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Permit Support Document (23) CITY OF TIGARD MECHANICAL PERMIT "'! x Permit#: M EC2017-00797 a: COMMUNITY DEVELOPMENT Date Issued: 10/12/2017 T[ aAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 r ��� �' /� Parcel: 1S133AD14000 ION , Jurisdiction: Tigard Site address: 12723 SW SORREL DOCK CT Project: Help/Sorrel Subdivision: SUMMER LAKE Lot: 21 Project Description: Vent 3 bathroom fans and a kitchen hood. 10/26/17:REPRINTED permit to include(1)laundry room exhaust fan. Contractor: EVERGREEN GAS INC. Owner: BELLEVEAU, JUNE PO BOX 388 12723 SW SORREL DOCK CT WEST LINN, OR 97068 TIGARD, OR 97223 PHONE: 503-407-9542 PHONE: FAX: 503-344-6345 FEES Specifics: Description Date Amount Range Hood/Other Kitchen 10/12/2017 $33.39 Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 10/26/2017 $93.28 Class of Work: ALT Type of Const: Utility Rooms) Occupancy Grp: 12%State Surcharge-Mechanical 10/26/2017 $15.20 Stories: Fuel Fuel Types: Gas Pressure: Total $141.87 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: �� _ ��7 -- Permittee Signature: (� i d Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received _ g Date/By: 0 v i 7 Permit No.: ,1 .-- r 74 II 13125 SW Hall Blvd.,Tigard,OR 97tCi Plan Review lip' Phone: 503.718.2439 Fax: 503.59 A-- Date/By: Other Permit: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris EI See Page 2 for Internet: www.tigard-or.gov t' '0\1 Notified/Method: Supplemental Information TYPE OF WO Oil."'"" OS COMMERCIAL FEE* SCHEDULE - USE CHECKLIST �� Gaols dl Mechanical permit fees*are based on the value of the work 0 New construction -,,cr. ddition/altera g r�.,, 4 performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: 03" ' ' : mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTIO `" Value:$ _,/ RESIDENTIAL EQUIPMENT/SYSTEMS FEES* [v, l-and 2-family dwelling 0 Commercial/industrial ❑ , f. building '= g For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 12.17,, SW SDpQ _, p0 C - G-r Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: IleiA17,--1:7 01:7- p1-1.1/2, Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 ;"4 Q Unit heaters(fuel-type,not electric), -Ali Ci. b l 4-1,^1±iJtn/L.( d!')I/ , ) in-wall,in-duct,suspended,etc. 46.75 r' is ti+.1( . ()) /«,t yxdl ,CAI v h.,_ Flue/vent for any of above 23.32 Subdivision: /4/1-4 / 7 .3 °� Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 . Flue vent for water heater or gas „ �jI�� ��1 T,' �v`\t'r GSM / �-" fireplace 23.32 (1 ) L _1,IV I t�- F t — O /,-- ^ z„ Log lighter(gas) 23.32 l Iv "1 F 1� ` T x t V `t �T,"1 I Wood/pellet stove 33.39 i 1 1"et �� v�i�fi — (J 1 yx C2- ci'\n1 Wood fireplace/insert 23.32 1 _" Chimney/liner/flue/vent 23.32 �(J Other: 23.32 PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name:iv 1,4� @ E% v Range hood/other kitchen equipment 33.39 Address: 1 iL-/. S J 5OV,, ,.._ D.Y4 eyir Clothes dryer exhaust 33.39 City/State/ZIP:--RA VA? 1:112- cf' 224 Single-duct exhaust(bathrooms, , toilet compartments,utility rooms) 1 23.32 ,1-3.3.2. Phone:( Q ) '11•2 — cjib.0 Q Fax:( ) Attic/crawlspace fans 23.32 APPLICANT 0 CONTACT PERSON Other: 23.32 Fuel piping: Business name: yf--- K�(2-01.117 2Crf $14.15 for first four;$4.03 for each additional Contact name: 10 .r2E,W I lu k..4-.)yr Z Do r2.. , Furnace,etc. Address: