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Permit Support Document (53) 2017-10-18 08:17 fourseason heat 12 ,i> 5 P 1/1 City of Tigard • COMMUNITY DEVPLOPMFNT/D13nAR4T-M NT RECEIVED A z, Request for Permit rmit Actxon O C T 1 9 2017 TI G A R D 13125 SW Hall Blvd.•Tigard,Oregon 97223.503-718-2439•winv.tic:izd-oz OUI1_DII9C3 DIVISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-71$-2439 Fax: 503-598-1960 TigtrdBuildingPcctmits r©tigtrd-or.gov FROM: ❑ Owner 0 Applicant Z Contractor 0 City Staff Check(1)one REFUND OR Name: INVOICE TO: (BualnesaorIndividual) Four Seasons Heating MailingAddress: fi Air Conditioning, Inc 008 Industrial Pkwy City/State/Gip: eWberg,OR 9713,2 Phone No.: r,37, — ;5gk->9,,y0 PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED(✓): ,CANCEL/VOXD PERMIT APPLICATION. .0 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#: / C 020/7 — OC (,00 j Site Address or Parcel#: 9(:2o SW 4f tg+ Ti ,.. e(l OR (722,' Project Name: Q it Subdivision Name: Lot#: ______T EXPLANATION: (.'free+ Cart tied e c.37// Signature: (,/ _ `' 'r'°Signature: Date: /0 /.Q(//7 Print Name; ,yr � , jtrfu l 5,liry 1, The city's Communi ,Development Director,Building Official or City Engineer may authorize the refund oft • Any fcc which was erroneously paid or collected, • Nor more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 fcc 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. Cj G /'CC: �d xe, , cv. c . /,6 FOR OFFICE USE ONLY Route to Sys Admin: Date /?J/f/-7 By , Route to Records: Date ..4 if B l�- Refund Processed: _Dare �t/7! , - By ;', °lee Processed: Date By Permit Canceled: Dare ///// By. . 1 Parcel Tag Added: Dare I:\Building\IormARcecrmitAetion_01 31 .doe �' T� By November 20, 2017 CltyTIOfGATigRDqard Four Seasons Heating&Air Conditioning, Inc. 1005 Industrial Pkwy Newberg, OR 97132 Re: Permit No. MEC2017-00601 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9620 SW Frewing St Project Name: McCoy Job No.: N/A Refund Method: ® Check#226745 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 cancelled. Refund 80% 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 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: Four Seasons Heating&Air DATE: Conditioning, Inc. 11/8/2017 1005 Industrial Pkwy Newberg, OR 97132 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 412281 Date: 8/10/2017 Case#: MEC2017-00601 Pay Method: CreditC Address/Parcel: 9620 SW Frewing St arProject Name: McCoy EXPLANATION Per applicant's request as customer cancelled job. Refund 80%of permit fees. o e e i e yt ;1'7i e a* 17 "'"' tY7 fi �" •®•. t : .:'�''T y raA fa1��`w� 4� _„ ` e yi �yr �p Mechanical Permit _ 230-000043102 12%State Surchar.e $72.00 100-0000-24001 8.64 111111111111111111111111111111111..... TOTAL REFUND: $80.64 APPROVALS: SI S DATE: If under$5,000 Professional Staff 1P7 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 POR`I`I ti'A SYSTEM OM a' Waal'll ON USE . I. Case Refund Processed: Date: �� - B : pre®�g I:\Building\Refunds\RefundRequest.doc a 09/01/2010 CITY OF TIGARD RECEIPT !`" 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Project Name: McCoy Site Address: 9620 SW FREWING ST Receipt Number: 416571 - 04/06/2018 CASE NO. FEE DESCRIPTION MEC2017-00601 REVENUE ACCOUNT NUMBER PAID $-80.64 Total: $-80.64 PAYMENT METHOD CHECK# CC AUTH.CODE Check ACCT ID CASHIER ID 226745 RECEIPT DATE RECEIPT AMT Payor: Four Seasons Heating&Air Conditioning DROWSE 04/06/2018 $-80.64 Total Payments: $-80.64 Balance Due: $80.64 Page 1 of 1 CITY OF TIGARD Ili 9! 13125 SW HaII Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 TIGARD Project Name: McCoy Site Address: 9620 SW FREWING ST Receipt Number: 412281 08/10/2017 I CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2017-00601 Furnaces<100K BTU MEC2017-00601 12%State Surcharge Mechanical 230-0000-43102 $46.75 10MEC2017-00601 Minimum Fee Adjustment-Mechanical 30-0000-4331102 $43.25 .01 0-0000-4 $ 23 Total: $100.80 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 05088G Payor: Diane M Hahn PUBLICUSER107 08/10/2017 $100.80 Total Payments: $100.80 Balance Due: $0.00 Page 1 of 1