Permit (2) TIGARD
City of Tigard
July 16, 2015
Ultimate Comfort
Attn: Kristina Parr
5946 SE Lloyd St.
Milwaukie, OR 97222
Re: Permit No. MEC2015-00250
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9401 SW 92'd Ave.
Project Name: Brophy
Job No.: N/A
Refund Method: ® Check #218028 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 duplicate permit created (see MEC2015-
000329). 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 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: Ultimate Comfort DATE: 7/9/2015
Attn: Kristina Parr
5946 SE Lloyd St REQUESTED BY: Dianna Howse
Milwaukie, OR 97222
TR4NSACTION INFORMATION:
Receipt#: 200545 Case #: MEC2015-00250
Date: 4/30/2015 Address/Parcel: 9401 SW 92nd Ave
Pay Method: CreditCard Project Name: Brophy
EXPLANATION: Per applicant's request as duplicate permit was created(see l C2015-00329). Refund
80°0 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 $72.00
12°'o State Surcharge 100-0000-24001 8.64
TOTAL REFUND: $80.64
APPROVALS: SIGNATURES DATE:
If under$5,000 Professional Staff /'
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 y��,
Case Refund Processed: Date: 7/4/45" By: °�-E'/Y --
I:\Building\Refunds\RefundReyuest.dnc x 09/01/2010
1
\I ® i ,II
71 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RE 45 .`/i
a
3 Request for Permit Action C ED
TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • ,�t;Tw.tii iird-or L 7 2015
TO: CITY OF TIGARD BUILDING' D!ARD
Building Division VISION
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov
tigard-or.gov
FROM: ❑ Owner ❑ Applicant 13 Contractor. ❑ City Staff
check(✓)one
REFUND OR Name:
INVOICE To: (Business or Individual) i- en, c t D U l h,►,,a C/Y>I.
Mailing Address: 5lj(p se 1(otd s't ,
City/State/Zip: _ ! 7i2Z
Phone No.: 503 77 :3(o. 61494
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
ICANCEL/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#: Mee_ 2-015 --Op26p
Site Address or Parcel#: `Not scv z2 ,-7/ / �12 9-7 2- 3
Project Name: -Op�LJ (�
Subdivision Name: 1 / Lot#:
EXPLANATION: 2 it xr?-- ut fr tt. WY �f -6
,
1..: - r ,drl. i�� 0 / — r r -
Signature: AI/0 Date: _7/7 7/e s Print Name: KXLSiiv�
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. ,144,6 fiA/E
2 All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests. 9Q,CD — 2. r CrO _ A7 p.,c
/0 .i-0 - #.6y ----- .2 /6
FOR'OFFICE USE ONLY
Route to Sys Admin: EMMAIIMIFAMS Route to Records: ®Er/s B II.:"r�'
Refund Processed: Emetzo Ge zial nvoice Processed: Date By
Permit Canceled: Date 7 - / By —. 'arecl Tag Added: Date By
I:\Building\Dorms\RegPermitArtion_t 231 doe