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Permit Support Document Apr 09 2015 08:22PM Columbia Heating Cooing 503-598-0270 page 1 ti Community Development APR 9 2015 Request for Permit Action (,ITj,01 l l Li,\is 1, = 86Il h/Ne;11/A10# TO: CITY OF TIGARD 11, I Building Division Services Coordinator V 13125 SW Hall Blvd,Tigard,OR 97223 0 I jam) Phone: 503.718.2430 Fax: 503.598.1%0 www.tigard-or.gov -5-77/1- FROM: ❑ Owner X Applicant Contractor ❑ City Staff (check ore) REFUND OR Name: L INVOICE TO: (Business or individual) �I f t tin ,41 a s C/ (toil n Mailing Address: .& ç .Z34039 City/State/Zip: l t rd (A 437 as Phone No.: ° 505- 6.2)4 .a7n14 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ►g, CANCEL PERMIT APPLICATION. /in REFUND PERMIT FEES (attach receipt,if available). . ❑ INVOICE FOR FEES DUE(attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). . Permit#: V LLJ lC I —LJDo Site Address or Parcel #: r 0.3 4' 'e ri Project Name: W 1 a 1( mcvy Subdivision Name: /� Lot#: EXPLANATION: j Carrie o DO Q r Signature: ..,, �""` Date: Ai"'q .-I J Print Name: L r'Ieno 1 I LQQ4 7 Refund Policy Hi #7"2' /27 t. The Director or Building Official may authorize the refund of a) any fee which was erroneously paid or collected. /bef q` 7e2 rrg'3, zp nded. ,2 Q r 9 5- b) not more than 80%of the land use application fee when an application is withdrawn or canceled ore any review effort has been e c) not more than 80%of the land use application fee for issued permits d) not more than 80%of the building plan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. c) not more than 80%of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will lx returned to the original Payer in the sane method in which payment was received. Please allow 1-2 weeks for processing refunds. l.(ll: uri I(:I 1 "l (i;i 1 Rtc to Sys Admin: Date I im�vrR Rte to Pall Admin: Date ���� B. ,,.lr� Refund Processed: Date _ /Mil B (./'A Invoice Processed: Date B Permit Canceled: Date ,7© B try •arcel T.:Added: Date B Receipt# Date Method Amount$ t:\Building\Forms\RegPcrmitAcnon.doc Rev 07/26/07 1111 Ill TIGARD May 7, 2015 City of Tigard Columbia Heating&Cooling Attn: Marlena Meedom PO Box 230397 Tigard, OR 97281 Re: Permit No. MEC2015-00165 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10341 SW Ken Ct Project Name: Williamson Job No.: N/A Refund Method: ® Check #217282 in the amount of$83.77. ❑ Credit card "return" receipt in the amount of$ . 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, 4 A ; —Ze:____— 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: Columbia Heating&Cooling DATE: 4/30/2015 Attn: Marlena Meedom PO Box 230397 REQUESTED BY: Dianna Howse Tigard, OR 97281 TRANSACTION INFORMATION: Receipt#: 199973 Case #: MEC2015-00165 Date: 3/26/2015 Address/Parcel: 10341 SW Keri Ct Pay Method: CreditCard Project Name: Williamson 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: Building Permit Fee Example: 2300000-43104 $Amount Mechanical Permit 230-0000-43102 $74.80 12% State Surcharge 100-0000-24001 8.97 TOTAL REFUND: $83.77 APPROVALS: SIGNATI ES./DATE: If under$5,000 Professional Staff 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 0/\4.,Y Case Refund Processed: Date: s 72/,[s By: y I:\Building\Refunds\RefundRequest.doc x 09/01/2010