Permit Support Document To: Request for Permit Action Page 3 of 3 2016-04-26 17:08:01 (GMT) 15039Q, 0 3 From: Kyle Birman
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pLE8S1;TAKE ACTION FOR'3'I1 ITE t(S)C.1IEr(..K.EY)(s ):
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TIGARD
City of Tigard
June 3, 2016
Integrity Air LLC
Attn: Todd Beam
7301 SW Kable Ln, Suite 500
Portland, OR 97224
Re: Permit No. MEC2016-00208
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13596 SW Rosemary Ln
Project Name: Olson
Job No.: N/A
Refund Method: ® Check#221197 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 the permit was duplicate permit. Refund 80%
of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,,cf: st7:2.:, 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
■
City of Tigard
Accela Refund Request
TIGARD
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: Integrity Air LLC DATE: 5/26/2016
Attn: Todd Beam
7301 SW Kable Ln,Suite 500 REQUESTED BY: Dianna Howse
Portland, OR 97224
TRANSACTION INFORMATION:
Receipt#: 402749 Case#: MF016-00208
Date: 3/25/2016 Address/Parcel: 13596 SW Rosemary Ln
Pay Method: CreditCard Project Name: Olson
EXPLANATION: Per applicant's request as this was a duplicate permit. Refund 80%of permit fees.
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Egypte:"$eliding Permit Fee•`,, _, ,
Mechanical Permit 230-0000-43102 $72.00
12%State Surcharge 100-0000-24001 8.64
TOTAL REFUND: $80.64
APPROVALS: SIGNAT 'ft'AT :
If under$5,000 Professional Staff 'E ✓ r 0
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: I Date: I 07y/4. I BY: I d ,
I:\Building\Refunds\RefundRequest.doc x 09/01/2010