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Permit Support Document 1,„ . n : . TIGARD City of Tigard August 6, 2015 Able Heating& Cooling LLC Attn: Kelly Wilhite 16285 SW 85th Ave,Ste. 105 Tigard, OR 97224 Re: Permit No. MEC2015-00340 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 13746 SW 130th P1 Project Name: Gobel Job No.: N/A Refund Method: ® Check#218174 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 permit was a duplicate permit (see MEC2015- 00378). Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 413/e-zej-i-e-- 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 npli! 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: Able Heating& Cooling LLC DATE: 8/3/2015 Attn: Kelly Wilhite 16285 SW 85th Ave, Ste. 105 REQUESTED BY: Dianna Howse Tigard, OR 97224 TRANSACTION INFORMATION: Receipt#: 201104 Case #: MEC2015-00340 Date: 6/4/2015 Address/Parcel: 13746 SW 130th P1 Pay Method: CreditCard Project Name: Gobel EXPLANATION: Per applicant's request as they pulled two permits for the same job (MEC2015-00378). 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 $72.00 120 o State Surcharge 100-0000-24001 8.64 TOTAL REFUND: $80.64 APPROVALS: SIGNA -RES/DATE: If under$5,000 Professional Staff /I tom' 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: ",lo /jam By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 Jul 241501:59p Able Heating&Cooling 503-620-3980 p.1 VOID III City of Tigard • COMMUNITY DEVELOPML NT DEPARTMENT RECEIVED �s Request for Permit Action q T i G \ :P 13125 SW Hall Blvd.hd. •Tigard, Oregon 97223 • 503-718-2439 • �� �w.ti�ardtt�.�,272015 Lt l Y Or TIGARD TO: CITY OF TIGARD BUILDING DIVISION Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPc�rmits @tigard-or.gov FROM: ❑ Owner ❑ Applicant Lniractor ❑ City Staff cir. V)one REFUND OR Name: ' INVOICE TO: (11ussncssorIndividual) W. '—c�1�! is E1( t ` .'�■ Mailing Address:---�,,* �� t - .� Q - City/State/Zip: - : 1:41.,k, t C �• ck�ca Phone No.: 96f j`1°\— aaS 0, PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ C 'CEL/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#: ME.0 . VS - �© ` -0 Site Address or Parcel#: \ (1 \ .Ui 1 N r Project Name: jte)E_L.. Subdivision Name: . R k j�L ,� Lot#: EXPLANATION• • 1. �.1__ A f.. 1.�- k •- .. '1 /vs -_if --✓AO _ • Signature: t t (latritd -- Date: ' l —cal_) —VS- Print Name: IE--kk■ Li 1` '11*� Refund Policy R 1. The city's Community Development ector,Building Official or City Engineer may authorize the refund of: • Any fcc which was erroneously paid or collected. • Not more than 30%,of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 30%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. �0 3. Please allow 3-4 weeks for processing refund requests. 90.t71 O 2 ,40 aa-a-O , r /4, = .2e , /ta I-OR OFFICIi VS[;t7\It.1 Route to Sys Admire mirialsvficumm Route to Records: ai` By .,.r Refund Processed: Date ,'�,� B va103 Invoice Processed: Date 1 B Permit Canceled: Date , Mall B :4)12411 Parcel Ta:Added: Date B t:\Building\Forms\ReciPermitAc runt 3 4.doc