i l O 00 ki x/ / \4 D- i �j Gas heat pump "{ �V Wall/suspended/unit heater City/State/ZIP: pal-i-L arz �� Water heater Phone:(Gd(y31ii (323/L Fax::( ) Fireplace Y i Range E-mail: + v vi---Fri p �xiI A x Y . L� o Barbecue ' � ACTOR Clothes dryer(gas) Business name: ��4`-, O C \-- E Other: � MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) 2,10 CCB lie.: IQ2i�1 4 / TOTAL PERMIT FEE 9�/ ix, This permit application expires if a permit is not obtained WIthin 180 days after it has been accepted as complete. Authorized signature: it * Fee methodology set by Tri-County Building Industry Service Board Print name: — k ate: 1 p-0:14 /IA, ` �'l I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1 t/02/COM/WEB) E� � ,,{ 111111 . City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT NOV 7 2017 Request for Permit Action CiTY k.,} ' , i17t TI G A R w D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • ww .tiga>C3LJILI r gov a �� � TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits@tigard-or.gov FROM: Owner Check(✓)one ❑ Applicant ErContractor ❑ City Staff REFUND OR Name: INVOICE TO: (Business or Individual) - Mailing Address: lcc tN �� }►� - City/State/Zip: ,17L ..-p ) <5V-- 61-12:2--S Phone No.: C jc; 249- 4Z.�Z PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑1• � CANCEL/VOID PERMIT APPLICATION. ❑LJ 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#: 7� \"l — Ofl'1 "� Site Address or Parcel#: 1211!LZ cvv S (2-&L Project Name: J i) 4 \Av Subdivision Name: Lot#: EXPLANATION: 1 - Au. h. l_.- 1. : N /©tick, 4' 672rtiir-T- Co e-tzs /Al _ Signature: C Date: 11/ 1/ 1-1 Print Name: i2-i S-1 I/k r-hJ ' Refund P�hcv 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. 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. FOR OFFICE USE ONLY Route to S s Admin: Date B Refund Processed: Date �/ �� Route to Records: Date B '�-_ '•���' Invoice Processed: Date B Permit Canceled: Date/�/ � I:\Building\Forms\RegPernutAction_0 2314.d� •�'�i� Parcel Ta:Added: Date B 14 p TIGARD City of Tigard November 20,2017 Help Group 10006 SW Canyon Rd. Portland, OR 97225 Re: Permit No. MEC2017-00797 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 12723 SW Sorrel Dock Ct Project Name: Belleveau Job No.: N/A Refund Method: ® Check #2267525 in the amount of$26.12. ❑ Credit card "return"receipt in the amount of$ 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): Mechanical permit fees collected under the wrong permit. Refund 100% 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 a N City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building e application fees. Receipts, documentation and the Aequertforpermit Action form (if applicable) t be attached to this request form. Refund requests are due to Accela System Administrator each Wednesday at 5:00 PM. Please allow up to 3 weeks for processingof refunds. must Payable will route refund checks to Accela System Administratortrator by Y for distribtion to plicantccounts PAYABLE TO: Help Group 10006 SW Canyon Rd. DATE: 11/8/2017 Portland, OR 97225 REQUESTED BY: Dianna Howse TRANSAC'ITON INFORMATION: Receipt#: 413548 Date: 10/26/2017 Case#: MEC2017-00797 Pay Method: 1CreditCard 0/26/201 Address/Parcel: 12723 SW Sorrel Dock Ct Project Name: Belleveau EXPLANATION Mechanical permit fees collected under wrong permit. Refund 100%of permit ! � p �a� � w� r�•1�iI�e tzc 1,"'""' +r E,, fees. 7C4T, ax.,.