Permit Support Document (31) VOID
City of Tigard ' COMMUNITY DEVELOPMENT DERLU
IVEJ174/7 l;11,1
Request for Permit Action JUL 3 2017
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439+ r
TO: CITY OF TIGARD BU�'DIN DIVIST®
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: Owner ❑ Applicant `/ Contractor
Check(V)one ❑ City Staff
REFUND OR Name:
INVOICE TO: (Business or Individual) S 10.1ilt } ,q i4
Mailing Address: 130.1' 'S W 'Te tutu e
City/State/Zip: TU ft bit oe q 7 D cOZ
Phone No.: 50 3 1 3 5 0 3 F
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
1 CANCEL/VOID PERMIT APPLICATION.
►g► REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
III INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: Ft e C Z O l 1 , 0 0 36( I
Site Address or Parcel#: Z 0 C (.4) t 0 q e it/so, Ole 97Z 61
Project Name: 54/V C�G 2._ f
Subdivision Name: i fe bU,e j 0 o d 5 (OL) o Lot#:
EXPLANATION:
(U 5 f <41Jcelled p e tie o lU
C1 S
Signature: ; .--- �'"""�` Date: ( / 0/ 17
Print Name: ice iieodee lac
Refund Policy
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
-----7/0,9,f0 d , c% e70.,,W
FOR OFFICE USE ONLY
Route to Sys Admin: Date I B r •/ Route to Records: Date,3/2. /ap' B -F�"'
Refund Processed: Date B . � Invoice Processed: Date
Permit Canceled: Date B
17 By .,, 'arceI Tag Added: Date B
I:\Building\Forms\RegPemutAcdoo,0 231 .doc
,' "
TIGARD
City of Tigard
July 26, 2017
Sky Heating&Air Conditioning Inc.
Attn: Kelly Broderick
19305 SW Teton Ave.
Tualatin, OR 97062
Re: Permit No. MEC2017-00391
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14820 SW 109th Ave.
Project Name: Sanchez
Job No.: N/A
Refund Method: ® Check#225364 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 job was cancelled. Refund 80% of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,,C94ext-C____
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
'PI
I 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: Sky Heating&Air Conditioning Inc DATE: 7/6/2017
Attn: Kelly Broderick
19305 SW Teton Ave. REQUESTED BY: Dianna Howse
Tualatin, OR 97062
TRANSACTION INFORMATION:
Receipt#: 410960 Case#: MEC2017-00391
Date: 6/2/2017 Address/Parcel: 14820 SW 109th Ave.
Pay Method: CreditCard Project Name: Sanchez
EXPLANATION: Per applicant's request as job was cancelled. Refund 80%of
77
a �? r€spc . : spermt f7e7 es.
7_,,,,,,,..„.7,.,,,:w:
"" £"� r � -
'W y c: f 1,71",.:5-47 k_ sl � t , ,��x v 99s}E�e 11a : j � 4 � S* W � �a1" ' ! i '': .` a x1n? F - e; rw ' ,,,,,,,,q,':,-, .„,,.,..„,,,,,t...,..:, $72.00
Mechanical
vt e ' 230-0000-43102
12%State Surchar.a 100-0000-24001 8.64
TOTAL REFUND: $80.64
APPROVALS: SIGN U:ES/DATE:
If under$5,000 Professional Staff 4, '4,-
If
4,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
. ' ,, :o.r?;r0,...___
Case Refund Processed: Date: 1/ate By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: SANCHEZ �y
Site Address: 14820 SW 109TH AVE /e--67.1A/-6
Receipt Number: 415905 - 03/02/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2017-00391 $-80.64
Total: $-80.64
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 225364 DHOWSE 03/02/2018 $-80.64
Payor: Sky Heating&Air Conditioning Inc.
Total Payments: $-80.64
Balance Due: $80.64
Page 1 of 1
CITY OF TIGARD RECEIPT
■ . 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Tri_;ir-r T3
Project Name: SANCHEZ
Site Address: 14820 SW 109TH AVE A(ctid-v.
