Permit Support Document From: 03/12/2015 07:57 #975 P.001 /001
03/11/2015 01:29 5035981960 CITY OF TIGARD _ _ PAGE 01/01
From: 03/11/2015 14:36 t974 P 001 /001
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City of Tigard • COMnMUNITY DEVnLOPMENT DEPARTMENT MAR 7 X i n7�
_. ' Request for Permit Action 8r���;���,(
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TO: CITY OP TIGARD
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Building Division
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13125 SW Hall Blvd.,Tigard,OR 97223 ,j //J C
Phone; 503-718.2439 Fax: 503-598-1960 TigardB uildingPermits(aytigard-or.-gov
FROM: ❑ Owner ❑ Applicant IP Contractor ❑ City Staff
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REFUND OR Name: S(-+eeiatiu ciaatire9 5-Coot urg,Liao.
INVOICE TO (13uaincra or lnctitxluaf 75fif1,,S 1N.Thch_S pt9r rat.
Suite 130
Mailing Address: Tigard,OR 97223
www.speclaltyheatrng.com
City/State/Zip: 503-620-5643
Phone No.: ,S 3 3- (02D- S (r`(�
J PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (✓):
\:----1
0 CANCEL/VOID PERMIT APPLICATION,
0 REFUND PERMIT FEES(attach co py of original receipt and provide explanation below).
❑
EjINVOICE FOR FEES DUE(attach case fcc schedule and provide explanation below).
REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
1 Permit##: sit c, Z-O jE-
Site Address or Parcel : t [ 07 0 _ S4.-..3 /_, rre)j S- .
r Project Name: S kY et e t -
ilSubdivision Names Lor#:
C EXPLANATION: l(-o•Yt.y r• ` ( 41
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1. Y1u city's Community Development Director,building Official or City Engineer may authorize the refund of
• Any fee which wet erroneously paid or collected.
• Not more than 80%of the app:ieetion or plan review fee when an application u withdrawn or canceled before review effort
hen been depended.
• Nov more then 80%of the appticttion or permit fee for issued permits prior to any inspection requestr.
2. All refunds will be rammed to the original payer in the form of a check via US postal service
3. faleetc allow 3-4 weeks for pmteseirre refund requests. e,CV — 7a�- 6n' = /cf. trb
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�r FOR O1FF1-1c1:USE ONLY
Route to S•s Admix Doe ` /irJ C VI Route to Records: AT� i�
Refund Processed: Dare i1MIln/a Invoice Processed; t)ate Q
Permit Canceled: Date j., ,/,(iEllre Parcel'T•.Added: Date
r Anuildin(t\FormslRco Permit heeen.,fly 31 .dos
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TIGARD
City of Tigard
April 2, 2015
Specialty Heating&Cooling Inc.
Attn: Andrea Dripps
7500 SW Tech Center Dr. #130
Tigard, OR 97223
Re: Permit No. MEC2015-00048
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11070 SW Errol St
Project Name: Clute
Job No.:
Refund Method: ® Check#216964 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 customer cancelled job. Refund 80%of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
rill
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 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: Specialty Heating&Cooling Inc. DATE: 3/26/2015
Attn: Andrea Dripps
7500 SW Tech Center Dr#130 REQUESTED BY: Dianna Howse
Tigard, OR 97223
TRANSACTION INFORMATION:
Receipt#: 199203 Case#: MEC2015-00048
Date: 1/30/2015 Address/Parcel: 11070 SW Errol St
Pay Method: CreditCard Project Name: Clute
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Permit Fee 230-0000-43102 $72.00
12%State Surcharge 100-0000-24001 8.64
TOTAL REFUND: $80.64
APPROVALS: SIGNAT -R S DATE:
If under$5,000 Professional Staff 11-Wr
dr
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: Date: I 1///!s I By: I 0X,
I.\Building\Refunds\RefundRequcst.doc x 09/01/2010