Permit Support Document 7/1/2014 9:35 AM FROM: Heating and Cooling TO: 5035981960 PAGE: 001 OF 001
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUL 1 2014
�! • ' Request Permit Action c1TY
tit;Ai;d) 13125 Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.ti bH OFTI�ARD
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1'0: CITY OF TIGARD
Building Division Services Supervisor VOID
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov 7/79/V AtOr-
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check one)
REFUND OR Name: Tri County Temp Control
INVOICE TO: (Business or Individual)
Mailing Address: 13150 S Clackamas River Drive
City-/State/Zip: Oregon City,OR 97045
Phone No.: 503-557-2220
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (✓):
® 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#: MEC2014-00322
Site Address or Parcel#: 14048 SW Walnut Creek Way
Project Name: Nelson
Subdivision Name: Lot#:
EXPLANATION: Installation Cancelled
Signature: (� ,e' Date: 7/1/2014
Diane Mason ��
Print Name: 9O,O Z) — ?Z•O'7) _ /t,cry
Refuel Policy l0 .4 U . ,, y
I. The Director or Building Official may authorize the refund of: AO r lb
a) any fee which was erroneously paid or collected. �O /
b) not more than St►'i,of the land use application fee when an applicatioe is withdrawn or canceled before any review effort has been expended.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) not 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 Air o 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 method in which payment was received. Please allow 2-4 weeks for processing refunds
I I H■ t tl l If I. l -I 11'.1.1
Rte to S s Admin: Date '7 flf,_EZIMIM Rte to Bld:Admin: Date 7RraZ B, :47A1
Refund Processed: EffeiffiraMILM Invoice Processed: Date B
Permit Canceled: Date /F'r' B -1" arcel Ta,Added: Date B
Receipt# Date Method Amount$
I:\Building\forms\RcgPctn»tAction.doc Rcv 05/25/20l2
TIGARD
City of Tigard
July 30,2014
Tri County Temp Control
Attn: Diane Mason
13150 S Clackamas River Dr
Oregon City, OR 97045
Re: Permit No. MEC2014-00322
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14048 SW Walnut Creek Way
Project Name: Nelson
Job No.: N/A
Refund Method: ® Check#214534 in the amount of$80.64.
❑ Credit card"return" receipt in the amount of$
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 job was cancelled. 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
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 fir 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: 7/24/2014
Attn: Diane Mason
13150 S Clackamas River Dr REQUESTED BY: Dianna Howse
Oregon City, OR 97045
TRANSACTION INFORMATION:
Receipt#: 196662 Case#: MEC2014-00322
Date: 6/30/2014 Address/Parcel: 14048 SW Walnut Creek Way
Pay Method: CreditCard Project Name: Nelson
EXPLANATION: Per applicant's request as job was cancelled. Refund 80%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example:;BuildingPerm t Fee Example:. 2300000-43104 $Amo ni
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 7/2,7//
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: I 7/„Tety I By:
I:\Building\Refunds\RefundRequescdoc x 09/01/2010