[g ay�r�„ g PW' 'vr afk ' ' x" Fuse.s mekt.ianical 12%State 230 0000-43102 `z 100-0000-24001 2.80 TOTAL REFUND: $26.12 APPROVALS: SIG L S'DATE: If under$5,000 Professional Staff lr�1 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 .... ;'FQ TIDE Case Refund Processed: K sys NxUSE ON ' DMNIS' 'I ,�'IO , Date. ©� , 1Y x B . I.\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD i` •. 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 TIGARD Project Name: Help/Sorrel Site Address: 12723 SW SORREL DOCK CT Receipt Number: 416572 - 04/06/2018 CASE NO. FEE DESCRIPTION MEC2017-00797 REVENUE ACCOUNT NUMBER PAID $-26.12 Total: $-26.12 PAYMENT METHOD CHECK# CC AUTH.CODE Check ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT 2267525 Payor: Help Group DROWSE 04/06/2018 $-26.12 Total Payments: $-26.12 Balance Due: $26.12 Page 1 of 1 INCITY OF TIGARD RECEIPT I• 13125 SW Hall Blvd.,Tigard OR 97223 - 503.639.4171 Tf[3A11T) Project Name: Help/Sorrel Site Address: 12723 SW SORREL DOCK CT a Receipt Number: 413548 - 10/26/2017 CASENO. FEE DESCRIPTION CASE 7-00797 REVENUE ACCOUNT NUMBER Single Duct Exhaust(Bathrooms, Toilet, PAID Utility Rooms) 230-0000 43102 $23.32 MEC2017-00797 12%State Surcharge-Mechanical 100-0000-24001 $2.80 Total: $26.12 PAYMENT METHOD CHECK# CC AUTH.CODE Credit Card ACCT ID CASHIER ID RECEIPT T PATE RECEIPT AMT 644748 BTAGGART 10/26/2017 $26.12 Payor: Christina Hunt Total Payments: $26.12 Balance Due: $0.00 Page 1 of 1 Mechanical Permit Application F012 OFFICE USE ONL1 City of Tigard likrigli) Received 13125 S W Hall Blvd.,Tigard,OR 97 Date By; /0 (�/ j//"I .477._ Permit No.: Phone: 503,718.2439 Fax: 503.59 DPlan ate/By: view � cIl 7'—(.�� 7 1,1 . Inspection Line: 503.639.4175 Date/By: Other Permit; TI(iAILl7 p Internet: Line:g 03.63 gov Date Ready/By: kris: of�p Zu\I Notified/Method: I �See Page 2l for '6\ M ! ' 0 11 Supplemental Information • TYPE OF WO tiGN 4j (1 i,, ' °COMMERCIAL FEE*.SCHEDULE; USE UItCXLIST ❑New construction Addition/alters �r s• rInI �S V Mechanical permit fees*are based on the value of the work El Demolition S�� ' performed.Indicate the value(rounded to the nearest dollar)of all ❑Other: U mechanical materials,equipment,labor,overhead,and profit. CATEGORY OF CONSTRUCTIO a` Value:$ SI- ,/ L1 1-and 2-family dwelling0 �' RESIDENTIAL EQUIPMENTISYSfEMSFEES* • Y ❑Commercial/industrialbuilding ❑Multi-family MasterFor special information use checklist. ❑ builder 0 Other: Description JOB SITE INFORMATION AND LOCATION i Ea. Total Heating/cooling: Job site address: 12,2;b SW sopvhL po Air conditioning 46.75 - GT Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 116-1 c- o¢ crl.-7 y3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: I Project name: Heatpump 61.06 Cross street/directions to job site: Duct work 23,32 Hydronic hot water system 23.32 Residential boiler(radiator or 014n > hydronic) 23.32 4/li5tr�t c.