Permit Support Document (130) RECEIVED
city of Tio-ar(i . f ,.)v,,i-, v i ,' [-0,\ l'i )I'VH ', In-I' \K J NfiN
JUN
1 6 2016
. , .
1.,...,
. .
: .
. ...
•.,.4 ,...2 ,..., Request fc)r Ipci-rnit „Action
IN
CITY
JI OF TIGARD
Iii-v,i 0 1 l 'LILL ( h..(: ,,)ii 9722") * 5'C" 7
TO: GITftif OF TIGARD
Building Division \e'l Q I Li
)--1 - \V I Ld1 .ii,,,d.,'h.:,..,;..rd., ( )1.> '}-22
PI..,1 ir '''-)'i'''., :I'-',. ') 11.9 I';>;.- '"),;', '1198-!0(A) ti iffirnilialtitiiPernittt,rifitiR,ard-()Gitlin
, .,
FROM: ' : i GDR r I \RR:IR:Dv i ,ftntrai i r I 1:Hy Sian
itt RI-TItN14 OR
fft Itnititif
o t , ,tt ,, ti it fr? i t tfli ttf t Gift t
Gm R.Siiinf tittitn:
Prft RI tfiff- tt tif '1(ti
onn Nit_ ‘„
PLEASE; 'RAKE t\It:1'10N FOR THE ITI:iNf(S) CI-1 RfCK_ED (1):
inlioGiii ,itiii v I (
,\
htiftf-4/ P1s 1 R 'Rill I'f I<tft I1<\ 11 !TA ,S itt rifilt itt Div t tif,Ttnistit riDifipt, find [Do\iiiic nstn)lartraton Lint(in R
II„if fttf f R 11'R,S, I R., i ' tarvici. Gni: int- ttchotitin :Ind providc c\-ph-nritniin hclinvi,
rtfl Ri tf\R A !-"Ski,,i'l, \ij, i ,()N't R.Vt.",:( 0 1 )N P1'11\11T N riot ninecti pcirrtt.
Pt-mitt ff:
SD: Rdifirtif i or Rtrisi tf nntl"- cn: t - I It
Pr ,& Ninitc frt t t , , , , t , ro_ 1
_. ..
33:,klikNirkki'ki4)( \'20'',.k3Y:
- UJ
_ ,..... _.._.
I::X RI fAN 4T1ON:
( ' 1:,ft, R ft .ft ,ftti 'ft i )tt . k,, ', '. )-(..- ( i ' __<-
pi.,H1 N.aine,
,i.i.:..q:h.i....r..!.A.f..(„Y..
..:V':+, it 01,
N I'LW ''' '''' '' 11'''` '''''' ' ' '''' 11111'' "V"'W
* N'I ''''''''d'm N''' '': 'I''''''''Th"''''''''' '-'""` •f“ t", '''',“°,;,'r1WH',-,r=,,, D,„,1,,, .-.-n.r,' itl',11r,q,:.c,--.1.;,
Z2 SO ''..* Sk. tr.-0 '..7 /4/. 5.0,
P/, , •- 0
c f 4/''‘.0' /4' ' 2,/'
1),..,k., ', ''1 1:;,„: ,..„, I •Ri,,,A;r: Rec,„,rtir. i,,,_1)-a„(--- ,77.2,1._ ,_ze:rc,,_
,, 1 63:4.,.....•-•„,,-..______I
.1. R:;,:-.J,...,-T,'•;., ,----77,1i--- 1 15:1:,._7/e,:29%// IfiLt ili* „nt,t ffitiitiffitiffPfLittfitifti iiit i
'''' Pittitit tt, ton drift . litint7Af/fc, i IL,Arip., i. R.0-.,T1 i A.,y, Idklio.:' "),,t,: iii,,,,,,,_,,,,,,,_____I
`' �1 ', ,
TIGARD
City of Tigard
July 29, 2016
The Plumbers Inc.
Attn: Misty Brown
90 NW 150th Ave.
Beaverton, OR 97006
Re: Permit No. PLM2016-00309
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 12559 SW Main St.
Project Name: SL Green Construction
Job No.: N/A
Refund Method: ® Check#221891 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 permit was pulled for the wrong address.
Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
4.lX ' ` s'
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 RequestforPermitAction 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: 7/21/2016
Attn: Misty Brown
90 NW 150th Ave REQUESTED BY: Dianna Howse
Beaverton, OR 97006
TRANSACTION INFORMATION:
Receipt#: 404485 Case#: PLM2016-00309
Date: 6/15/2016 Address/Parcel: 12559 SW Main St.
Pay Method: CreditCard Project Name: SL Green Construction
EXPLANATION: Per applicant's request as permit was pulled for wrong address. Refund 80%of permit
fees.
.REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. 'Reiz4d
Example Building Permit Fee Example 2300000-43104 $Atriiiitp
Plumbing Permit Fee 230-0000-43101 $58.00
12%State Surcharge 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGN `- /I TE:
If under$5,000 Professional Staff r
i
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: 7/„:2_,9//p,
I:\Building\Refunds\RefundRequest.doc x 09/01/2010