I Receipt Number: 410960 - 06/02/2017
I
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2017-00391 Heat Pump 230-0000-43102 $61.06
MEC2017-00391 12%State Surcharge-Mechanical 100-0000-24001 $10.80
MEC2017-00391 Minimum Fee Adjustment-Mechanical 230-0000-43102 $28.94
Total: $100.80
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 006608 PUBLICUSER161 06/02/2017 $100.80
Payor: TRAVIS SMITH
Total Payments: $100.80
Balance Due: $0.00
Page 1 of 1
,,
7/6 / ! WE
City of Tigard • COMMUNITY DEVELOPMENT DEPAR'l'MEN',
,� �l� Requestzo��
for Permit Action 2
1 . r 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •�c w.tigard- r�® T�GRD
sios
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner
A Applicant
Check(✓)one ❑ Ph ig Contractor 0 City Staff
REFUND OR Name:
INVOICE TO: (Business or Individual i 1, t LC i \ti\Lc 1i `
.. 1
Mailing Address: t�IL ,t. , y 1 C,
City/State/Zi •
Phone No.: .-:-.1----)..
f R.2)("''
( , Ci '-'":1
- .)
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
6 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#: l)L.t1% t , i t l..c --^ CC, (-'
CK r,
Site Address or Parcel#: i'-- `i , c \-
Project Name:
•
Subdivision Name:
Vi VI—C-Va AO Lot#:
EXPLANATION:
Signature: ". t ,,I
Print Name: ' ""--� Date: -/ t - i
Refundzkw
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.
7,„1. fl�yy __ _s-ii '--7)., /14 se)
6er70 r 4 n9 i< 7 /
r r, c(U /6,;Z
�j
FOR OFFIC1: t SF ONLY
Route to Sys Admin: Date By Route to Records: Date
Refund Processed: Date 7/� � / By
Permit Canceled: Date '�� > By ��" nvoice Processed: Date By
�s /7 By 3,7 v Parcel Tag Added: Date
t:\Building\Forms\RcyPermitAcrion_ 2314.doc By
q
TIGARD
City of Tigard
July 26, 2017
Trademark Landscapes
PO Box 2410
Oregon City, OR 97006
Re: Permit No. PLM2016-00598
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 8775 SW Schmidt Lp
Project Name: Heritage Crossing,Lot 2
Job No.: N/A
Refund Method: ® Check#225450 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 the job was cancelled. Refund 80%of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
e<C411
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
1111
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: Trademark Landscapes DATE: 7/6/2017
PO Box 2410
Oregon City, OR 97006 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 408930 Case#: PLM2016-00598
Date: 2/15/2017 Address/Parcel: 8775 SW Schmidt Lp
Pay Method: CreditCard Project Name: Heritage Crossing,Lot 2
EXPLANATION: Per applicant's request as job was cancelled. Refund 80%of permit fees.
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e b.,^ tl `n{{Y "": ,,cc F F Tv" t 6
R S: I 9 1 6 T��A. .. i ( > g }�;....r
s�v'
Plumbin:Permit 230-0000-43101 $58.00
12%State Surchar.a 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIG TURES/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
Case Refund Processed: Date: _� 7//e- By: /r 4`
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Heritage Crossing, Lot 2
Site Address: 8775 SW SCHMIDT LOOP /✓�
Receipt Number: 415906 - 03/02/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2016-00598 $-64.96
Total: $-64.96
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 225450 DHOWSE 03/02/2018 $-64.96
Payor: Trademark Landscapes
Total Payments: $-64.96
Balance Due: $64.96
Page 1 of 1
CITY OF TIGARD RECEIPT
' 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Heritage Crossing, Lot 2
Site Address: 8775 SW SCHMIDT LOOP
a/�/Ij
Receipt Number: 408930 - 02/15/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2016-00598 Backflow Preventer 230-0000-43101 $31.27
PLM2016-00598 12%State Surcharge-Plumbing 100-0000-24001 $8.70
PLM2016-00598 Minimum Fee Adjustment-Plumbing 230-0000-43101 $41.23
Total: $81.20
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 068842 PUBLICUSERO 02/15/2017 $81.20
Payor: dr horton
Total Payments: $81.20
Balance Due: $0.00
Page 1 of 1