit Support Document U q TIGARD City of Tigard December 3, 2013 Tri County Temp Control Attn: Diane Mason 13150 S Clackamas River Dr. Oregon City, OR 97045 Re: Permit No. MEC2013 -00658 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 14920 SW 83r Ave. Project Name: Friedman Job No.: N/A Refund Method: ❑ Check # in the amount of $ . ® Credit card "return" receipt in the amount of $80.64. 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 job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, /<6 • 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 Er City of Tigard TIGARD Accela Refund Request OD 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: Tri County Temp Control DATE: 12/3/2013 Attn: Diane Mason 13150 S Clackamas River Dr REQUESTED BY: Dianna Howse Oregon City, OR 97045 . • . TRANSACTION INFORMATION: tl E C o 13 - O0 6 8 Receipt #: 193790 ' i" " Case #: • "' ' Date: 11/04/2013' ' •• " ' Address /Parcel: 14920 SW 83 Pay Method: • CreditCard' Project Name: Friedman EXPLANATION: Per applicant's request as job was cancelled. 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 T°X=a4-e'sk--. If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY , Case Refund Processed: I Date: I l,4/3//.3 By: 1 i '// I \Building \Refunds \RefundRequest doc x 09/01/2010 NOV -6 -2013 10:38A FROM: TO: 5035981960 P.1 11/06/2013 10:58 5035981960 CITY OF TIGARD PAGE 02/02 Lotir NW- 6-2013 09:00A FROM: M:5035991950 P. A U O Tigard • COMMUN DEV ELOPMENT D ARTMEN r% City � 11" 4 y.t g Nov 0 -- Request Permit Action 6 2 413 . , : , : 1 3125 SW Hall Blvd. • Tigard, Oregon 97223.503.718.2439 • A.... , - , v :, , C D , RD TO: ©Tir OP TIGARD S /ON Building Division Services Supervisor 13125 SW Hall B1vti, Tigt ed, OR 97223 Ph.onc 503.7182430 Pat: 503.598.1960 www.tigard-or.gov PliOM: ❑ Owner ta Applicant ❑ Contractor ❑ City Staff Oka coo) REFUND OR Nome: T:d County Temp Contti+o INVOICE TO: 0400eea►tm.Ovidn'i) Mailing Addtms: 13150 S Clatdcamas River Drive City /State /Zip: 01 • Ci • OR 97045 Phone No.: 503 - 557 -2220 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PEST APPLICATION. RE,BUND PERMIT PEES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel per. Permit #: MEC2013-00658 Site Address or Parcel #: 14920 SW 83' Avenue Project Names Friedman Subdivision Name Lot #: EXPLANATION: Calton= cancelled install/job Signature: i n o1 � Date: 11/6/2013 Diane Ma son ^ l '' Print Name: hint.d.Bgisa t. 1114 Meow or Building O!6mal me/ tmdeodee the Wend of ) w &odd& wee meeoudt proud or eopeeed. b) not met dim cox at lend ate embolden fee when m tppYndoe illritteleiwn or coaled before oily review Arms ire been aipendai d, nn mom ttw [O3 of d. t id ame on Ibe for Land prnn not t men: dun IDK Of the . radldi e g en fee Whoa on eppRotim is mead befo,e any Om mice effort he, boat uptake. 4 'immix dun xY of die bufdbyr permit the few orated pan9em prior to soy mmpeeima requPew 1 Ret nWa wi l be retuned to the aeitinal Plyetie the some medrod in width pa}matt wem mired. Wale ebow 2-4 weeds fat peeeanteig (d ue& Ni : • I I, •1 t 1 .1 Rte to Amain: Dots a Magni C Mete : ,. • Adtein: Dote 6 E1'. A Refund Promottetr AY/1 II IElr ,74111 „ Th • , r ' NI • rte 3 . = D• �_1' /_� �'1r6 :n1 ! 't r ` cumuli Bate Meth .. ,� u:11 ;r' . - . am •.. tivf5/25/70 2 ®N 077 io • 8' o 7.2. ire Q5 .: 6 y ,QC`�."v.6 11/12/2013 9:12 AM FROM: Heating and Cooling Tri County Temp Control TO: 5035981960 PAGE: 001 OF 002 F A X •••• • Tri County Temp Control • 13150 S Clackamas River Dr ' Oregon City, OR 97045 • • • • • • To: <5035981960> Fax number: 5035981960 From: Victoria Allen Fax number: 503 - 557 -0919 Business phone: 503 - 557 - 2220 Home phone: Date & Time: 11/12/2013 9 12:20 AM Pages: 2 Re: Refund request for MEC2013 -00658 Please refund to the following credit card. Thank you. Victoria