Permit Support Document N
TIGARD
City of Tigard
August 6, 2015
The Plumbers Inc
Attn: Misty Brown
90 NW 150th Ave.
Beaverton, OR 97006
Re: Permit No. PLM2015-00224
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14690 SW 106th Ave.
Project Name: Benz
Job No.: N/A
Refund Method: ® Check#218223 in the amount of$64.96.
❑ Credit card"return" receipt in the amount of$
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,
tom .
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
Er, 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 A ction 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: The Plumbers Inc. DATE: 8/3/2015
Attn: Misty Brown
90 NW 150th Ave. REQUESTED BY: Dianna Howse
Beaverton, OR 97006
TRANSACTION INFORMATION:
Receipt#: 201678 Case#: PLM2013-00224
Date: 7/16/2015 Address/Parcel: 14690 SW 106th Ave.
Pay Method: CreditCard Project Name: Benz
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
Plumbing Permit 230-0000-43101 $38.00
12% State Surcharge 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGNATU-RES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$23,500 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: (FlG/is By: 14
I:\Building\Refunds\RefundRequest.doc x 09/0)1/2(1W
07/21/2015 14:57 5036841202 THE PLUMBERS INC PAGE 01
- • .. . V.: -voD*ft, 9
City of Tigard • COMMUNITY DRY EL )PMF.NT DF.PARTIA
'PI 21.2p15 !.�
Request for Permit Action � A- o
u 1 c;A 1t1) 13125 SW Hall Blvd. •Tigard,Oregon 97223 . 503-718-2439 •_www.ti -o
TO: CITY OF TIGARD
Building Division .
13125 SW Hall Blvd.,Tigard,OR 97223 •
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPcrmits @tigard-or.goV
FROM: ❑ Owner [Applicant ❑ Contractor ❑ City Staff
Check(1)one
REFUND OR Name: �
INVOICE TO: (1iu.ines.orIndividual) I l�I >L./ Lr` (S \ c\C ,
Mailing Address: q Nw \%�
City/State/Zip: ewe Pc C ciz. co C0\U
Phone No.: 5\O- lQkt9`tt I+1
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
(� 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#: RL \ao1S- 0 Caa k
Site Address or Parcel #: \1/4-1p0.C) .JV \ O P1
Project Name: ` c-t fbeo
Subdivision Name: Lot#:
EXPLANATION: Cl C Q-C CGc p\.1 JGf X ._ t n ee_d
. c . 1 '♦ �. '_e3 r ' • - ♦.o • _,''
Signature: `4; a`--Q Date: CY1 @ --"p C)1'
Print Name: VI)Y--5C`/\ 5, V\iv\i"'
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fec 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.
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. 702,,,ce — e, (Ti /y' s-O
.ye, 7 7y
FOR OFFICE USE ONLY
Route to Sys-Amin: ' Dare 7 AI AM IA Rourc to Records; Date_ ,41/ 1 0i2=111
Refund Processed: Date .�( /s By i! voice Processed: Date By
Permit Canceled: Dare .- ,S By Parcel Tag Added: Dare By
1:\Mudding\FormARcglrcrmitAction_ )2 4.doc