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Permit I rom: 08/25/2014 12:22 #215 P.001/001 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED = . Request Permit Action AUG 2 5 2014 TIGARD 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503.718.2439• www.torrvivTic4RD BUILDING DIVISION TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd.,Tigard,OR 97223 VO I D Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov • riefpf4rwee- FROM: I=1 Owner [l Applicant ❑ Contractor ❑ City St (check one) REFUND OR Name: INVOICE TO: (Business or Individual) R1 O.(`C MIC\ C ) • Mailing Address: -pc, city/state/zip: b\m,\Lcunk aiS , U42 Cne l CJ Phone No.: D3`- cl I PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): 12:1 CANCEL/VOID PERMIT APPLICATION. ® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ IN'VOICE FOR FEES DUE(attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: PlJ(W2,.0\,4-CCU Q.1 Site Address or Parcel#: VC,\)5 j) `fi,URA Project Name: 3311 -\-N,Utc 1 Q.� Subdivision Name: �� Lot#: 1..� EXPLANATION: MCC f' �UO�k Q(u-'oD rk 'CYtYYm '410s\sz\K■ur 'Ar) \i,t9itt te-S-S 7714A/ ...5" A/ i)e-7-2.wr l No 6,9-ek-Ctif-ii Ailsvaas Signature: A I_ '1 , — _ Z---- Date: Print Name: L �11w'1G� ��C{. tl{•f.,U 93.J /- ? r05 - /P, 7(0 Refund Policy /t. g4' - 9.0/ = a as 1. The Community Development Director or Building Official may authorise the refund of: O T/ 0 to 02 a) any fee which was erroneously paid or collected. b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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) not more than 80°o 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. All refunds will be returned to the original payer in the form of a check. Picric allow 3-4 weeks for pr messing refund requests. FOR OFFICE USE ONLY Rte to Sys Admin: Date: Rte to Bldg Admin: Date • / / B Refund Processed: Date e /y By .C.4 Invoice Processed: Date By Permit Canceled: Date f f1�- r By Parcel Tag Added: Date By Receipt# Date /�/ Method Amount$ l:\Building\Forms\RcyPerritAction_0626 l4.doc Pri TIGARD City of Tigard September 18, 2014 MP Plumbing Co. Attn: Donna Mathews PO Box 393 Clackamas, OR 97015 Re: Permit No. PLM2014-00267 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10515 SW Century Oak Dr. Project Name: Durgan Job No.: N/A Refund Method: ® Check#214965 in the amount of$84.06. ❑ Credit card "return" receipt in the amount of$ . 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 scope of work changed from replacement to repair not requiring a permit. Refund check for 80% of permit fees was mailed separately. If you have any questions please contact me at 503.718.2430. Sincerely, .."(C ini 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 Accela Refund Request TIGARD This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request forPermit 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: MP Plumbing Co. DATE: 9/10/2014 Attn: Donna Mathews PO Box 393 REQUESTED BY: Dianna Howse Clackamas, OR 97015 TRANSACTION INFORMATION: Receipt#: 197194 Case#: PL 2014-00267 Date: 8/12/2014 Address/Parcel: 10515 SW Century Oak Dr Pay Method: CreditCard Project Name: Durgan EXPLANATION: Per applicant's request as scope of work changed from replacement to repair. Refund 80% of-permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Plumbing Permit 230-0000-43101 $75.05 12% State Surcharge 100-0000-24001 9.01 TOTAL REFUND: $84.06 APPROVALS: SIGNATURES/DATE: If under 53,000 Professional Staff . f If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$30,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY, Case Refund Processed: Date: f/76V7 7 By: 1:\Building\Refunds\RefundRequest.doc x 09/01/2011)