„ki Di / ry-iok f I, Unit heaters(fuel-type,not electric), /'-e in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above Subdivision: 23.32 ��/YL/j E j Lot no.: Other; 23.32 Tax map/parcel no.: Other fuel appliances: Water heater 23.32 j DESCRIPTION OF WORK Gas fireplace/insert �i� �Pc j�-) �/�-� � ,, 1 Flue vent for water heater or gas 33.39 vt 4 F-`Q,S — uocd �"R/) / 1-" fireplace L pt j n 23.32 � A r ) �"r �� �0 �,v l � Log lighter(gas) 23.32 V--rtie� mup n._, -r — U N �� Wood/pellet stove 33.39 v tVSJt� G'��/�1 Wood fireplace/insert 23 32 / Chimney/liner/flue/vent Ly PROPERTY OWNER „ 23.32 ❑ TENANT Other: 23.32 Name:0 04 'w � Environmental exhaust and ventilation: Range hood/other kitchen Address: 12-12 .\.N60p,g,r V equipment 33.39 City/StatelZIP �Yry y w(.- Clothes dryer exhaust 33.39 �� ()111,-124 Single-duct exhaust(bathrooms, Phone:(503) — � I Fax:( ) toilet compartments,utility rooms) I 23.32 .]•32. "✓ 1 Attic/crawlspace fans 23.32 [*/APPLICANT 0 CONTACT PERSON Other: ' 23.32 Business name: ,;tV� >? Fuel piping: Contact name: KJ � .r�r I 514.15 for first four;54.03 for each additional NI,wr ....Dor2� :,,,1 Furnace,etc. Address: i O 00 �� D� Gas heat pump City/State/ZIP:/ pn az K� Waler heaternded/unit heater Phone:( -7.,, Water _"�3) � c32�L_ I Fax::( ) Fireplace E-mail: +h Q 1 Y/, _wr2 pA x Range OR t...tr r� Barbecue OishRACTClothes dryer(gas) Other: Business name: ci i` N A E v Address: t� vL MECHANICAL PERMIT FEES * City/State/ZIP: Subtotal Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) I Fax:( ) CCB lie.• 1 ec,' >,_ State surcharge(12%of permit fee) `� `T TOTAL PERMIT FEE e/ +j, This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete, • Fee methodology set by Tri-County Building Industry Service Board Print nam / ate: Y's`o 11/ti, 1 A I /11 I:\Building\Permits\lvtEC_PermitApp 040113.doc 440-4617T(11/02/COM/WEB) v r) I F*1 „.. .. ..,., '4-. ..0 RECEIVED , . .. . City 49/Tigard 0 cOmN'1'm TY Dr”\ Ii 01 '13}'PA''1'''''''''I OCT 26 1017 1 74 ..,, .../Request for 1 rmit Action CITY OF TIGARD . r f(,A tit 1) i 3125 SW Itall 13.1%(1. . 'figartl,i )02):00 97223 * 5"3'71 8-2439 TO: CITY OF TIGARD Building Division 1,3125 S\V I lall.13.1vd,,Tigai!,I,I)R 9722.3 Phone: 503-718-2439 1 nx: 503-598-1960 'FittarkibuildinePermit,',u,tigani , ,,, FROM: Owner E] ,..,,,:Ttpliilf,ilt4,,,,„ ,C,D.1._11.yrt,„11(.`tor H (.1:11,',--:,. i'2.31:•-, c i tl.hcck,V..).onc - !..1U41---' . inrilti• ly\ ' . C ... REFUND OR Naille: 1. , ' , , , iNvt-ncE To: ttit:sincts or Individual) , 0 p. # ---ic,{,c7.,, 1 ./1 Afailini,..; Address: i C '.(f))+- -• (..lir‘/State/Zip: '', Lk.r-t (...)-. ... 9-7DP) Pht/rie-.No.: ic 04 )'-* (--io I -- ( 10 : PLEASE TAKE ACTION FOR THE I `"EM(S) CHECKED (V): ( ANCEL/V(5)11) l'ERN1IT AP10.1C, Tli).N. REF('NE) 1)1..i,RAII2 FEES '"attach coil,y of(/riOnal receyr and pun idc cxyq,mation below', sg, IN VC/f(IT, rit)R 11..'1'.„S 1)(71,', (anach chs e Ric schedule and provide explanatit,n below), REM()VE/REP1-N.CU C(.1.,),NMACT1)R ON Pt ANIIT (do mu caner I pernitc. i Permit#: ., . C Site Address or Parcel P. : ,,,,,#) -.). C'''' ipiv .( i 0 :1 . t7--- ..(A,_ e......, ._„......„,„_„...„ . ..... .. . . .. .. Project Name: 1 Subdivision Name: I f...,....._ . ... : — EXPLANATION: CaOr-).(-e,„( (ed ...,,....... 5 ....: ' A., ,„,.. Alf Signature: „...„ , Print Name: .1 i 1,-) --i-------C4 -i, - ---- 7 7" • i lleb2ilil15ille4, i. l'he cif)"ttt t....Attnin.mity Dev,,,,tptratttti Divcctttr,Builititil. ..41:-,t.i..d id Cm irlwreirr 111,1:t .I.Lith.(',1'..1.L ft".,-.'r031`.1.i.l. * \ny fct,tv ilk h seas erni.invousb raid ie-cogrricti." at Na more Man mr"ii of Mc dpplicalliel N. p:art,t.`1.,'....."`3.