Permit Support Document III
A
TIGARD
City of Tigard
February 6,2014
Watts Heating&Cooling
Attn: Lisa Thurber
580 Portland Ave.
Gladstone, OR 97027
Re: Permit No. MEC2014-00028
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 7900 SW Hunziker Rd
Project Name: N/A
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 they requested permit for the wrong address.
Refund 80% of permit fees.
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
IIIIIII .,
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: Watts Heating&Cooling DATE: 1/30/2014
Attn: Lisa Thurber
580 Portland Ave. REQUESTED BY: Dianna Howse
Gladstone, OR 97027 r--
TRANSACTION INFORMATION:
Receipt#: 194663 Case#: MEC2014-00028
Date: 1/23/2014 Address/Parcel: 7900 SW Hunziker Rd.
Pay Method: CreditCard Project Name: N/A
EXPLANATION: Per applicant's request as they requested permit at the wrong address. Refund 80%.
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 • 4
If under$12,500 Division Manager
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: /0//Y. By: K✓„tf
I:\Buildin S\Refunds\RefundRequest.doc x 09/01/2010
Jan. 23. 2014 1 :41PM WATTS HEATING No. 5701 P. 2
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request Permit Action
� IVES
r i c;A RD 13125 SW Hall Blvd, • Tigard, Oregon 97223 • 503,718.2439 • www. . •. ov
g
TO; CITY OF TIGARD Cgy OFTIIGv S k
Building Division Services Supervisor/ 0 1 sour c,
13125 SW Hall Blvd.,Tigard,OR 97223 a2 i�
Phone: 503.718.2430 Fax: 503.598.1960 /ww*.tigard-or.gov
FROM; ❑ Owner 171 Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO; Nosiness or Individual) y J . -1. / °i ra l l
Mailing Address: 5E0 Por-(-ta.n
City/State/Zip: C -7•
Phone No.: 533 -72(0. 2 25'8
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/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).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: m EC2�1 0002 $
Site Address or Parcel#: lcL su) - 1.1 n-7_1 1<e r
Project Name:
Subdivision Name: Lot#:
EXPLANATION: C prrv-lL4 --F0( W v
Signature: 4)0A__ Date: l ° 2.3. 114
Print Name: L s9t hulk !r /D /cf:
Refund Policy re •6 9 . /4'
I. The Director or Building Official may authorize the refund of: O
a) any fee which was erroneously paid or collected. /2e-A4^/vT /car'£
b) not more than 80%of the had use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits.
d) nor more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80%of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same medtod in which payment was received. Please allow 2-4 weeks for processing refunds.
FOR OFFICE I!SI; ONLY
Rte to Sys Admin: Date auraumuj Rte to Bid:Admin; Date , / B. ,
Refund Processed: Datc,2 <o Ag/�� B• :rte Invoice Processed: Date B
Permit Canceled: Date .agAgrA t E jM Parcel Ta- Added: Date B
Receipt# Date Method Amount$
,1rf 1:1 Building\Forms\RegPemutAcdon.dac Rev 05/25/2012
141 1.-/S64- c'' /'9/ Z7- ,N.6
Jan. 30. 2014 10:55AM WATTS HEATING No. 5727 P. 1
RECal
JAN a() 2O\4
Lisa Thurber can OVre ►ROB,
Watts Heating&Cooling Q,` �`��1v11%-
580 Portland Ave pV'�O11V
Gladstone,OR 97027
503-786-2858 Office
503-786-2807 Fax
facsimile transmittal
To: -DI Ana_) Fax: 5v 3. 11 $' 2'3ct
From: L1 2 Date: I ` 30, I LI
Re: rn �',-Zt�l� •OfiY2 8 Pages: Z.
P e , re--fund r9ui zt
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