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Permit Support Document (33) Nov. 10.2017 04:49 PM Mike Patterson Plumbing 503 655 4349 PAGE. 22:17 /1 2 a,,�t , 'E CityofCOMMUNITY Tigard • Nov 1 3 20of:wni,,oPM.ENT DEPARTMENT Request for Permit Action RI - art NI VGARD Wig,r It;nut 13125 SW Hall Blvd. •Tigard, Oregon 97223 t ' ° B 503-718-243) •www ti,,iia-u •, , TO: CITY OF TIGARD Building Division V 0 1 D 13125 SW Hall Blvd.,Tigard,OR 97223 Phone; 503-718-2439 Fax: 503-598-1960 TigardBuildingPermitk@til;ard-or,gov/� FROM: ❑ Owner 0Applic>tnx t{ C /� / Chuck(✓)ona ontractor Q City Staff REFUND OR Narnc; INVOICE TO: (Business or individual) N .. .),4!. 0 6►-t1ia 1 , •` Mailing Address: PO go x g City/State/Zip; C ba 0 Phone No.: a ,, 0, PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (✓): 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#; h ~ a I 41 Site Address or Parcel#: 13'7 Project Name: /m/, ' WI, Subdivision Name: Lot#; EXPLANATION: A / 4 / /, Il I /.• .e - 1 ��✓ IA �� Signature: 4•` f ,1 �, Date: UpLii 17 Print Name: / - i itakiLuisa 1. The ity's Community Development Director,Building Official or City Engineer may nuthcnizc the refund of: • Any Ice 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended, • Not more than 80%of the application or permit:Ice for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a Cheek via US postal service. 3. Please allow 3-4 weeks for processing refund requests. /e • 0 -- 'f',6 r = .... ,/ i0-0 0 pd. to (., g ,i6, mit Ole I(:r uSl,; ONI.V Route to S s Admin: Date MEM Route to Records: ilr r r= EIZEIMMIIMEEMIT.R.Mnall �,,� Invoice Processed: Date Date/ , i I:\Building\Forms\ItemPcmaitActloai+— �b9..3'14,d ac �� II C a TIGARD City of Tigard January 18, 2018 Mike Patterson Plumbing Attn: Jennifer Bergen PO Box 850 Gladstone, OR 97027 Re: Permit No. MEC2017-00883 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 13975 SW Benchview Ter Project Name: Jost Job No.: N/A Refund Method: ® Check #227193 in the amount of$80.64. 0 Credit card"return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. 0 Trust account "deposit"receipt in the amount of$ . Comment(s): Per applicant's request as job was completed under existing permit MEC2017-00785. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, ,,,e4.67.e- , --1.—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 ,111 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: Mike Patterson Plumbing DATE: 12/28/2017 PO Box 850 Gladstone, OR 97027 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 413800 Case#: MEC2017-00883 Date: 11/9/2017 Address/Parcel: 13975 SW Benchview Ter Pay Method: CreditCard Project Name: Jost EXPLANATION: Per applicant's request work was completed under existing permit MEC2017-00785. Refund 80%of permit fees. �� ' 3 '""} 3 Y' ^R .r?^"' '"",‘..717 :i�E'�.P.:�`��'�'.�, :.� z�... '�� ; � �rv.� ,�.sa'�"'` i .�, Mechanical Permit 230-0000-43102 $72.00 12%State Surchar.e 100-0000-24001 8.64 TOTAL REFUND: $80.64 APPROVALS: SIGN S/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: � t,/k � B �` �'�'��'`' � Y I Ii'y I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 111/ * 13125 SW Hall Blvd.,Tigard OR 97223 - 503.639.4171 TF(.ARD Project Name: Natureworks Site Address: 13975 SW BENCHVIEW TER Receipt Number: 416595 - 04/06/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2017-00883 $-80.64 Total: $-80.64 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 227193 DHOWSE 04/06/2018 Payor: Mike Patterson Plumbing $80.64 Total Payments: $-80.64 Balance Due: $80.64 Page 1 of 1 14 n CITY OF TIGARD RECEIPT . 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Natureworks Site Address: 13975 SW BENCHVIEW TER ��Gf#1/4Z-- Receipt 1/4Z__Receipt Number: 413800 - 11/09/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2017-00883 Fuel Piping 230-0000-43102 $14.15 MEC2017-00883 12%State Surcharge-Mechanical 100-0000-24001 $10.80 MEC2017-00883 Minimum Fee Adjustment-Mechanical 230-0000-43102 $75.85 Total: $100.80 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 08679G PUBLICUSER111 11/09/2017 $100.80 Payor: Bryan O'Doherty Total Payments: $100.80 Balance Due: $0.00 Page 1 of 1