-L. ''' C'''d"APPlielll'll"bi-nildriiv"'lr Li"iii"-'`.3 illil'''' hay bet:11 kApC11.<li:d. • Not 01+03'thin 80',)ttl!'htt.trohct,triott t q'pint;t't. 13W 64110i111CtrliP!,prm ,:l'AV.", Inn qi.rC4',1:,..-1,,. 1 All refunds will be cc wind to diu:original Nyt:r in Ilk.:I 1,roi 4,1 c hcck yil I.,,` l',,Jt.A:SerViCt„, 3. Please allou, 3 1 week,for proccssiug rermul wqm.qui.. : tie 3, s 5 tea_6, --_- ,19...e - t..., .7 i A . vo -- , ........... ','. i/-5 f 7-5' g• 6 V -23. /.5- : -':';:.Ft;'. Routt to Sys Admin.: Date Be : Route to Records: I D no A __... .... Refund Processed: Datey ., 1P .fr. , 1.,,ice. Pio,,,,,cd, ),, ... . _ - 1 -Permit Canceled: ll)ate it 7 i Ikvi. i areel lily,Added: LI)dde i7\-IT,;11,1ir7,Til ; Tiriilr;TreeNellnil_ 21314.0c — -''' 1, 1111 i R - TIGARD November 20, 2017 City of Tigard Evergreen Gas, Inc. PO Box 388 West Linn, OR 97068 Re: Permit No. MEC2017-00797 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 12723 SW Sorrel Dock Ct Project Name: Belleveau Job No.: N/A Refund Method: 11 Check#226744 in the amount of$92.60. ❑ Credit card "return"receipt in the amount of$ 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 customer cancelled job. Refund 80%of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, eat 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 li III _ 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 Regmeds 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: Evergreen Gas, Inc. DATE: PO Box 388 11/8/2017 West Linn, OR 97068 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 413331 Date: Case#: MEC2017-00797 10/12/2017 Address/Parcel: 12723 SW Sorrel Dock Ct Pay Method: CreditCard Project Name: Belleveau EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%of permit fees. $ 1 s ak # .--...,41—y---..,1-.3.----..r.- r .f y �4,a 3 N`.�+ 'cid `L 7 ✓ ,... - "*'Y J +� � 4 f 0 f �RLpeC t�'` Mechanical Permit 230-0000-43102 12%State Surcharge $82.68 100-0000-24001 9.92 TOTAL REFUND: $92.60 APPROVALS: SIG ATU /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 V I t ST3i '1<' �C?N,LTSIS,QNLY Case Refund Processed: I Date: 1/ 7114 1 By. I � I:\Building\Refunds\RefundRequestdoc x 09/01/2010 CITY OF TIGARD 1111111 = 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 TIGAK);T Project Name: Help/Sorrel Site Address: 12723 SW SORREL DOCK CT I Receipt Number: 416573 - 04/06/2018 I CASE NO. FEE DESCRIPTION f REVENUE ACCOUNT NUMBER PAID MEC2017-00797 $-92.60 Total: $-92.60 PAYMENT METHOD CHECK# CC AUTH.CODE Check ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT 226744 DROWSE Payor: Evergreen Gas, Inc. 04/06/2018 $-92.60 Total Payments: $-92.60 Balance Due: $92.60 Page 1 of 1 CITY OF TIGARD !_ 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 TIGARD Project Name: Help/Sorrel Site Address: 12723 SW SORREL DOCK CT Receipt Number: 413331 - 10/12/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2017-00797 Range Hood/Other Kitchen MEC2017-00797 Single Duct Exhaust(Bathrooms, Toilet, 230-0000-43102 $69.99 230-0000-43102 $6 Utility Rooms) 9.96 MEC2017-00797 12%State Surcharge-Mechanical 100-0000-24001 $12.40 Total: x115.75 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID Credit Card CASHIER ID RECEIPT DATE RECEIPT AMT 07467D PUBLICUSER107 10/12/2017 Payor: william belden $115.75 Total Payments: $115.75 Balance Due: $0.00 Page 1 of 1